Electroacupuncture promotes peripheral nerve regeneration after facial nerve crush injury and upregulates the expression of glial cell-derived neurotrophic factor

Comparison of the efficacy of acupuncture with tuina with acupuncture-only in the treatment of peripheral facial paralysis: a network meta-analysis

At present, traditional Chinese medicine treatment is considered safe for treating peripheral facial paralysis (PFP). Acupuncture-only and acupuncture combined with tuina are widely used for this purpose. However, it is not clear whether acupuncture combined with tuina is better for treating PFP than acupuncture-only. Conventional meta-analysis and network meta-analysis were used to compare the clinical efficacies of acupuncture combined with tuina and acupuncture-only in the treatment of PFP. Randomized controlled trials (RCTs), with the subjects being patients with PFP and treatment interventions including acupuncture combined with tuina, acupuncture-only, tuina-only, placebo, single Western medicine, and steroids combined with other Western medicine were searched from both Chinese and English databases. The primary outcomes included Modified House-Brackmann (MHBN) scores and Sunnybrook Facial Grading System, whereas the secondary outcomes included cure time, Portmann scores, and physical function scale of Facial Disability Index, using conventional meta-analysis and network meta-analysis. The study included 22 RCTs with a sample size of 1814 patients. The results of conventional meta-analysis (MD = 16.12, 95%CI 13.13,19.10) and network meta-analysis (MD = 14.53, 95%CI 7.57,21.49) indicate that acupuncture combined with tuina was better than acupuncture-only in improving MHBN and shortening the cure time (MD = - 6.09, 95%CI  - 7.70, - 4.49). Acupuncture combined with tuina was the optimal therapy for improving MHBN (SUCRA was 100%) and shortening the cure time (SUCRA was 100%). The results of this meta-analysis indicate that acupuncture combined with tuina can significantly improve MHBN and shorten the cure time, compared with acupuncture-only. However, the current evidence is insufficient, and more high-quality clinical studies are needed.Registration: This study had been registered with PROSPERO (CRD42022379395).

Electroacupuncture Promotes Functional Recovery after Facial Nerve Injury in Rats by Regulating Autophagy via GDNF and PI3K/mTOR Signaling Pathway

OBJECTIVE

To explore the mechanism of electroacupuncture (EA) in promoting recovery of the facial function with the involvement of autophagy, glial cell line-derived neurotrophic factor (GDNF), and phosphatidylinositol-3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway.

METHODS

Seventy-two male Sprague-Dawley rats were randomly allocated into the control, sham-operated, facial nerve injury (FNI), EA, EA+3-methyladenine (3-MA), and EA+GDNF antagonist groups using a random number table, with 12 rats in each group. An FNI rat model was established with facial nerve crushing method. EA intervention was conducted at Dicang (ST 4), Jiache (ST 6), Yifeng (SJ 17), and Hegu (LI 4) acupoints for 2 weeks. The Simone's 10-Point Scale was utilized to monitor the recovery of facial function. The histopathological evaluation of facial nerves was performed using hematoxylin-eosin (HE) staining. The levels of Beclin-1, light chain 3 (LC3), and P62 were detected by immunohistochemistry (IHC), immunofluorescence, and reverse transcription-polymerase chain reaction, respectively. Additionally, IHC was also used to detect the levels of GDNF, Rai, PI3K, and mTOR.

RESULTS

The facial functional scores were significantly increased in the EA group than the FNI group (P<0.05 or P<0.01). HE staining showed nerve axons and myelin sheaths, which were destroyed immediately after the injury, were recovered with EA treatment. The expressions of Beclin-1 and LC3 were significantly elevated and the expression of P62 was markedly reduced in FNI rats (P<0.01); however, EA treatment reversed these abnormal changes (P<0.01). Meanwhile, EA stimulation significantly increased the levels of GDNF, Rai, PI3K, and mTOR (P<0.01). After exogenous administration with autophagy inhibitor 3-MA or GDNF antagonist, the repair effect of EA on facial function was attenuated (P<0.05 or P<0.01).

CONCLUSIONS

EA could promote the recovery of facial function and repair the facial nerve damages in a rat model of FNI. EA may exert this neuroreparative effect through mediating the release of GDNF, activating the PI3K/mTOR signaling pathway, and further regulating the autophagy of facial nerves.

TsMS combined with EA promotes functional recovery and axonal regeneration via mediating the miR-539-5p/Sema3A/PlexinA1 signalling axis in sciatic nerve-injured rats

Enhancing axonal regeneration is one of the most important processes in treating nerve injuries. Both magnetic and electrical stimulation have the effect of promoting nerve axon regeneration. But few study has investigated the effects of trans-spinal magnetic stimulation (TsMS) combined with electroacupuncture (EA) on nerve regeneration in rats with sciatic nerve injury. In this study, we compared the improvement of neurological function in rats with sciatic nerve crush injuries after 4 weeks of different interventions (EA, TsMS, or TsMS combined with EA). We further explored the morphological and molecular biological alterations following sciatic nerve injury by HE, Masson, RT-PCR, western blotting, immunofluorescence staining and small RNA transcriptome sequencing. The results showed that TsMS combined with EA treatment significantly promoted axonal regeneration, increased the survival rate of neurons, and suppressed denervation atrophy of the gastrocnemius muscle. Subsequent experiments suggested that the combination treatment may play an active role by mediating the miR-539-5p/Sema3A/PlexinA1 signaling axis.

