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Hassan ES, Maged AM, Kotb A, Fouad M, El-Nassery N, Kamal WM. Effect of laser acupuncture on pain and density of bone in osteoporotic postmenopausal women: a randomized controlled trial. Menopause 2023; 30:545-550. [PMID: 36944142 DOI: 10.1097/gme.0000000000002166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study aimed to evaluate the value of laser acupuncture (LA) on forearm bone mineral density (BMD) and wrist pain in osteoporotic postmenopausal women. METHODS Sixty-eight postmenopausal women diagnosed with osteoporosis were randomly allocated equally to one of two sets. The drug-only group received calcium and vitamin D 3 supplement containing fluoride daily for 12 weeks, whereas the drug/LA group received LA therapy for 20 minutes per session, three sessions weekly, in addition to the same supplementation. The primary outcome parameter was assessment of BMD of the nondominant arm. Other outcomes included wrist pain. RESULTS There was a highly significant improvement in the T-score of forearm BMD in both groups (-2.844 ± 0.476 to -2.597 ± 0.478 and -2.944 ± 0.486 to -1.652 ± 0.728 in the drug-only and drug/LA groups, respectively; P < 0.0001) and visual analog scale score (7.50 ± 0.79 to 4.24 ± 1.07 and 7.24 ± 0.82 to 3.09 ± 0.75 in the drug-only and drug/LA group, respectively; P < 0.0001). The improvement of both BMD and pain score was significantly higher in the drug/LA group (-1.303 and 4.15) compared with the drug-only group (-0.247 and 3.26; P < 0.0001). CONCLUSIONS LA in combination with calcium and vitamin D supplementation containing fluoride is an effective modality in improving forearm BMD and reducing pain in osteoporotic postmenopausal women.
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Affiliation(s)
- Elham S Hassan
- From the Department of Physical Therapy for Woman's Health, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Ahmed Mohamed Maged
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Amal Kotb
- Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt
| | - Mona Fouad
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Noura El-Nassery
- Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Cairo, Egypt
| | - Wafaa M Kamal
- Department of Physical Therapy for Woman's Health, Faculty of Physical Therapy, Benha University, Benha, Egypt
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2
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Wang H, Wang D, Li Z, Liu S, Dong J, Zhang J, Wang H, Wang M, Ji B, Li Y. Electroacupuncture stimulation at BL20, BL23 and SP6 prevents hind limb unloading-induced osteoporosis in rats. Acupunct Med 2021; 39:656-662. [PMID: 33715459 DOI: 10.1177/0964528421995494] [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: 11/16/2022]
Abstract
BACKGROUND Bone loss induced by microgravity is a serious problem in space flight. However, the effects of acupuncture stimulation on osteoporosis induced by microgravity have not been studied. With the goal of developing an effective countermeasure, our aim was to evaluate the effects of electroacupuncture (EA) stimulation at BL20, BL23, and SP6 on osteoporosis induced by simulated microgravity in rats. METHODS Thirty male Wistar rats (aged 10 weeks) were randomly divided into three groups: healthy control group (CON, n = 10), hind limb unloading by tail-suspension group (T-S, n = 10), and EA treatment group (TRE, n = 10). Rats in the T-S and TRE groups were subjected to tail-suspension at -30° for 30 days, while the CON group experienced freedom of activity. In this period, the TRE group received EA treatment at BL20, BL23, and SP6 for 30 min every other day, which continued for 30 days. The microarchitecture of the proximal tibia and the biomechanical features of the femur in the rats were analyzed. In addition, the levels of serum biomarkers bone alkaline phosphatase (BALP) and osteocalcin (BGP) were measured. RESULTS Compared with the CON group, the value of bone volume/total volume (BV/TV) and trabecular number (Tb.N) of the tibias in the TRE group remarkably decreased (p < 0.01). However, these changes were markedly less than those of the T-S group after 4 weeks of EA treatment (p < 0.05). Moreover, the serum concentration of BGP in the TRE group was also significantly higher than that of the T-S group (p < 0.05). CONCLUSIONS These findings indicate that EA stimulation at BL20, BL23, and SP6 retards osteoporosis induced by hind limb unloading in rats.
