Specific Correlation between the Hegu Point (LI4) and the Orofacial Part: Evidence from an fMRI Study

The short-term effects of Jin's three needles in conjunction with mirror therapy on brain function in patients with upper limb disability following an ischemic stroke were evaluated using ReHo analysis

BACKGROUND

Jin's three needle (JTN) is a commonly utilized treatment for ischemic stroke in China. Mirror therapy (MT) is also gradually transitioning from treating limb discomfort to restoring motor function in the damaged limb. Investigations into the 2 treatments' mechanisms of action are still ongoing. We used functional magnetic resonance imaging (fMRI) technique in this study to examine the effects of JTN combined with mirror therapy MT on brain function in patients with upper limb dysfunction in ischemic stroke, as well as potential central mechanisms. The goal was to provide a solid evidence-based medical basis to support the continued use of JTN combination MT.

METHODS

This study will be a single-blind, randomized, and controlled experiment. Randomization was used to assign 20 patients who met the study's eligibility requirements to the JTN + MT treatment group or the JTN control group. Each intervention will last for 4 weeks, with 6 days of treatment per week. The JTN acupuncture points are 3 temporal acupuncture points on the opposite side of the wounded limb, 3 hand acupuncture points on the injured upper limb, 3 shoulder acupuncture points, Renzhong and Baihui, The (JTN + MT) group simultaneously takes MT for 30 minutes. fMRI of the brain using BOLD and T1-weighted images was done both before and after therapy. Brain areas exhibiting changes in regional homogeneity during the pre and posttreatment periods were analyzed.

RESULTS

By the end of the treatment course, Jin three-needle therapy plus MT activated more relevant brain functional regions and increased cerebral blood oxygen perfusion than Jin three-needle therapy alone (P <.05).

CONCLUSION

In patients with upper limb impairment following an ischemic stroke, JTN with MT may improve brain function reconstruction in the relevant areas.

Research trends of acupuncture therapy on facial paralysis in a decade spanning 2013-2023: A bibliometric analysis

OBJECTIVE

This study aimed to employ bibliometric approaches to assess the worldwide scientific achievements in acupuncture for facial paralysis research from 2013 to 2023, and explore the hotspots and frontiers.

METHODS

Articles related to acupuncture facial paralysis were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was utilized to examine journals, publication year, country, institution, cited authors, as well as authors.Research hotspots and trends were analyzed by mapping co-citation networks and keywords.

RESULTS

The period from January 1, 2013, to July 31, 2023, yielded nearly 145 research records on acupuncture treatment for facial paralysis, with a steady increase in the number of annual publications.In terms of the number of publications, OTOLARYNGOLOGY HEAD NECK had the highest publication count, while AM J CHINESE MED exhibited the highest centrality and citation frequency among the cited journals. Further, 54.4 % of publications originated from China, followed by USA (8.2 %) and Germany (8.2 %). Guangzhou University of Chinese Medicine stood out with the highest publication volume among institutions. Guntinas-lichius, Orlando was the most prolific author, and PEITERSEN E was the most cited author. The keywords "Randomized controlled trials" and "multicenter" displayed high frequency and centrality, indicating that clinical trials with a randomized controlled design and multicenter studies were prevalent research methods, likely to remain a future trend.

CONCLUSION

Acupuncture's potential in the treatment of facial paralysis merits further research. Authors from different countries/regions and organizations need to eliminate language and academic barriers and strengthen collaboration and communication. Current research hotspots focus on "brain", "nerve", "electrical stimulation", "RCT" and "guidelines". The study of acupuncture mechanisms, especially based on the central nervous system mechanism, may be the future research hotspot.

Effectiveness of low-level laser therapy in reducing pain perception of children during dental local anesthetic administration using laser acupuncture pen on the LI4 point: a randomized clinical trial

PURPOSE

Laser acupuncture, a non-invasive variant of acupuncture, has been proven effective in the medical and dental fields. Hence, the present study aims to determine the effect of low-level laser therapy on the LI4 point, using a laser acupuncture pen, in reducing children's pain during local anesthetic (LA) administration.