Electroacupuncture with intermittent wave stimulation as rehabilitation approach for chronic Bell's palsy: a randomized controlled trial

PURPOSE

To evaluate the effectiveness and safety of electroacupuncture (EA) using intermittent wave stimulation in enhancing facial symmetry and nerve function in chronic Bell's palsy patients.

METHODS

A 6-week assessor-blinded, randomized trial followed by an 18-week observational period was conducted. Sixty individuals with chronic Bell's palsy, showing no signs of recovery after 12 months, were equally divided to receive either 18 sessions of EA using intermittent wave stimulation or Transcutaneous Electrical Stimulation (TES), administered thrice weekly over 6 weeks. The primary outcome measure was the change in the total facial nerve index (TFNI) score from baseline to Week 6, with secondary outcomes including TFNI scores at Weeks 12 and 24, as well as the change in Sunnybrook Facial Grading System (SFG) score from baseline to Week 6, and SFG scores at Weeks 12 and 24.

RESULTS

The EA group showed a significant improvement, with a mean total facial nerve index score increase of 24.35 (4.77) by Week 6 compared with 14.21 (5.12) in the Transcutaneous Electrical Stimulation group (P<.001). This superiority persisted during the 24-week follow-up. While no significant difference was observed in the Sunnybrook Facial Grading System score change from baseline to Week 6, variations were noted at Weeks 12 and 24. No major adverse effects were reported.

CONCLUSION

EA with intermittent wave stimulation notably enhanced facial symmetry in chronic Bell's palsy patients over Transcutaneous Electrical Stimulation by Week 6, maintaining this edge throughout the follow-up.

Electroacupuncture Promotes Nerve Regeneration and Functional Recovery Through Regulating lncRNA GAS5 Targeting miR-21 After Sciatic Nerve Injury

Although the benefits of electroacupuncture (EA) for peripheral nerve injury (PNI) are well accepted in clinical practice, the underlying mechanism remains incompletely elucidated. In our study, we observed that EA intervention led to a reduction in the expression of the long non-coding RNA growth-arrest-specific transcript 5 (GAS5) and an increased in miR-21 levels within the injured nerve, effectively promoting functional recovery and nerve regeneration following sciatic nerve injury (SNI). In contrast, administration of adeno-associated virus expressing GAS5 (AAV-GAS5) weakened the therapeutic effect of EA. On the other hand, both silencing GAS5 and introducing a miR-21 mimic prominently enhanced the proliferation activity and migration ability of Schwann cells (SCs), while also inhibiting SCs apoptosis. On the contrary, inhibition of SCs apoptosis was found to be mediated by miR-21. Additionally, overexpression of GAS5 counteracted the effects of the miR-21 mimic on SCs. Moreover, SCs that transfected with the miR-21 mimic promoted neurite growth in hypoxia/reoxygenation-induced neurons, which might be prevented by overexpressing GAS5. Furthermore, GAS5 was found to be widely distributed in the cytoplasm and was negatively regulated by miR-21. Consequently, the targeting of GAS5 by miR-21 represents a potential mechanism through which EA enhances reinnervation and functional restoration following SNI. Mechanistically, the GAS5/miR-21 axis can modulate the proliferation, migration, and apoptosis of SCs while potentially influencing the neurite growth of neurons.

Acupuncture on "Huantiao" (GB30) and "Yanglingquan" (GB34) acupoints promotes nerve regeneration in mice model of peripheral nerve injury

Objective

To investigate the effects of acupuncture on promoting nerve regeneration in mice with sciatic nerve crushed injury, an animal model of peripheral nerve injury (PNI).

Methods

Acupuncture was performed on the "Huantiao" (GB30) and "Yanglingquan" (GB34) acupoints in PNI mice model for 2 weeks. Gait analysis, toe spreading test, electrophysiological test, toluidine blue staining and immunostaining of myelin basic protein (MBP), neurofilament-200 (NF200), p75 neurotrophin receptor (p75NTR), and growth associated protein-43 (GAP43) were respectively performed to investigate the effects of acupuncture on crushed sciatic nerve.

Results

Acupuncture stimulation of "Huantiao" (GB30) and "Yanglingquan" (GB34) acupoints promoted the recovery of motor function and electrophysiological function in PNI mice model, which was indicated by a better gait level, toe spreading level and CMAP value in acupuncture group. The number of myelinated nerve fibers and the fluorescence intensity of MBP, NF200, p75NTR and GAP43 staining demonstrated that the acupuncture stimulation promoted the regeneration of injured nerves in PNI mice model.