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Affiliation(s)
- Honghui Wang
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China.,The Key Laboratory of Aerospace Medicine, Ministry of Education, Air Force Medical University, Xi'an, China
| | - Desheng Wang
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Zhili Li
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Shujuan Liu
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Jingjing Dong
- The Key Laboratory of Aerospace Medicine, Ministry of Education, Air Force Medical University, Xi'an, China.,Lintong Aeromedical Evaluation and Training Center, Xi'an, China
| | - Jianfeng Zhang
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Huijuan Wang
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
| | - Minjie Wang
- Beijing Jingmei Group General Hospital, Beijing, China
| | - Bo Ji
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yinghui Li
- State Key Lab of Space Medicine Fundamentals and Application, China Astronaut Research and Training Center, Beijing, China
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Xu G, Xiao Q, Zhou J, Wang X, Zheng Q, Cheng Y, Sun M, Li J, Liang F. Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review. Medicine (Baltimore) 2020; 99:e19334. [PMID: 32118767 PMCID: PMC7478384 DOI: 10.1097/md.0000000000019334] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.
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Affiliation(s)
- Guixing Xu
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Qiwei Xiao
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Jun Zhou
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Xu Wang
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Qianhua Zheng
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Ying Cheng
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Mingsheng Sun
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Juan Li
- Acupuncture moxibustion and tuina school, Chengdu University of Traditional Chinese Medicine
| | - Fanrong Liang
- The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Permuy M, López-Peña M, Muñoz F, González-Cantalapiedra A. Rabbit as model for osteoporosis research. J Bone Miner Metab 2019; 37:573-583. [PMID: 31087186 DOI: 10.1007/s00774-019-01007-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
Osteoporosis is a major public health problem affecting more than 200 million people worldwide. The use of different animal models, for the study of its pathophysiology and treatments, is important being actually the ovariectomized rat the most widely used; although this model has several problems due its small size, lack of true closure of epiphyseal plate and bone differences with humans. This review is aimed at summarizing the most common methods published for osteoporosis induction in rabbits as model for human disease with their advantages and disadvantages. The paper shows the advantages of the use of this specie compared with the rat. All the techniques seemed to achieve the osteoporotic condition, but the one which obtained the most consistent bone mineral reduction in less time was the combination of surgery and corticoid treatment. The conclusion of the review was that rabbits are promising as a model of osteoporosis research because of their size, haversian remodelling and closure of epiphyseal plate, which solve some of the problems of the rat model. There are different techniques in the literature used to achieve the osteoporotic condition with diverse results, but there is a lack of consensus as to the best one.
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Affiliation(s)
- María Permuy
- Departamento de Anatomía, Producción Animal e Ciencias Clínicas Veterinarias, Universidade De Santiago de Compostela, Campus Universitario s/n, 27002, Lugo, Spain.
| | - Mónica López-Peña
- Departamento de Anatomía, Producción Animal e Ciencias Clínicas Veterinarias, Universidade De Santiago de Compostela, Campus Universitario s/n, 27002, Lugo, Spain
| | - Fernando Muñoz
- Departamento de Anatomía, Producción Animal e Ciencias Clínicas Veterinarias, Universidade De Santiago de Compostela, Campus Universitario s/n, 27002, Lugo, Spain
| | - Antonio González-Cantalapiedra
- Departamento de Anatomía, Producción Animal e Ciencias Clínicas Veterinarias, Universidade De Santiago de Compostela, Campus Universitario s/n, 27002, Lugo, Spain
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5
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Acupuncture for Primary Osteoporosis: Evidence, Potential Treatment Prescriptions, and Mechanisms. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2705263. [PMID: 31281397 PMCID: PMC6594290 DOI: 10.1155/2019/2705263] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/25/2019] [Accepted: 05/13/2019] [Indexed: 12/12/2022]
Abstract
Many clinical trials and meta-analyses related to acupuncture for osteoporosis (OP) have been published. However, identifying the evidence from these studies still remains a challenge for acupuncturists. We conducted a systematic search of the Chinese Biomedical Medicine (CBM), VIP Database, Wanfang Data, China National Knowledge Infrastructure (CNKI), PubMed, Springer, Cochrane Library, and Embase to identify relevant trials, systematic reviews, and/or meta-analyses up to October 31, 2018. Data were extracted to assess the methodological quality using Veritas plots and to explore potential acupuncture prescriptions using the Traditional Chinese Medicine inheritance support system (TCMISS). In addition, potential mechanisms of core acupoints identified by data mining were summarized based on published studies. A total of 218 clinical trials and ten meta-analyses were included, involving 212 acupuncture prescriptions, 102 acupoints, 13 meridians, three extra meridians, and one Ashi point. The mean Veritas score of publication year, type of study, Assessment of Multiple Systematic Reviews 2, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, heterogeneity, and publication bias were 5.5, 7.2, 6, 5.6, 5.8, and 7.5, respectively. The study of Pan et al. received the highest Veritas score of 8.67 points. The most frequently used meridian was BL. Acupoint combinations BL23 and BL20, BL23 and GV4, and BL23 and ST36 were used frequently. The core acupoints association networks were acupoints BL23, BL20, ST36, GV4, SP6, CV4, and KI3. The potential mechanisms of core acupoints involved upregulated expression of members in OPG/RANKL, Wnt/β-catenin, and MAPK pathways, such as LRP5, β-catenin, Runx2, and OPG. In conclusion, our Veritas plots enable acupuncturists to evaluate key attributes of meta-analysis quality related to acupuncture for primary OP and to improve the quality of evidence-based medicine relating to acupuncture. Data mining analysis revealed an association network of meridians, acupoint combinations, core acupoints, and the underlying mechanisms of acupuncture for primary OP.