METHODS

Children in the age range of 8-12 years, in need of LA administration, were randomly assigned to two groups: Group I: laser acupuncture, Group II: control. For all the children, baseline simplified Modified Child Dental Anxiety Scale-Faces version (MCDAS_(f)) was recorded, followed by laser acupuncture or standard care. Following the conventional protocol, LA was administered. The procedural pain was assessed using the Faces, Legs, Activity, Cry and Consolability scale (FLACC) and Faces Pain Scale-Revised (FPS-R). All the variations in pulse rate were recorded from baseline to the completion of LA administration. After the procedure, simplified MCDAS_(f) was recorded one more time. The data were tabulated and analyzed statistically.

RESULTS

A significant reduction in anxiety after LA administration, as observed in MCDAS_(f) score, was noticed only in the laser acupuncture group. The pain scores, as reported in FPS-R, were low in children randomized to the laser group compared to the control. The FLACC pain scores also showed low values in the experimental group.

CONCLUSION

Based on the study findings, within the limitations, low-level laser therapy using a laser acupuncture pen can reduce the pain perception of children undergoing LA administration and alleviate dental anxiety.

Changes in Degree Centrality and Functional Connectivity after the First Cycle of Neoadjuvant Chemotherapy in Newly Diagnosed Breast Cancer: A Longitudinal Study

Purpose

To evaluate the longitudinal changes of brain degree centrality (DC) and functional connectivity (FC) in breast cancer patients after the first cycle of neoadjuvant chemotherapy (NAC).

Methods

Thirty-five breast cancer patients were included in the NAC group. Resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological test were performed at baseline before NAC (time point 0, TP0) and after the first cycle of NAC (time point 1, TP1). The healthy controls (HC) included 30 healthy subjects and received the same rs-fMRI scan and neuropsychological test as the above-mentioned NAC group at one time point. DC and FC analyses were conducted to assess brain connectivity of all participants. Receiver operating characteristic (ROC) curve was used to assess the ability of DC and FC in distinguishing patients before and after chemotherapy.

Results

In the NAC group, the Self-Rating Anxiety Scale scores decreased significantly over time. At TP0 and TP1, the Digital Span Test forward score of the NAC group was significantly lower than that of the HC group. In the NAC group, DC in the right middle frontal gyrus and left precentral gyrus/middle frontal gyrus decreased significantly at TP1, and FC between the left precentral gyrus/middle frontal gyrus and bilateral precuneus was significantly reduced at TP1. Through ROC analysis, we found that the area under the curve (AUC) of DC, FC, and the combined model in distinguishing patients in TP0 or TP1 was 0.7886, 0.7665, and 0.8278, respectively.

Conclusions

Brain connectivity, involving executive and motor function related brain areas, changes in the short term after NAC treatment in breast cancer patients.

Improved Iatrogenic Facial Nerve Paralysis Based on House-Brackmann Facial Nerve Grading System by Using Acupuncture Therapy: A Case Report

Background

Iatrogenic facial nerve paralysis is often caused by surgical procedures on temporomandibular joint due to temporomandibular disorder. It can affect the quality of life of the patient due to the facial nerve's importance in communication and expressions.

Case

We hereby report a case of a 22-year-old man with right facial nerve paralysis after he had arthroplasty surgery. He received Mefenamic Acid 3 × 500 mg (if necessary) and Mecobalamin 1 × 500 mg. He was treated with manual acupuncture therapy for 3 times a week with 30 minutes of each session until he has reached the deqi sensation. Acupuncture points used were points on the affected side and several points on both sides.

Results

The patient underwent acupuncture treatments for 28 sessions in 4.5 months. On the eighth session, the patient had no visible right lagophthalmos. The patients' jaws could open normally after the 12th session, and at the end of the sessions (28th) the patient could raise and lower his right eyebrow perfectly. We found that patient's facial nerve function was improved to normal based on House-Brackmann facial nerve grading system. The nerve conduction velocity and electromyography test results also improved.