Conclusion

Acupuncture significantly promoted the functional and morphological recovery of crushed sciatic nerve via promoting the expression of p75NTR in Schwann cells.

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.

Application and underlying mechanism of acupuncture for the nerve repair after peripheral nerve injury: remodeling of nerve system

Peripheral nerve injury (PNI) is a structural event with harmful consequences worldwide. Due to the limited intrinsic regenerative capacity of the peripheral nerve in adults, neural restoration after PNI is difficult. Neurological remodeling has a crucial effect on the repair of the form and function during the regeneration of the peripheral nerve after the peripheral nerve is injured. Several studies have demonstrated that acupuncture is effective for PNI-induced neurologic deficits, and the potential mechanisms responsible for its effects involve the nervous system remodeling in the process of nerve repair. Moreover, acupuncture promotes neural regeneration and axon sprouting by activating related neurotrophins retrograde transport, such as nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), glial cell-derived neurotrophic factor (GDNF), N-cadherin, and MicroRNAs. Peripheral nerve injury enhances the perceptual response of the central nervous system to pain, causing central sensitization and accelerating neuronal cell apoptosis. Together with this, the remodeling of synaptic transmission function would worsen pain discomfort. Neuroimaging studies have shown remodeling changes in both gray and white matter after peripheral nerve injury. Acupuncture not only reverses the poor remodeling of the nervous system but also stimulates the release of neurotrophic substances such as nerve growth factors in the nervous system to ameliorate pain and promote the regeneration and repair of nerve fibers. In conclusion, the neurological remodeling at the peripheral and central levels in the process of acupuncture treatment accelerates nerve regeneration and repair. These findings provide novel insights enabling the clinical application of acupuncture in the treatment of PNI.

Perspectives of Electroacupuncture as a New Option for the Treatment of Denervated Muscles

Introduction

Conservative treatment of peripheral nerve injuries is based on physical therapy approaches, including electrostimulation of denervated muscle. Electrostimulation retards denervation atrophy and prolongs the time window for axon reinnervation.

Aim

This article focuses on the potential of electroacupuncture, which combines electrostimulation with acupuncture, in the context of the latest knowledge on the mechanisms of axonal regeneration.

Results and conclusions

The possibilities of influencing the growth rate of the axon itself through neurotrophic factors have primarily been previously proven in rodent models. Electroacupuncture as mini-invasive electrostimulation using acupuncture needles appears to be a promising option for the treatment of peripheral nerve paresis. However, this therapy needs to be evaluated in the context of human medicine.

The treatment of post-stroke dysarthria with a combination of different acupuncture types and language rehabilitation training: a systematic review and network meta-analysis

Background

This study used a network meta-analysis to evaluate the efficacy of various different acupuncture types and language rehabilitation training on post-stroke dysarthria (PSD), and examined the possible mechanisms involved. There are often clinical studies comparing the effects of different acupuncture methods on dysarthria after stroke. The efficacy of these methods can be ranked by network meta-analysis. This is necessary for clinical acupoints selection. The results of this study illustrated the comparison of the therapeutic effects of 6 different acupuncture types, which can provide some reference for clinical acupoints selection and research.

Methods

A comprehensive search for clinical studies related to the use of acupuncture to treat PSD was conducted in eight English and Chinese databases. Patients were divided into six groups based on the acupoints selected, namely, tongue, neck, scalp, body, combination, and traditional acupuncture. The recovery of neurological function in the patients was assessed based on the curative impact and the National Institutes of Health Stroke Scale (NIHSS) score. The quality of the included studies was evaluated using the Cochrane risk bias assessment tool and the STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) criteria. A network meta-analysis was performed using the network-meta package of Stata 15.1 software based on frequency. The heterogeneity test, consistency test, head-to-head mixed comparison, efficacy ranking, and publication bias study were all performed.

Results

A total of 47 studies were finally included. There was a total of 4,197 patients in the eligible studies. The model for network meta-analysis proved robust, with minimal heterogeneity and high consistency. Combined acupuncture combined with language rehabilitation training was the most effective in treating dysarthria symptoms, followed by tongue acupuncture (TA) and nape acupuncture (NA). In addition, the combined effect of acupuncture and language training was superior to that of acupuncture alone. In terms of recovery of nerve function, traditional acupuncture and body acupuncture were more effective. To facilitate the recovery of nerve function, increasing the frequency of acupoints is necessary.

Conclusions

Combined acupuncture may have the most beneficial healing effect on PSD, followed by acupuncture of the tongue and the nape of the neck. In terms of recovery of nerve function, traditional acupuncture and body acupuncture may have more effective.

Comparison of Tongue Acupuncture and Traditional Acupuncture in the Treatment of Poststroke Dysarthria: A Meta-Analysis and Tongue Acupuncture System Classification Evaluation

OBJECTIVE

To discuss whether tongue acupuncture is more effective than traditional acupuncture in the treatment of poststroke dysarthria and explore the advantage of tongue acupuncture treatment parameters.