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Mak JCS. Acupuncture in Osteoporosis: More Evidence is Needed. Acupunct Med 2018; 33:440-1. [DOI: 10.1136/acupmed-2015-010983] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Jenson C S Mak
- Department of Geriatric Medicine, Gosford Hospital, Gosford, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia
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Luo D, Liu Y, Wu Y, Ma R, Wang L, Gu R, Fu W. Warm needle acupuncture in primary osteoporosis management: a systematic review and meta-analysis. Acupunct Med 2018; 36:215-221. [PMID: 29986901 PMCID: PMC6089200 DOI: 10.1136/acupmed-2016-011227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed. OBJECTIVE The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP. METHODS PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V.5.3 software. RESULTS Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)=0.06, 95% CI 0.03 to 0.08, P<0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P<0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P<0.001) when used alone, and additionally decreased VAS scores (MD=-1.10, 95% CI -1.14 to -1.06, P<0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported. CONCLUSIONS WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment.
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Affiliation(s)
- Ding Luo
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
- Acupuncture and Moxibustion Department, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yue Liu
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yanan Wu
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
- Tranditional Chinese Medicine Department, Fourth Hospital of Changsha City, Changsha City, Hunan Province, China
| | - Rui Ma
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
- Acupuncture and Moxibustion Department, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Lin Wang
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
- Acupuncture and Moxibustion Department, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Ronghe Gu
- Orthopedics Department, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Wenbin Fu
- Second Clinical Department, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
- Acupuncture and Moxibustion Department, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong Province, China
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Zheng X, Nie Y, Sun C, Wu G, Cai Q, Huang S, Lin Y. Long-term electroacupuncture stimulation prevents osteoporosis in ovariectomised osteopaenic rats through multiple signalling pathways. Acupunct Med 2018; 36:176-182. [PMID: 29625972 DOI: 10.1136/acupmed-2016-011268] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The pathogenic mechanisms of postmenopausal osteoporosis (PMOP) development are complex and are related to multiple cellular signalling transduction pathways. The aim of this study was to compare the effects of electroacupuncture (EA) at GV4/GV6 versus BL20/BL23 on the bones in ovariectomised (OVX) rats to explore the pathways that mediate the effects of EA on bone. METHODS Forty female Sprague-Dawley rats were allocated to one of four groups (n=10 rats each) that received sham surgery (Sham group), OVX surgery only (OVX group), OVX surgery plus EA at GV4/GV6 (GV group) and OVX surgery plus EA at BL20/BL23 (BL group). Bone turnover markers osteocalcin (OC) and tartrate-resistant acid phosphatase 5b (TRACP 5b) were measured in serum, and bone mineral density (BMD) of the lumbar vertebrae and histomorphology of the femur were evaluated. Moreover, the expression of osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) was detected by ELISA. The expression of lipoprotein receptor-related protein (LRP) 5, β-catenin, runt-related transcription factor (Runx) 2 involving Wnt/β-catenin signalling and p38, c-Jun N-terminal kinase (JNK) and extracellular regulated protein kinases 1/2 involving mitogen-activated protein kinase signalling were determined by Western blotting. RESULTS The two EA-treated groups demonstrated increased levels of OC and the BMD of lumbar vertebrae, decreased levels of TRACP 5b and improved bone microstructure in the femur, compared with the untreated OVX group (P<0.05). Histomorphology analysis showed that EA treatment significantly increased the values of the trabeculae (µm), trabecular area (%) and trabecular bone number (per mm) and reduced trabecular separation (mm), compared with the OVX group. In addition, the ratio of OPG to RANKL and LRP5, β-catenin and Runx2 expression were significantly upregulated, while the expression of phosphorylated (p)-p38 and p-JNK were downregulated in EA-treated groups compared with the OVX group. CONCLUSION EA attenuates PMOP and it appears that the mechanism involves the regulation of multiple targets and pathways.