Conclusions

Acupuncture should be considered as one of the therapeutic tools for treating iatrogenic facial nerve paralysis.

Acupuncture for the Treatment of Chronic Rhinosinusitis: A PRISMA-Compliant Systematic Review and Meta-Analysis

Background. Chronic rhinosinusitis (CRS) is a highly prevalent disease associated with poor quality of life. In this paper, we appraised the role of acupuncture in the treatment of CRS. Methods. Electronic databases were searched for randomized controlled clinical trials (RCTs) that examined the role of acupuncture in CRS. The primary outcome measures included posttreatment CRS severity, as measured by the Visual Analogue Scale (VAS) and Total Effective Rate (TER). The risk of bias and quality of evidence were evaluated according to the Cochrane Collaboration’s risk-of-bias tool and GRADE tool, respectively. Results. Evidence from the RCTs (n = 10) suggested that acupuncture as a monotherapy or adjunctive therapy to conventional treatment was associated with significant improvements in VAS, TER, and quality of life when compared with conventional treatments for CRS. However, there was a similar incidence of adverse events. The risk of bias was unclear and the quality of evidence for each finding was generally moderate to low. Conclusions. Acupuncture as a stand-alone or adjunctive treatment for CRS was associated with clinical symptom improvement and better quality of life, without any risk for serious adverse events. However, the high clinical heterogeneity of the included RCTs and overall moderate-to-low quality of evidence necessitates rigorous, well-designed trials to confirm these findings. Trial Registrations. This trial is registered with PROSPERO (no. CRD42021292135).

The Temporal Dynamics of EEG Microstate Reveals the Neuromodulation Effect of Acupuncture With Deqi

The electroencephalography (EEG) microstate has recently emerged as a new whole-brain mapping tool for studying the temporal dynamics of the human brain. Meanwhile, the neuromodulation effect of external stimulation on the human brain is of increasing interest to neuroscientists. Acupuncture, which originated in ancient China, is recognized as an external neuromodulation method with therapeutic effects. Effective acupuncture could elicit the deqi effect, which is a combination of multiple sensations. However, whether the EEG microstate could be used to reveal the neuromodulation effect of acupuncture with deqi remains largely unclear. In this study, multichannel EEG data were recorded from 16 healthy subjects during acupuncture manipulation, as well as during pre- and post-manipulation tactile controls and pre- and post-acupuncture rest controls. As the basic acupuncture unit for regulating the central nervous system, the Hegu acupoint was used in this study, and each subject’s acupuncture deqi behavior scores were collected. To reveal the neuroimaging evidence of acupuncture with deqi, EEG microstate analysis was conducted to obtain the microstate maps and microstate parameters for different conditions. Furthermore, Pearson’s correlation was analyzed to investigate the correlation relationship between microstate parameters and deqi behavioral scores. Results showed that: (1) compared with tactile controls, acupuncture manipulation caused significantly increased deqi behavioral scores. (2) Acupuncture manipulation significantly increased the duration, occurrence, and contribution parameters of microstate C, whereas it decreased those parameters of microstate D. (3) Microstate C’s duration parameter showed a significantly positive correlation with acupuncture deqi behavior scores. (4) Acupuncture manipulation significantly increased the transition probabilities with microstate C as node, whereas it reduced the transition probabilities with microstate D as node. (5) Microstate B→C’s transition probability also showed a significantly positive correlation with acupuncture deqi behavior scores. Taken together, the temporal dynamic feature of EEG microstate could be used as objective neuroimaging evidence to reveal the neuromodulation effect of acupuncture with deqi.