METHODS

We evaluated the efficacy of tongue acupuncture compared with traditional acupuncture through a rigorous meta-analysis process. The included studies were from eight databases in English and Chinese. The Cochrane risk of bias assessment tool was used to evaluate the quality of studies. Stata15.1 software was used for meta-analysis and sensitivity analysis. Tongue acupuncture therapeutic parameters were classified and counted based on tongue acupoint location, acupuncture manipulation, and the number of manipulations. Subgroup analysis was used to compare the differences between various treatment parameters. Outcome The meta-analysis eventually included a total of 9 studies. Tongue acupuncture is superior to traditional acupuncture in clinical efficacy [OR = 3.62, 95%Cl (2.24, 5.85), P < 0.0001], FDA score [SMD = -1.99, 95%Cl (-3.77, -0.21), P=0.028], and NIHSS score [WMD = 0.86, 95%Cl (0.15, 1.57), P=0.017, I2 = 31.7%] in the treatment of poststroke dysarthria. According to the classified statistics of tongue acupuncture treatment parameters, there are three kinds of tongue acupuncture points in 9 studies: lingual surface, sublingual, and both lingual surface and sublingual acupoints. The operation methods include the oblique stabbing of the root of the tongue, twisting after stabbing, and acupoint pricking. The number of operation methods varies from 1 to 3.

CONCLUSION

Tongue acupuncture outperforms traditional acupuncture in terms of clinical efficacy, FDA score, and NIHSS score in the treatment of poststroke dysarthria. The curative effect of sublingual acupoints is better than that of lingual surface acupoints, the combined use of multiple manipulations is better than that of a single manipulation, and acupuncture manipulation has a cumulative effect. PROSPERO registration number: CRD42021285722.

Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation

Previous studies on the mechanisms of peripheral nerve injury (PNI) have mainly focused on the pathophysiological changes within a single injury site. However, recent studies have indicated that within the central nervous system, PNI can lead to changes in both injury sites and target organs at the cellular and molecular levels. Therefore, the basic mechanisms of PNI have not been comprehensively understood. Although electrical stimulation was found to promote axonal regeneration and functional rehabilitation after PNI, as well as to alleviate neuropathic pain, the specific mechanisms of successful PNI treatment are unclear. We summarize and discuss the basic mechanisms of PNI and of treatment via electrical stimulation. After PNI, activity in the central nervous system (spinal cord) is altered, which can limit regeneration of the damaged nerve. For example, cell apoptosis and synaptic stripping in the anterior horn of the spinal cord can reduce the speed of nerve regeneration. The pathological changes in the posterior horn of the spinal cord can modulate sensory abnormalities after PNI. This can be observed in cases of ectopic discharge of the dorsal root ganglion leading to increased pain signal transmission. The injured site of the peripheral nerve is also an important factor affecting post-PNI repair. After PNI, the proximal end of the injured site sends out axial buds to innervate both the skin and muscle at the injury site. A slow speed of axon regeneration leads to low nerve regeneration. Therefore, it can take a long time for the proximal nerve to reinnervate the skin and muscle at the injured site. From the perspective of target organs, long-term denervation can cause atrophy of the corresponding skeletal muscle, which leads to abnormal sensory perception and hyperalgesia, and finally, the loss of target organ function. The mechanisms underlying the use of electrical stimulation to treat PNI include the inhibition of synaptic stripping, addressing the excessive excitability of the dorsal root ganglion, alleviating neuropathic pain, improving neurological function, and accelerating nerve regeneration. Electrical stimulation of target organs can reduce the atrophy of denervated skeletal muscle and promote the recovery of sensory function. Findings from the included studies confirm that after PNI, a series of physiological and pathological changes occur in the spinal cord, injury site, and target organs, leading to dysfunction. Electrical stimulation may address the pathophysiological changes mentioned above, thus promoting nerve regeneration and ameliorating dysfunction.

Acupuncture for abducens nerve palsy after radiochemotherapy: a CARE-compliant case report

BACKGROUND

Delayed abducens nerve palsy after chemoradiotherapy for nasopharyngeal carcinoma (NPC) is often accompanied by ocular ischemia and cranial nerve damage, thereby increasing the risk of conventional strabismus surgery. Therefore, patients often prefer conservative treatment. Herein we report a case of acupuncture for delayed abducens nerve palsy after chemoradiotherapy for NPC.

CASE PRESENTATION

A 39-year-old patient who previously received chemotherapy and radiotherapy for NPC developed a unilateral abducens nerve palsy with numbness in the face and stiffness in the neck muscles after six years. Based on magnetic resonance imaging (MRI), medical history, and physical examination, he was diagnosed with abducens nerve palsy after chemoradiotherapy. The acupuncture treatment regimen was mainly based on periocular electroacupuncture, supplemented with wheat grain moxibustion and warming needle moxibustion, which were performed three times a week. After one month with a total of 17 acupuncture sessions, the patient's affected eye abduction function recovered completely. Facial sensory abnormalities and neck stiffness also improved significantly. Follow-up at two months reported no recurrence.