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Affiliation(s)
- Xuefeng Zheng
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yan Nie
- Chinese Medicine Hospital of Fuzhou, Fujian Universityof Traditional Chinese Medicine, Fuzhou, China
| | - Chengtao Sun
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Guangwen Wu
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qiaoyan Cai
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shu Huang
- People's Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yanping Lin
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Ma S, Li D, Feng Y, Jiang J, Shen B. Effects of electroacupuncture on uterine morphology and expression of oestrogen receptors in ovariectomised rats. Acupunct Med 2016; 35:208-214. [PMID: 27834684 DOI: 10.1136/acupmed-2016-011093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2016] [Indexed: 11/04/2022]
Abstract
AIM To observe the effects of electroacupuncture (EA) on uterine morphology and expression of oestrogen receptor (ER) α and β in ovariectomised (OVX) rats. METHODS Thirty female Sprague-Dawley rats with regular 4-day oestrus cycles were divided into a sham operation group (Control, n=10) and two OVX groups that remained untreated (OVX group, n=10) or received EA treatment (OVX+EA group, n=10). In the latter group, EA was applied at CV4, CV3, SP6 and bilateral Zigong (30 min per day) for 3 days. The effects of EA on uterine morphology were observed by H&E staining. Quantitative real-time reverse transcription-PCR (qRT-PCR) and Western blotting were used to measure ERα and ERβ mRNA and protein expression, respectively. RESULTS Relative to the (untreated) OVX group, EA treatment significantly increased the uterine wet weight to body weight (UWW/BW) ratio (0.47±0.04 vs 0.31±0.03 g/kg, p=0.04), and myometrial thickness (109.39±10.71 vs 60.81±8.1 μm, p=0.016) of OVX rats. Similarly, the total number of endometrial glands per cross section and endometrial thickness in the OVX +EA group was significantly increased compared to the (untreated) OVX group. EA treatment also increased protein (but not mRNA) expression of both ERα and ERβ in the uteri of OVX rats. CONCLUSIONS This study has demonstrated that EA treatment decreases uterine atrophy in OVX rats. This unique effect of EA on the uterus may be due to upregulation of serum levels of E2 and differential regulation of sex steroid receptors ERα and ERβ.
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Affiliation(s)
- Shulan Ma
- Training Center of Medical Experiments, Basic Medical School, Fudan University, Shanghai, China.,Department of Integrative Medicine and Neurobiology, State Key Lab of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dongju Li
- Training Center of Medical Experiments, Basic Medical School, Fudan University, Shanghai, China
| | - Yi Feng
- Department of Integrative Medicine and Neurobiology, State Key Lab of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianwei Jiang
- Department of Integrative Medicine and Neurobiology, State Key Lab of Medical Neurobiology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bo Shen
- Institute of Radiation Medicine, Fudan University, Shanghai, China
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Guo T, Chen X, Wu X, Shan E, Jin Y, Tai X, Liu Z, Zhu B, Yuan K, Chen Z. Acupuncture for osteoporosis: a systematic review protocol. Syst Rev 2016; 5:161. [PMID: 27653783 PMCID: PMC5031268 DOI: 10.1186/s13643-016-0330-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/31/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Osteoporosis is a global high prevalence of chronic metabolic disease with serious disability-adjusted life years losing. Acupuncture is used to treat osteoporosis broadly in China and other countries although the evidence on effectiveness cannot give a certain answer. The aim of this systematic review protocol is to appraise the efficacy and safety of acupuncture for osteoporosis. METHODS A literature search of randomized controlled trials focusing on acupuncture for osteoporosis will be performed in the databases of Medline, Cochrane Library, Web of Science, EBASE, Springer, WHO International Clinical Trials Registry Platform (ICTRP), China National Knowledge Infrastructure (CNKI), Wan fang, Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and other possible resources with a valid search strategy. Outcomes of pain, bone mineral density, fracture, mortality, improvement proportion, biochemical indicators, quality of life, adverse event, and other valid will be extracted and merged for quantitative analysis using Review Manager software (V.5.3.5) or descriptive analysis correspondingly. DISCUSSION This is the first systematic review to estimate the effect of acupuncture on osteoporosis, and the result may provide evidence to clinical doctor. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016037829.