Acupuncture With deqi Modulates the Hemodynamic Response and Functional Connectivity of the Prefrontal-Motor Cortical Network

As a world intangible cultural heritage, acupuncture is considered an essential modality of complementary and alternative therapy to Western medicine. Despite acupuncture’s long history and public acceptance, how the cortical network is modulated by acupuncture remains largely unclear. Moreover, as the basic acupuncture unit for regulating the central nervous system, how the cortical network is modulated during acupuncture at the Hegu acupoint is mostly unclear. Here, multi-channel functional near-infrared spectroscopy (fNIRS) data were recorded from twenty healthy subjects for acupuncture manipulation, pre- and post-manipulation tactile controls, and pre- and post-acupuncture rest controls. Results showed that: (1) acupuncture manipulation caused significantly increased acupuncture behavioral deqi performance compared with tactile controls. (2) The bilateral prefrontal cortex (PFC) and motor cortex were significantly inhibited during acupuncture manipulation than controls, which was evidenced by the decreased power of oxygenated hemoglobin (HbO) concentration. (3) The bilateral PFC’s hemodynamic responses showed a positive correlation trend with acupuncture behavioral performance. (4) The network connections with bilateral PFC as nodes showed significantly increased functional connectivity during acupuncture manipulation compared with controls. (5) Meanwhile, the network’s efficiency was improved by acupuncture manipulation, evidenced by the increased global efficiency and decreased shortest path length. Taken together, these results reveal that a cooperative PFC-Motor functional network could be modulated by acupuncture manipulation at the Hegu acupoint. This study provides neuroimaging evidence that explains acupuncture’s neuromodulation effects on the cortical network.

Acupuncture for radiation-induced toxicity in head and neck squamous cell carcinoma: a systematic review based on PICO criteria

Purpose

In head and neck squamous cell carcinoma (HNSCC), the potential mitigating effect of complementary medicine interventions such as acupuncture for radiation-induced toxicity is unknown. This study aimed to assess the impact of acupuncture on the incidence and degree of severity of common radiation-induced side effects.

Methods

In accordance with pre-specified PICO criteria, a systematic review was performed. Two electronic databases (Medline and Embase) were searched over a 10-year time frame (01/01/10 to 30/09/20). Patients undergoing a curatively intended, radiation-based treatment for histologically confirmed squamous cell carcinoma of the nasopharynx, oropharynx, larynx, hypopharynx and oral cavity represented the target population of our study. Accurate information on the acupuncture methodology was reported. All included articles were evaluated to identify any potential source of bias

Results

Five papers were included in our qualitative analysis, for a total of 633 subjects. Compliance to per-protocol defined schedule of acupuncture sessions was high, ranging from 82 to 95.9%. Most patients (70.6%) were randomly allocated to receive acupuncture for its potential preventive effect on xerostomia. The large heterogeneity in study settings and clinical outcomes prevented from performing a cumulative quantitative analysis, thus no definitive recommendations can be provided.

Conclusions

Although shown to be feasible and safe, no firm evidence currently supports the use of acupuncture for the routine management of radiation-induced toxicity in HNSCC.

Short-term effect of electroacupuncture on rehabilitation after arthroscopic triangular fibrocartilage complex repair: a randomised study

Background

Electroacupuncture (EA) alleviates chronic pain and acute postoperative pain after several surgical procedures. However, whether EA facilitates postoperative functional recovery after arthroscopic surgery has yet to be determined. This study investigated the short-term effect of EA on a rehabilitation course after arthroscopic triangular fibrocartilage complex (TFCC) repair.

Methods

Forty-two patients undergoing arthroscopic TFCC repair were randomised to an EA group (n = 19) or control group (n = 23). In the EA group, patients received EA treatment and standard active rehabilitation for 4 weeks. In the control group, patients received standard active rehabilitation for 4 weeks. At the end of the treatment and at the follow-up visit 4 weeks after the treatment, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, wrist range of motion (ROM), handgrip strength, and key pinch strength were collected and analysed.

Results

The EA group improved significantly than the control group in terms of DASH scores, all wrist motion arcs, and key pinch strength (P < 0.05) at the end of the 4-week treatment and the follow-up visit another 4 weeks later.

