Modulatory effect of International Standard Scalp Acupuncture on brain activation in the elderly as revealed by resting-state fMRI

Noninvasive brain stimulations modulated brain modular interactions to ameliorate working memory in community-dwelling older adults

Non-invasive brain stimulations have drawn attention in remediating memory decline in older adults. However, it remains unclear regarding the cognitive and neural mechanisms underpinning the neurostimulation effects on memory rehabilitation. We evaluated the intervention effects of 2-weeks of neurostimulations (high-definition transcranial direct current stimulation, HD-tDCS, and electroacupuncture, EA versus controls, CN) on brain activities and functional connectivity during a working memory task in normally cognitive older adults (age 60+, n = 60). Results showed that HD-tDCS and EA significantly improved the cognitive performance, potentiated the brain activities of overlapping neural substrates (i.e. hippocampus, dlPFC, and lingual gyrus) associated with explicit and implicit memory, and modulated the nodal topological properties and brain modular interactions manifesting as increased intramodular connection of the limbic-system dominated network, decreased intramodular connection of default-mode-like network, as well as stronger intermodular connection between frontal-dominated network and limbic-system-dominated network. Predictive model further identified the neuro-behavioral association between modular connections and working memory. This preliminary study provides evidence that noninvasive neurostimulations can improve older adults' working memory through potentiating the brain activity of working memory-related areas and mediating the modular interactions of related brain networks. These findings have important implication for remediating older adults' working memory and cognitive declines.

Effects of acupuncture synchronized rehabilitation therapy on upper limb motor and sensory function after stroke: a study protocol for a single-center, 2 × 2 factorial design, randomized controlled trial

Background

Upper limb function reconstruction has been an important issue in the field of stroke rehabilitation. Due to the complexity of upper extremity dysfunction in stroke patients, the clinical efficacy produced by central or peripheral stimulation alone is limited. For this reason, our group has proposed acupuncture synchronized rehabilitation therapy (ASRT), i.e., simultaneous scalp acupuncture and intradermal acupuncture during rehabilitation. Pre-experiments results showed that this therapy can effectively improve the motor and sensory functions of upper limbs in post-stroke patients, but the clinical efficacy and safety of ASRT need to be further verified, and whether there is a synergistic effect between scalp acupuncture and intradermal acupuncture also needs to be studied in depth. Therefore, we designed a randomized controlled trial to compare the efficacy and safety of different therapies to explore a more scientific "synchronous treatment model."

Methods

This is a single-center, randomized controlled trial using a 2 × 2 factorial design. We will recruit 136 stroke survivors with upper extremity dysfunction and randomize them into four groups (n = 34). All subjects will undergo routine treatment, based on which the Experimental Group 1: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb; Experimental Group 2: rehabilitation training of the affected upper limb synchronized with focal-side scalp acupuncture treatment, and Experimental Group 3: rehabilitation training synchronized with intradermal acupuncture treatment of the affected upper limb synchronized with focal-side scalp acupuncture treatment; Control Group: rehabilitation training of the affected upper limb only. The intervention will last for 4 weeks, 5 times a week. Both acupuncture treatments will be performed according to the Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). The primary outcome indicators for this trial are Fugl-Meyer Assessment-Upper Extremity and Somatosensory Evoked Potential. Secondary outcome indicators include Wolf Motor Function Test, Upper Extremity Function Test, revised Nottingham Sensory Assessment Scale, Diffusion Tensor Imaging, and Modified Barthel Index. The incidence of adverse events will be used as the indicator of safety.

Discussion

The study will provide high-quality clinical evidence on whether ASRT improves upper limb motor and sensory function and activities of daily living (ADL) in stroke patients, and determine whether scalp acupuncture and intradermal acupuncture have synergistic effects.

Clinical trial registration

https://www.chictr.org.cn/, Chinese Clinical Trial Registry [ChiCTR2200066646].

Effects of acupuncture on earthquake survivors with major psychiatric disorders and related symptoms: A scoping review of clinical studies

BACKGROUND

This scoping review aimed to determine the current research status of acupuncture for major psychiatric disorder (MPD) in earthquake survivors.

METHOD

We followed the scoping review process described previously. A literature search on 14 electronic databases was conducted from inception to November 29, 2022. Data from the included studies were collected and descriptively analyzed to address our research question. Extracted data were collated, synthesized, and summarized the according to the analytical framework of a scoping review.

RESULT

This scoping review included nine clinical studies: four randomized controlled trials (RCTs) and five before-after studies. The most frequent MPD type among the included acupuncture studies was posttraumatic stress disorder (PTSD; 6/9, 66.67%). The most frequent acupuncture type was scalp electro-acupuncture (4/9, 44.44%), followed by manual acupuncture and ear acupressure/ear acupuncture (3/9, 33.33%). Studies using scalp electro-acupuncture all used common acupoints, including GB20, GV20, GV24, and EX-HN1. In general, the treatment period lasted between 4 and 12 weeks. Validated assessment tools for PTSD severity and accompanying symptoms were used for patients with PTSD, while the corresponding evaluation tools were used for patients with other diagnoses or clinical symptoms. Acupuncture-related adverse events were generally mild and temporary, such as mild bleeding and hematoma, and syncope was a rare but potentially serious adverse event (1/48 patients and 1/864 sessions over a treatment period of 4 weeks).

CONCLUSION

Acupuncture studies for MPD after an earthquake mainly focused on PTSD. RCTs accounted for around half of the included studies. Scalp electro-acupuncture was the most common acupuncture type, and EX-HN1 and GV24 were the most important acupoints in the acupuncture procedures for MPD. The included studies mostly used validated symptom assessment tools, though some did not. Clinical studies in this field need to be further expanded regardless of the study type.