CONCLUSION

Acupuncture may be a conservative treatment option for patients with abducens nerve palsy after chemoradiotherapy.

Comparison of therapeutic effects of different acupuncture and moxibustion therapies in the treatment of peripheral facial nerve paralysis: A protocol for systematic review and network meta-analysis

BACKGROUND

Previous evidences show that acupuncture and moxibustion therapy has positive effects on peripheral facial nerve paralysis (PFP), but there are many acupuncture treatments based on meridian theory, and there are differences in the efficacy of each program. This study will compare the clinical efficacy of different acupuncture treatments for PFP through mesh meta-analysis.

METHODS

Randomized controlled trials of acupuncture therapy in the treatment of PFP are going to be retrieved from 8 Science databases including CNKI, Wanfang, VIP and Chinese Biomedical Science, PubMed, Embase, Web of Science and the Cochrane Library from establishment to January 2022. We will use the Cochrane Risk Bias Assessment Tool to assess the quality of the studies and the grading of recommendation assessment, development and evaluation method to assess the strength of the evidence. All data analyses will be performed by Revman5.3, Gemtc 0.14.3, and Stata 14.0.

RESULTS

This study will evaluate the efficacy of different acupuncture treatments for PFP by evaluating clinical efficacy rate, facial nerve function score, facial disability score scale, facial electromyography, adverse reactions, etc, and further explore the mechanism of action of each therapy.

CONCLUSION

This study will provide a reliable evidence-based basis for selecting the best acupuncture treatment for PFP.

TRIAL REGISTRATION

Open science framework registration number: DOI 10.17605/OSF.IO/XQRK9.

Effect of Comprehensive Rehabilitation Training Program in Orthopedic Nursing of Patients with Residual Limb Injury Caused by Crush

This study was developed to explore the role and application value of a comprehensive rehabilitation training (CRT) program based on the remote monitoring system of limb rehabilitation training (LRT-RM system) in the rehabilitation nursing of patients with residual limb injuries caused by crush. The LRT-RM system was constructed based on the characteristics of limb movement and using the time-domain analysis method and support vector machine (SVM). The 84 crush injury patients were selected as the research objects and divided into a control group (Con group, received conventional rehabilitation therapy) and a CRT group (received conventional rehabilitation therapy + functional training) according to different therapies, with 42 people in each group. The incidence of compound injuries and the incidence of residual limb injuries were counted and compared for patients in two groups. The differences in renal function, blood electrolytes, and biochemical indicators before and after treatment were analyzed. The MOS 36-item short-form health survey (SF-36) scale was selected to evaluate the improvement of physical and mental health of the patients before treatment and 1 month (time point (TP1)), 3 months (TP2), 6 months (TP3), and 12 months (TP4) after the treatment. It was found that, after the intervention, the values of serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA), K+, P3+, and white blood cells (WBC) of patients in CRT group were obviously lower than those of Con group (P < 0.05), and the values of carbon dioxide combining power (CO2CP), Ca2+, hemoglobin (Hb), red blood cell (RBC), total protein (TP), and albumin (ALB) were obviously higher than the values in Con group (P < 0.05). In the CRT group, the residual limb injury rate was lower in elbow, wrist, shoulder joint, ankle joint, and toe (P < 0.05) and extremely lower in knee joint in contrast to that in the Con group (P < 0.001). The score of SF-36 was dramatically higher than that in the Con group (P < 0.05). It suggested that the CRT program based on the LRT-RM system was helpful for the rehabilitation of patients with crush injuries, and it can reduce the incidence of residual limb injuries in patients. Results of this study could provide a reference basis for the treatment of residual limb injuries caused by crush.

Rehabilitation Training Combined with Jiaji Electroacupuncture Can Promote the Recovery of Muscle Group Function and Improve the Quality of Life in Patients with Upper Limb Peripheral Nerve Injury

This study was designed to probe into the improvement of rehabilitation training combined with Jiaji electroacupuncture intervention on patients with upper limb peripheral nerve injury. A total of 114 patients with peripheral nerve injury of upper limbs in our hospital from August 2017 to November 2019 were collected as the research participants. Among them, 59 in the control group (CG) received rehabilitation training alone, while 65 in the observation group (OG) received rehabilitation training combined with Jiaji electroacupuncture intervention. The therapeutic efficacy, Barthel index, and Fugl-Meyer assessment score, motor nerve conduction velocity, sensory nerve conduction velocity and amplitude, and quality of life (score SF-36) were compared between the two groups before and after treatment. The total effective rate of the OG was markedly higher than that of the CG. After treatment, the Barthel index, Fugl-Meyer assessment score, motor nerve conduction velocity, and sensory nerve conduction velocity and amplitude of the OG were obviously higher than those of the CG, and the SF-36 scores of the OG were higher than those of the CG in 8 dimensions. Rehabilitation training combined with Jiaji electroacupuncture intervention can dramatically promote the recovery of muscle group function and improve the quality of life of patients with upper limb peripheral nerve injury.