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Affiliation(s)
- Taipin Guo
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Xiao Chen
- Xi'an Encephalopathy Hospital of Traditional Chinese Medicine, Xi'an, Shanxi Province, China
| | - Xiangnong Wu
- Acupuncture Department, the First Affiliated Hospital, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Exian Shan
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Yaju Jin
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Xiantao Tai
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China.
| | - Zili Liu
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Bowen Zhu
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Kai Yuan
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China
| | - Zukun Chen
- School of Acupuncture-Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan Province, China.
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11
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Wang Y, Li Y, Chen R, Cui X, Yu J, Liu Z. Electroacupuncture for reproductive hormone levels in patients with diminished ovarian reserve: a prospective observational study. Acupunct Med 2016; 34:386-391. [PMID: 27177929 PMCID: PMC5099178 DOI: 10.1136/acupmed-2015-011014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2016] [Indexed: 11/21/2022]
Abstract
Background Effective methods for the treatment of reproductive dysfunction are limited. Previous studies have reported that acupuncture can modulate female hormone levels, improve menstrual disorders, alleviate depression and improve pregnancy rates. However, studies of acupuncture for diminished ovarian reserve (DOR) are lacking. Objective To carry out a prospective observational study aimed at assessing the effect of EA on the reproductive hormone levels of patients with DOR seeking fertility support and consider its safety. Methods Eligible patients with DOR received EA for 12 weeks: five times a week for 4 weeks followed by three times a week for 8 weeks. The primary outcome was the change in mean follicle-stimulating hormone (FSH) level at week 12. Mean luteinising hormone (LH) and serum oestradiol (E2) levels, FSH/LH ratios and symptom scale scores were simultaneously observed. Results Twenty-one patients with DOR were included in the final analysis. Mean FSH levels fell from 19.33±9.47 mIU/mL at baseline to 10.58±6.34 mIU/mL at week 12 and 11.25±6.68 mIU/mL at week 24. Change in mean FSH from baseline was −8.75±11.13 mIU/mL at week 12 (p=0.002) and −8.08±9.56 mIU/mL at week 24 (p=0.001). Mean E2 and LH levels, FSH/LH ratios and irritability scores were improved at weeks 12 and/or 24. Approximately 30% patients reported subjective increases in menstrual volume after treatment. Conclusions EA may modulate reproductive hormone levels and the effects seem to persist for at least 12 weeks after treatment with no significant side effects. EA may improve the ovarian reserve of patients with DOR, though further research is needed. Trial registration number NCT02229604; Results.