Conclusion

Patients treated with 4 weeks of EA after the arthroscopic TFCC repair had better wrist ROM and DASH scores than patients of control group

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02361-1.

Changes in cerebral glucose metabolism after acupuncture at KI3 in spontaneously hypertensive rats: a positron emission tomography study

Objective:

The aim of this study was to explore the effect of acupuncture stimulation at KI3 on brain glucose metabolism in spontaneously hypertensive rats (SHRs).

Methods:

Brain glucose metabolism in SHRs after acupuncture stimulation at KI3 was detected using 18F-2-fluorodeoxy-D-glucose positron emission tomography (18F-FDG-PET). SHRs were randomly divided into three groups: no treatment (SHR group); acupuncture at KI3 (KI3 group); and sham acupuncture (Sham group). Wistar Kyoto (WKY) rats were used as a normal blood pressure (BP) control group. Rats were subjected to 10 min of acupuncture once a day for 7 days. BP and positron emission tomography–computed tomography (PET-CT) were measured after the first acupuncture session and after 7 days of treatment.

Results:

The results showed that BP was lower in the KI3 group than in the SHR group, both 30–60 min after the first acupuncture session and 24–48 h after the 7-day treatment. Compared with the WKY group, the SHR group had lower glucose metabolism in the motor cortex, sensory cortex, basal ganglia, corpus callosum, caudate putamen, and visual cortex. Compared with the untreated/sham-treated SHR control groups, cerebral glucose metabolism was lower in the medulla oblongata, thalamus, dorsal thalamus, orbital cortex, and hypothalamus after acupuncture at KI3, while it was higher in the olfactory cortex and inferior phrenic muscle.

Conclusion:

Our results show that, in SHRs, needling at KI3 reduces high BP, most likely by altering the activation of cerebral regions.

Different Brain Activation after Acupuncture at Combined Acupoints and Single Acupoint in Hypertension Patients: An Rs-fMRI Study Based on ReHo Analysis

Background

Acupuncture is proved to be effective on hypertension by numerous studies and resting-state functional magnetic resonance imaging (Rs-fMRI) is a widely used technique to study its mechanism. Along with lower blood pressure, patients with hypertension receiving acupuncture also presented improvement in function of cognition, emotion, language, sematic sensation, and so on. This study was a primary study to explore the acting path of acupuncture at combined acupoints in stimulated brain areas related to such functions.

Methods

In this research, regional homogeneity (ReHo) was applied to analyze the Rs-fMRI image data of brain activities after acupuncture at LR3, KI3, and LR3+KI3 and to compare the differences of functional brain activities between stimulating combined acupoints and single acupoint under pathological conditions. A total of thirty hypertension patients underwent Rs-fMRI scanning before acupuncture treatment and then were randomly divided into three groups following random number table, the LR3 group (3 males and 7 females), the KI3 group (3 males and 7 females), and the LR3+ KI3 group (4 males and 6 females) for needling, respectively. When the 30-min treatment finished, they received a further Rs-fMRI scanning. The Rs-fMRI data before and after the acupuncture treatment were analyzed through ReHo.

Results

Compared with preacupuncture, respectively, ReHo values increased in Brodmann areas (BAs) 3, 18, and 40 and decreased in BAs 7 and 31 in LR3+ KI3 group. However, ReHo values only decreased in BA7 of KI3 group while the results showed no significant difference of brain regions in LR3 group between pre- and postacupuncture. Compared with LR3 group, LR3+KI3 group exhibited decreased ReHo values in BAs 7, 9, and 31. Meanwhile, compared with KI3 group, LR3+KI3 group exhibited increased ReHo values in the BAs 2, 18, 30, and 40 and decreased ReHo values in BA13.

Conclusion

Combined acupoints of LR3 and KI3 could act on wider brain areas than the sum of single acupoints, whose functions include emotional processing, cognition, somatic sensation, spatial orientation, language production, and vision.