Tetrahedral framework nucleic acids facilitate neurorestoration of facial nerves by activating the NGF/PI3K/AKT pathway

The facial nerve is a crucial nerve in the maxillofacial region and is vulnerable to damage. As a consequence of the complications during nerve restoration, existing remedies have certain limitations, thus the treatment of facial nerve injury is always a perplexing task for people. Regulation of Schwann cells is always the breakpoint of neurorestoration since Schwann cells count a great deal in injured nerve repair. In this study, we presented proof that tetrahedral framework nucleic acids (tFNAs), a kind of nucleic acid nanomaterial, were capable of regulating the neurorestorative pathway NGF/PI3 K/AKT, resulting in the activation of a series of cell behaviors related to injured nerve restoration such as proliferation and migration. In vivo experiments also proved that tFNAs enhanced the expressions of axon and myelin marker proteins, impelled histological recovery, promoted the efficient restoration of nerve conduction and muscle movement. Additionally, tFNAs possessed excellent biocompatibility and superior endocytosis ability. Thus, there is good potential for tFNAs to be applied in the therapy of facial nerve injury or even peripheral nerve injury.

Acupuncture Therapies for Addressing Post Odontectomy Neuropathy

Background: Third-molar extraction is a common oral surgical procedure that can cause complications. Although rare, nerve injuries that result in permanent neuropathy can occur and include a variety of complaints such as sensory disorders, taste-sensation disorders, speech articulation disorders, etc. Acupuncture is one of several nonpharmacologic therapies that has played a role in managing neuropathic lesions and has been proven to produce good results. Case: A 44-year-old woman with postodontectomy neuropathy developed paresthesia, dysarthria, xerostomia, dysgeusia, pain in the gums and lower right jaw, a chewing disorder, and cephalgia. Her numerical rating scale (NRS) results were: lower right gum pain, 3/10; numbness of the tongue, 4/10; and headache, 1/10. A physical examination revealed dysarthria, a decreased sense of sharpness and dullness in the right mandibular nerve branches, decreased right masseter muscle contractions, and tenderness on the right GB 20 point. Electromyography revealed partial functional lesions in the postganglion at the right fifth cranial nerve. She had body acupuncture therapy at GV 20, GB 20, ST 5, ST 6, ST 7, CV 23, LI 4, HT 5, ST 36, LU 7, and KI 6; ear acupuncture at the Parotid and Shenmen points; and treatment with the Tan Balance Method. Results: After 3 consecutive sessions of acupuncture therapy, this patient's symptoms were reduced. Conclusions: Acupuncture was helpful for reducing paresthesia, dysarthria, xerostomia, dysgeusia, gum and lower right jaw pain, a chewing disorder, and cephalgia in this patient with postodontectomy neuropathy. Clinical trials are needed to support the findings in this case.

Efficacy evaluation and mechanism study of electroacupuncture intervention in acute phase of IFP: study protocol for a randomized controlled trial

Background

Previous studies had already reported the efficacy of electroacupuncture treatment for idiopathic facial nerve palsy (IFP) in a recovery phase; however, the initial use of electroacupuncture in the acute phase remains controversial. Hence, in the present study, we will add electroacupuncture intervention based on oral prednisone tablets in the acute phase of IFP and compare the clinical effects with simple oral prednisone tablets. Besides, the prognosis and safety will be evaluated. The present study aims to evaluate the clinical efficacy, prognosis, and safety of electroacupuncture combined with oral prednisone tablets in the acute phase of IFP, using surface electromyography (sEMG) to objectively observe the recovery of facial expression muscle function. In addition, the morphological changes of the facial nerve were observed dynamically by magnetic resonance imaging (MRI) in the acute phase to reveal the effect mechanism of this therapy.

Methods

Randomized controlled trials will be conducted in the first teaching hospital of Tianjin University of Traditional Chinese Medicine in China from September 2020 to April 2021. The treatment will be carried out in two phases, including the acute phase and the recovery phase. Eighty IFP patients will be recruited and randomized into two groups with a 1:1 ratio. Subjects in the acute phases of the control group will be given oral prednisone tablets, based on the control group, and subjects of the experimental group will be given electroacupuncture therapy simultaneously in the acute phase. Both groups will be stopped taking prednisone tablets and turn to electroacupuncture therapy in a recovery phase. Patients in the experimental group will receive treatment at least 6 times in the acute phase and both groups will receive treatment 9 times in the recovery phase, and there will be a follow-up period of 15 days after the treatment. The primary outcome is supposed to be related to the changes observed in the Sunnybrook (Toronto) Facial Grading System (SFGS) on the baseline and day 30 after the onset. Secondary outcome measures will include House-Brackmann Facial Nerve Grading System (H-B), measurement of Numerical Rating Scale (NRS), Facial Disability Index scale (FDI, including physical function subscore, FDIP, and social functioning and well-being subscore, FDIS), surface electromyogram (sEMG), and magnetic resonance imaging (MRI). Adverse events will be recorded for safety assessment.