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Affiliation(s)
- Yang Wang
- Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanhong Li
- Gynecology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ruixue Chen
- Gynecology Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoming Cui
- Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jinna Yu
- Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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12
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Wang HD, Chen Z, Inoue I, Fu SJ, Shi XL, Tang L, Zhang FZ, Jiang Y, Jiang H. Effects of electroacupuncture at GB points on markers of osteoporosis and bodyweight in ovariectomised rats. Acupunct Med 2015; 33:465-71. [PMID: 26245584 PMCID: PMC4860971 DOI: 10.1136/acupmed-2014-010743] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/20/2022]
Abstract
Background Based on a description of acupuncture to treat a bone disease resembling osteoporosis in the ancient text of Huangdi Neijing, we aimed to assess the effects of electroacupuncture (EA) at GB points in ovariectomised (OVX) rats. Methods 40 female Wistar rats were randomly divided into four groups (n=10 each): ovariectomised model group (OVX); ovariectomised group treated with EA at GB points (OVX+GB); ovariectomised group treated with EA at non-GB points (OVX+N) in the hindlimb; and a sham surgery group (Sham). Three months after ovariectomy, rats in the OVX+GB and OVX+N groups received EA treatment for 3 months. Urine, blood and femur samples were collected from each animal for analysis. Results Bodyweight (BW) in the OVX+GB group decreased after EA treatment, reaching a minimum of ∼12% below the OVX and OVX+N groups at 1 month. Concentrations of urine deoxypyridinoline, a bone resorption marker, were significantly elevated in the OVX and OVX+N groups but not the OVX+GB group. Concentrations of serum bone specific alkaline phosphatase, a bone formation marker, were significantly higher in the OVX+GB group versus the Sham and OVX groups. Bone mineral density (BMD) did not differ between the OVX, OVX+GB and OVX+N groups, but was ∼10% lower than the Sham group. However, BMD/BW in the OVX+GB group was significantly higher than in the OVX and OVX+N groups and similar to the Sham group. Histological assessment of the femur showed that EA at GB points improved the bone architecture. Conclusions EA treatment at GB points had anti-osteoporotic effects in a rat model of osteoporosis.
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Affiliation(s)
- Hong-Du Wang
- Department of Acupuncture, School of Traditional Chinese Medicine Combined with Western Medicine, Sichuan Medical University, Luzhou, Sichuan, China
| | - Zhuang Chen
- Laboratory of Infection and Immunology, Affiliated Hospital, Sichuan Medical University, Luzhou, Sichuan, China
| | - Isao Inoue
- Institute of Cardiovascular Research, Sichuan Medical University, Luzhou, Sichuan, China
| | - Shi-Jie Fu
- Department of Orthopaedics, Affiliated TCM Hospital, Sichuan Medical University, Luzhou, Sichuan, China
| | - Xiao-Lin Shi
- Laboratory of Infection and Immunology, Affiliated Hospital, Sichuan Medical University, Luzhou, Sichuan, China
| | - Li Tang
- Laboratory of Infection and Immunology, Affiliated Hospital, Sichuan Medical University, Luzhou, Sichuan, China
| | - Feng-Zheng Zhang
- Department of Acupuncture, School of Traditional Chinese Medicine Combined with Western Medicine, Sichuan Medical University, Luzhou, Sichuan, China
| | - Yang Jiang
- Department of Acupuncture, School of Traditional Chinese Medicine Combined with Western Medicine, Sichuan Medical University, Luzhou, Sichuan, China
| | - Hua Jiang
- Department of Acupuncture, School of Traditional Chinese Medicine Combined with Western Medicine, Sichuan Medical University, Luzhou, Sichuan, China
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13
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Zheng X, Wu G, Nie Y, Lin Y. Electroacupuncture at the governor vessel and bladder meridian acupoints improves postmenopausal osteoporosis through osteoprotegerin/RANKL/RANK and Wnt/β-catenin signaling pathways. Exp Ther Med 2015; 10:541-548. [PMID: 26622351 DOI: 10.3892/etm.2015.2553] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 05/15/2015] [Indexed: 11/06/2022] Open
Abstract
Previous studies have demonstrated that pretreatment with electroacupuncture (EA) at the zusanli/ST36 and sanyinjiao/SP6 acupoints prevents ovariectomy-induced osteoporosis in rats; however, the therapeutic effects of EA at the governor vessel (GV) and bladder meridian (BL) acupoints remain unclear. In the present study, the effects of EA at the GV4, GV6, BL20 and BL23 acupoints on the bones of ovariectomized (OVX) rats were investigated to identify the pathways that mediate the action of EA on the bones. A postmenopausal osteoporosis model was established by performing an ovariectomy in six-month-old female Sprague Dawley rats. Following the ovariectomy, EA treatment was administered once per day for 90 days, with an interval of 5 days per 10 days. The changes in the serum levels of estradiol (E2) and the bone turnover markers, osteocalcin (OC) and tartrate-resistant acid phosphatase 5b (TRACP 5b), were determined, while the bone mineral density (BMD) of the lumbar vertebra and the histomorphology of the femur were observed. Furthermore, the expression of osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL), which are involved in the OPG/RANKL pathway, were detected by ELISA. In addition, the protein expression levels of low-density lipoprotein receptor-related protein (LRP) 5, β-catenin and runt-related transcription factor (Runx) 2, which are involved in the Wnt/β-catenin signaling pathway, were detected by western blot analysis. The results revealed that the GV and BL EA treatment groups significantly increased the serum levels of E2 and OC, decreased the serum levels of TRACP 5b and increased the BMD of the lumbar vertebra when compared with the OVX group. With regard to the histomorphology of the bone tissue, an ordered arrangement and a slight thinning of the trabeculae, with no evident hairline fractures, was observed in the femurs following EA treatment in the OVX rats. Furthermore, histomorphological analysis revealed that EA treatment significantly increased the values of the bone histomorphometry indices, trabecular area percentage, trabecular thickness and trabecular number, and reduced the value of trabecular separation, as compared with the OVX group. In addition, the ratio of OPG/RANKL expression was significantly upregulated, and the expression levels of LRP5, β-catenin and Runx2 were significantly upregulated in the EA treatment groups. Therefore, these results demonstrated that long-term stimulation with EA treatment at the GV and BL acupoints was able to alleviate osteoporosis induced by an ovariectomy through regulating the OPG/RANKL and Wnt/β-catenin signaling pathways.