Cortical Network Response to Acupuncture and the Effect of the Hegu Point: An fNIRS Study

Acupuncture is a practice of treatment based on influencing specific points on the body by inserting needles. According to traditional Chinese medicine, the aim of acupuncture treatment for pain management is to use specific acupoints to relieve excess, activate qi (or vital energy), and improve blood circulation. In this context, the Hegu point is one of the most widely-used acupoints for this purpose, and it has been linked to having an analgesic effect. However, there exists considerable debate as to its scientific validity. In this pilot study, we aim to identify the functional connectivity related to the three main types of acupuncture manipulations and also identify an analgesic effect based on the hemodynamic response as measured by functional near-infrared spectroscopy (fNIRS). The cortical response of eleven healthy subjects was obtained using fNIRS during an acupuncture procedure. A multiscale analysis based on wavelet transform coherence was employed to assess the functional connectivity of corresponding channel pairs within the left and right somatosensory region. The wavelet analysis was focused on the very-low frequency oscillations (VLFO, 0.01–0.08 Hz) and the low frequency oscillations (LFO, 0.08–0.15 Hz). A mixed model analysis of variance was used to appraise statistical differences in the wavelet domain for the different acupuncture stimuli. The hemodynamic response after the acupuncture manipulations exhibited strong activations and distinctive cortical networks in each stimulus. The results of the statistical analysis showed significant differences (p<0.05) between the tasks in both frequency bands. These results suggest the existence of different stimuli-specific cortical networks in both frequency bands and the anaesthetic effect of the Hegu point as measured by fNIRS.

Sensorimotor Cortical Neuroplasticity in the Early Stage of Bell's Palsy

Neuroplasticity is a common phenomenon in the human brain following nerve injury. It is defined as the brain's ability to reorganize by creating new neural pathways in order to adapt to change. Here, we use task-related and resting-state fMRI to investigate neuroplasticity in the primary sensory (S1) and motor cortex (M1) in patients with acute Bell's palsy (BP). We found that the period directly following the onset of BP (less than 14 days) is associated with significant decreases in regional homogeneity (ReHo), fractional amplitude of low frequency fluctuations (fALFF), and intrinsic connectivity contrast (ICC) values in the contralateral S1/M1 and in ReHo and ICC values in the ipsilateral S1/M1, compared to healthy controls. The regions with decreased ReHo, fALFF, and ICC values were in both the face and hand region of S1/M1 as indicated by resting-state fMRI but not task-related fMRI. Our results suggest that the early stages of BP are associated with functional neuroplasticity in both the face and hand regions of S1/M1 and that resting-state functional fMRI may be a sensitive tool to detect these early stages of plasticity in patient populations.

Disrupted functional connectivity of striatal sub-regions in Bell's palsy patients

The striatum plays an important role in controlling motor function in humans, and its degeneration has the ability to cause severe motor disorders. More specifically, previous studies have demonstrated a disruption in the connectivity of the cortico-striatal loop in patients suffering from motor disorders caused by dopamine dysregulation, such as Parkinson's disease. However, little is known about striatal functional connectivity in patients with motor dysfunction not caused by dopamine dysregulation. In this study, we used early-state Bell's palsy (BP) patients (within 14 days of onset) to investigate how functional connectivity between the striatum and motor cortex is affected by peripheral nerve injury in which the dopamine system remains fully functional. We found a significant increase in the connectivity between the contralateral putamen, and the ipsilateral primary sensory (S1) and motor cortex (M1) in BP patients compared to healthy controls. We also found increased connectivity between the ventral striatum and supplementary motor area (SMA), and the dorsal caudate and medial prefrontal lobe in BP patients compared to healthy controls. Our results demonstrate that the entirety of the striatum is affected following acute peripheral nerve injury, and suggests that this disrupted striatal functional connectivity may reflect a compensatory mechanism for the sensory-motor mismatch caused by BP.

Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.