Discussion

The results of this trial will allow the present study to compare the difference in efficacy and prognosis between the strategy of combined electroacupuncture in the acute phase and only oral prednisone tablets. The findings from this trial will be published in peer-reviewed journals.

Trial registration

CHICTR ChiCTR2000038472. Registered on 23 September 2020

Electroacupuncture and Transcutaneous Electrical Nerve Stimulation Induced Sensations in Bell's Palsy Patients: A Quantitative Current Intensity Analysis

Background

The intensity of electrical acupoint stimulation such as electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS) is regulated by the observation of skin shivering or the participant’s comfort response. However, the specific intensity and spatial scope following EA or TENS stimulation are unclear.

Objective

This study aimed to test the stimulatory current intensities of lower and upper sensation thresholds in TENS- and EA-based treatment of Bell’s palsy patients. Also, the spatial scope of the stimulation at these current intensities was simulated and measured quantitatively.

Methods

A total of 19 Bell’s palsy patients were recruited. Six acupoints on the affected side of the face were stimulated by TENS and EA successively at 30-min intervals. During the stimulation, the current intensity was regulated gradually from 0 to 20 mA, and we simultaneously measured the lower (sensory) and upper (tolerability) sensations. After the treatment by TENS and EA, the modified Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scales (C-MMASS) was applied to survey the de-qi sensations during stimulation. Additionally, we analyzed the correlation between current intensities and C-MMASS and comfort scores. Finite element models were established to depict the spatial distribution of electric field gradients at the lower and upper thresholds.

Results

The mean sensory and tolerability thresholds of TENS were 3.91–4.37 mA and 12.33–16.35 mA, respectively. The median sensory and tolerability thresholds of EA were 0.2 mA and 2.0–3.2 mA, respectively. We found a significant correlation between total C-MMASS scores and the current intensities at the tolerability threshold of TENS. The finite element model showed that the activated depths of TENS and EA at the lower threshold were 3.8 and 7 mm, respectively, whereas those at the upper threshold were both 13.8 mm. The cross-sectional diameter of the activated area during TENS was 2.5–4 times larger than that during EA.

Conclusion

This pilot study provided a method for exploring the current intensity at which the de-qi sensations can be elicited by TENS or EA. The finite element analysis potentially revealed the spatial scope of the electrical stimulation at a specific current intensity.

Acupuncture Medical Therapy and its Underlying Mechanisms: A Systematic Review

As a traditional Chinese alternative health care approach, acupuncture is gaining increasing attention and reputation in China and overseas. While becoming increasingly popular globally, some consumers and professionals still know little about the therapy and underlying mechanisms of acupuncture. Due to local superiority, there are large numbers of both clinical applications and mechanistic studies performed in China compared to countries overseas. Herein, this review attempts to give a comprehensive profile of the development, application, and mechanisms of acupuncture in treating major diseases. The number of clinical publications concerning acupuncture-treated neurological diseases, endocrine and metabolic diseases, circulatory diseases, respiratory diseases, etc. is first counted, and then, the application and therapeutic mechanisms of acupuncture on the predominant diseases in each category, including obesity, facial paralysis, sciatica, depression, hypertension, asthma, etc., are specifically discussed in this paper. The evolution of acupuncture tools and the rationality of acupoints are also discussed. This review not only summarizes the mechanisms of acupuncture but also provides useful information, such as specific acupoints and acupuncture procedures, for treating common diseases. Therefore, the current study provides useful information for both investigators and acupuncturists.

Variability in the development of synkinesis in a rabbit facial nerve axotomy model

OBJECTIVE

Weakness and synkinesis (involuntary cocontraction of different muscle groups) are common sequelae after facial nerve injury. We describe a rabbit model of facial nerve axotomy and repair, which can be used to study such sequelae and propose a grading tool to assess the facial movement outcomes. Using this rabbit model, we assess the effect of delaying facial nerve repair on the quality of the clinical result.

METHODS

A total of 15 rabbits (30 facial halves) were divided into 4 groups: control, facial nerve main trunk axotomy and immediate repair, axotomy and repair at 2.5 weeks as well as axotomy, and repair at 2 months. Functional recovery was graded according to the observable criteria. We performed retrograde fluorescence labelling of the distal facial nerve branches and assessed the distribution of tracers in the facial nucleus.

RESULTS

A consistent model of weakness and synkinesis was produced in all rabbits after immediate axotomy and repair. A grading tool was used to clinically grade the quality of the recovery. The somatotopy of the facial nucleus was disrupted, with axons projecting from the facial nucleus to incorrect facial muscle groups. Varying the denervation time before repair affected the quality of the recovery. The worst result was noted when repair was delayed for 2 months. Subtle changes in the pattern and severity of synkinesis was noted among the different treatment groups.