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Affiliation(s)
- Xuefeng Zheng
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Guangwen Wu
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
| | - Yan Nie
- The Affiliated Traditional Chinese Medicine Hospital of Fuzhou, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350001, P.R. China
| | - Yanping Lin
- Acupuncture College, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P.R. China
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14
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Lisboa MRP, Gondim DV, Ervolino E, Vale ML, Frota NPR, Nunes NLT, Mariguela VC, Taba M, Messora MR, Furlaneto FAC. Effects of electroacupuncture on experimental periodontitis in rats. J Periodontol 2015; 86:801-11. [PMID: 25741581 DOI: 10.1902/jop.2015.140630] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acupuncture has shown the capability of modulating the immuno-inflammatory response of the host. This study aims to evaluate the effects of electroacupuncture (EA) on ligature-induced periodontitis in rats. METHODS Thirty-two animals were divided into four groups: 1) control; 2) experimental periodontitis (EP); 3) sham-treated (EP/EA-sham); and 4) treated with EA (EP/EA). For the EP groups, a ligature was placed around the right mandibular first molars at day 1. Sessions of EA or EA-sham were assigned every other day. For EA treatment, large intestine meridian points LI4 and LI11 and stomach meridian points ST36 and ST44 were used. EA-sham was performed in off-meridian points. Animals were euthanized at day 11. Histomorphometric and microtomographic analyses were performed. Immunolabeling patterns for the receptor activator of nuclear factor κB ligand (RANKL), osteoprotegerin (OPG), and tartrate-resistant acid phosphatase (TRAP) were assessed. Expressions of interleukin (IL)-1β, matrix metalloproteinase (MMP)-8, IL-6, and cyclooxygenase (COX)-2 messenger RNAs (mRNAs) were evaluated by quantitative reverse transcription-polymerase chain reaction. Data were analyzed statistically (P <0.05, analysis of variance). RESULTS Histomorphometric and microtomographic analyses demonstrated that group EP/EA presented reduced alveolar bone loss when compared to group EP (P <0.05). Reduced RANKL immunolabeling and fewer TRAP-positive multinucleated cells were observed in the EA-treated group in relation to group EP. No differences were observed in OPG expression among groups. EA treatment decreased the genic expression of IL-1β and MMP-8 (P <0.05), increased the mRNA expression of IL-6 (P <0.05), and did not modify the genic expression of COX-2 in animals with EP (P >0.05). CONCLUSION It can be concluded that EA reduced periodontal tissue breakdown and the expression of some proinflammatory mediators and a proresorptive factor in EP in rats.