CONCLUSION

A slight delay in nerve repair by 2.5 weeks as well as contralateral facial paralysis (analogous to botulinum toxin (BTX) injection) appear to improve eye recovery and reduce synkinesis. Because of the large size of the rabbit, such variability in synkinesis severity can be graded.

Conductive Hydroxyethyl Cellulose/Soy Protein Isolate/Polyaniline Conduits for Enhancing Peripheral Nerve Regeneration via Electrical Stimulation

Nerve regeneration remains a challenge to the treatment of peripheral nerve injury. Electrical stimulation (ES) is an assistant treatment to enhance recovery from peripheral nerve injury. A conductive nerve guide conduit was prepared from hydroxyethyl cellulose (HEC)/soy protein isolate (SPI)/PANI sponge (HSPS) and then the HSPS conduits were used to repair 10 mm sciatic nerve injury in rat model with or without ES, using HSPS+brain-derived neurotrophic factor (BDNF) and autografts as controls. The nerve repairing capacities were evaluated by animal experiments of behavioristics, electrophysiology, toluidine blue staining, and transmission electron microscopy (TEM) in the regenerated nerves. The results revealed that the nerve regeneration efficiency of HSPS conduits with ES (HSPS+ES) group was the best among the conduit groups but slightly lower than that of autografts group. HSPS+ES group even exhibited notably increased in the BDNF expression of regenerated nerve tissues, which was also confirmed through in vitro experiments that exogenous BDNF could promote Schwann cells proliferation and MBP protein expression. As a result, this work provided a strategy to repair nerve defect using conductive HSPS as nerve guide conduit and using ES as an extrinsic physical cue to promote the expression of endogenous BDNF.

Aligned Biofunctional Electrospun PLGA-LysoGM1 Scaffold for Traumatic Brain Injury Repair

Due to poor regenerative capabilities of the brain, a treatment for traumatic brain injury (TBI) presents a serious challenge to modern medicine. Biofunctional scaffolds that can support neuronal growth, guide neurite elongation, and re-establish impaired brain tissues are urgently needed. To this end, we developed an aligned biofunctional scaffold (aPLGA-LysoGM1), in which poly (lactic-co-glycolic acid) (PLGA) was functionalized with sphingolipid ceramide N-deacylase (SCDase)-hydrolyzed monosialotetrahexosylganglioside (LysoGM1) and electrospinning was used to form an aligned fibrous network. As a ganglioside of neuronal membranes, the functionalized LysoGM1 endows the scaffold with unique biological properties favoring the growth of neuron and regeneration of injured brain tissues. Moreover, we found that the aligned PLGA-LysoGM1 fibers acted as a topographical cue to guide neurite extension, which is critical for organizing the formation of synaptic networks (neural networks). Systematic in vitro studies demonstrated that the aligned biofunctional scaffold promotes neuronal viability, neurite outgrowth, and synapse formation and also protects neurons from pressure-related injury. Additionally, in a rat TBI model, we demonstrated that the implantation of aPLGA-LysoGM1 scaffold supported recovery from brain injury, as more endogenous neurons were found to migrate and infiltrate into the defect zone compared with alternative scaffold. These results suggest that the aligned biofunctional aPLGA-LysoGM1 scaffold represents a promising therapeutic strategy for brain tissue regeneration following TBI.

Differential expression of glial cell line-derived neurotrophic factor splice variants in the mouse brain

Glial cell line-derived neurotrophic factor (GDNF) plays a critical role in neuronal survival and function. GDNF has two major splice variants in the brain, α-pro-GDNF and β-pro-GDNF, and both isoforms have strong neuroprotective effects on dopamine neurons. However, the expression of the GDNF splice variants in dopaminergic neurons in the brain remains unclear. Therefore, in this study, we investigated the mRNA and protein expression of α- and β-pro-GDNF in the mouse brain by real-time quantitative polymerase chain reaction, using splice variant-specific primers, and western blot analysis. At the mRNA level, β-pro-GDNF expression was significantly greater than that of α-pro-GDNF in the mouse brain. In contrast, at the protein level, α-pro-GDNF expression was markedly greater than that of β-pro-GDNF. To clarify the mechanism underlying this inverse relationship in mRNA and protein expression levels of the GDNF splice variants, we analyzed the expression of sorting protein-related receptor with A-type repeats (SorLA) by real-time quantitative polymerase chain reaction. At the mRNA level, SorLA was positively associated with β-pro-GDNF expression, but not with α-pro-GDNF expression. This suggests that the differential expression of α- and β-pro-GDNF in the mouse brain is related to SorLA expression. As a sorting protein, SorLA could contribute to the inverse relationship among the mRNA and protein levels of the GDNF isoforms. This study was approved by the Animal Ethics Committee of Xuzhou Medical University, China on July 14, 2016.