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Affiliation(s)
- Mario R P Lisboa
- *Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Delane V Gondim
- †Department of Morphology, Faculty of Medicine, Federal University of Ceará
| | - Edilson Ervolino
- ‡Department of Basic Sciences, Division of Histology, Dental School of Aracatuba, São Paulo State University, Aracatuba, São Paulo, Brazil
| | - Mariana L Vale
- §Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceará
| | - Nicolly P R Frota
- ‖Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto School of Dentistry, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Nara L T Nunes
- *Department of Clinical Dentistry, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Viviane C Mariguela
- ¶Department of Veterinary Pathology, São Paulo State University, Jaboticabal, São Paulo, Brazil
| | - Mario Taba
- ‖Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto School of Dentistry, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Michel R Messora
- ‖Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto School of Dentistry, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Flávia A C Furlaneto
- ‖Department of Oral and Maxillofacial Surgery and Periodontology, Ribeirao Preto School of Dentistry, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
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15
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Zhou J, Li X, Liao Y, Feng W, Guo X. Effects of Electroacupuncture on Bone Mass and Cathepsin K Expression in Ovariectomised Rats. Acupunct Med 2014; 32:478-85. [PMID: 25193930 DOI: 10.1136/acupmed-2014-010577] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To characterise the effects of early and late electroacupuncture (EA) treatment on serum 17β-oestradiol (E2), C-terminal cross-linking telopeptide of type I collagen (CTX-I), bone mineral density (BMD), biomechanical bone strength and mRNA expression of cathepsin K in ovariectomised (OVX) rats. Methods Sixty Sprague-Dawley rats underwent ovariectomy (n=40) or sham surgery (n=20) and were randomly divided into two batches. Batch 1 (n=30) consisted of 10 sham-operated rats (Sham-0 group) and 20 OVX rats: half commenced EA immediately (early EA group, n=10) and half were left untreated (OVX-0 group, n=10). Batch 2 (n=30) consisted of 10 sham-operated rats (Sham-12 group) and 20 OVX rats: half commenced EA treatment 12 weeks after ovariectomy (late EA group, n=10) and half were left untreated (OVX-12 group, n=10). Rats in batches 1 and 2 were killed after 12 and 24 weeks, respectively. Serum E2, CTX-I, BMD, bone strength and cathepsin K expression were determined by ELISA, dual energy X-ray absorptiometry, biomechanical assessment and qRT-PCR, respectively. Results Both early and late EA treatment increased serum E2 levels, reduced serum CTX- I levels and increased BMD and bone strength of the L5 vertebral body in OVX rats. Although early EA treatment similarly increased BMD and bone strength of the femur, late EA treatment did not. However, both early and late EA treatment reduced mRNA expression of cathepsin K in OVX rats. Conclusions Early EA completely prevented and late EA partially prevented bone loss and deterioration of bone strength in OVX rats. The timing of initiation of EA treatment may be an important consideration for optimisation of effects. The influence of EA on bone strength appears to be at least partially mediated through regulation of the expression of cathepsin K.
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Affiliation(s)
- Jun Zhou
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Xinhong Li
- Hunan Polytechnic of Environment and Biology, Hengyang, Hunan, People's Republic of China
| | - Ying Liao
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Weibing Feng
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Xin Guo
- Department of Rehabilitation, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
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16
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Meng Q, Liu X, Shan Q, Yu P, Mao Z, Zhang F, Li J, Zhao T. Acupuncture for treatment of secondary osteoporosis in patients with spinal cord injury: a controlled study. Acupunct Med 2014; 32:381-6. [PMID: 24926075 DOI: 10.1136/acupmed-2013-010463] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We explored the effect of adjunctive acupuncture on secondary osteoporosis in patients with spinal cord injury (SCI). METHODS Patients with subacute SCI were recruited and divided into two groups by patient choice: group 1 patients received standard combination therapy and group 2 patients received combination therapy plus acupuncture for 3 months. The concentrations of IgG, IgM and tumour necrosis factor α (TNFα) in serum and the bone mineral density were measured before and after treatment. RESULT The decrease in the concentration of TNFα and IgM in patients in group 2 compared with those in group 1 was statistically significant. The IgG level showed no significant change in either group. Bone mineral density increased more after adjunctive acupuncture, but the difference was not significant. CONCLUSIONS Further research is needed to determine whether acupuncture as an adjunct to combination therapy can reduce osteoporosis in patients with subacute SCI. TRIAL REGISTRATION NUMBER P153-2008-36.
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Affiliation(s)
- Qingxi Meng
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Xin Liu
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Qunqun Shan
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Peng Yu
- The First Veteran Institute of Jinan Military Region, Jinan, Shandong, China
| | - Zhaohu Mao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Fan Zhang
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Jian Li
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
| | - Tingbao Zhao
- Department of Spinal Cord Injury, Institute of Orthopedics and Traumatology of Chinese PLA, General Hospital of Jinan Military Area Command, Jinan, Shandong, China
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