PROTOCOL REGISTRATION

https://osf.io/wfru7/.

Acupuncture mechanism studies employing task-based fMRI: a scoping review protocol

BACKGROUND

Acupuncture is a widely used alternative and complementary therapy. Functional magnetic resonance imaging (fMRI) is an important technique to explore the underlying mechanism of acupuncture, and the task-based fMRI can reflect the instant effects or sustained effects of acupuncture in the brain. This scoping review aims to summarize the characteristics of acupuncture mechanism studies employing task-based fMRI and conclude a reference for future studies.

METHODS/DESIGN

This review will follow the Guidance for Conducting Scoping Reviews. Eligible articles will be collected from 7 databases (PubMed, Embase, Cochrane, CNKI, WanFang, VIP, and CBM) with the related keywords such as "Acupuncture" and "fMRI"; those articles should be published from January 1, 2000, to December 31, 2021; and the language should be restricted in English or Chinese. Each research step will involve at least two reviewers. The PRISMA-ScR (Preferred Reporting Items for Systemic Reviews and Meta-Analysis Extension for Scoping Reviews) will be used to organize the review. Data will be extracted from the illegible articles, and findings will be presented in tables and narrative form. A descriptive qualitative approach to analysis will be conducted to form the scoping review.

DISCUSSION

This review aims to clarify the extent of acupuncture mechanism studies employing task-based fMRI. It is supposed to make a critical evaluation or propose quality requirements for future studies by summarizing the objectives and designs of eligible studies. What is more, directional suggestions will be provided for further studies.

SCOPING REVIEW REGISTRATION

Open Science Framework https://osf.io/zjrdc/ .

Motor function and fALFF modulation in convalescent-period ischemic stroke patients after scalp acupuncture therapy: a multi-centre randomized controlled trial

BACKGROUND

Scalp acupuncture has been found to be effective at improving motor function after ischemic stroke, but few studies examining its central mechanisms of action have been carried out. The aim of this study was to investigate the clinical effects of scalp acupuncture on motor dysfunction and changes in spontaneous brain activity in patients with ischemic stroke.

METHODS

This was an evaluator- and analyst-blinded, multi-center randomized controlled trial. A total of 108 convalescent-stage ischemic stroke patients with motor dysfunction were allocated to receive either scalp acupuncture combined with rehabilitation treatment (SR group) or rehabilitation treatment alone (RE group). Patients in both groups received treatment 5 times per week for 8 weeks. The primary outcome measure was the Fugl-Meyer assessment (FMA). Secondary outcome measures included the modified Barthel index (mBI), modified Rankin scale (mRS) and values of fractional amplitude of low frequency fluctuation (fALFF) acquired using a resting-state functional magnetic resonance imaging (rs-fMRI) technique.

RESULTS

Both groups showed significant improvements in motor function, daily life ability and degree of disability, as measured by FMA, mRS and mBI (p < 0.05), and the SR group showed a significantly greater improvement (p < 0.05). Compared with the RE group, the areas where the fALFF values increased in the SR group were located in the cerebellum, praecuneus, precentral gyrus, superior frontal gyrus and parietal lobe. The improvement in FMA scores had the strongest correlation with the baseline fALFF values of the ipsilateral precentral gyrus.

CONCLUSION

Scalp acupuncture improved motor function in convalescent-period ischemic stroke patients, and effects were correlated with regulation of motor-relevant brain regions. The fALFF value of the ipsilateral precentral and postcentral gyri could be potential clinical indices for prognostication of motor dysfunction.

TRIAL REGISTRATION NUMBER

NCT03120650 (http://www.clinicaltrials.gov).

Revealing the Neuroimaging Mechanism of Acupuncture for Poststroke Aphasia: A Systematic Review

Background

Aphasia is a common symptom in stroke patients, presenting with the impairment of spontaneous speech, repetition, naming, auditory comprehension, reading, and writing function. Multiple rehabilitation methods have been suggested for the recovery of poststroke aphasia, including medication treatment, behavioral therapy, and stimulation approach. Acupuncture has been proven to have a beneficial effect on improving speech functions in repetition, oral speech, reading, comprehension, and writing ability. Neuroimaging technology provides a visualized way to explore cerebral neural activity, which helps reveal the therapeutic effect of acupuncture therapy. In this systematic review, we aim to reveal and summarize the neuroimaging mechanism of acupuncture therapy on poststroke aphasia to provide the foundation for further study.

Methods

Seven electronic databases were searched including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, the Wanfang databases, and the Chinese Scientific Journal Database. After screening the studies according to the inclusion and exclusion criteria, we summarized the neuroimaging mechanism of acupuncture on poststroke aphasia, as well as the utilization of acupuncture therapy and the methodological characteristics.

Result

After searching, 885 articles were retrieved. After removing the literature studies, animal studies, and case reports, 16 studies were included in the final analysis. For the acupuncture type, 10 studies used manual acupuncture and 5 studies used electroacupuncture, while body acupuncture (10 studies), scalp acupuncture (7 studies), and tongue acupuncture (8 studies) were applied for poststroke aphasia patients. Based on blood oxygen level-dependent (BOLD) and diffusion tensor imaging (DTI) technologies, 4 neuroimaging analysis methods were used including amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), seed-based analysis, and independent component analysis (ICA). Two studies reported the instant acupuncture effect, and 14 studies reported the constant acupuncture's effect on poststroke aphasia patients. 5 studies analyzed the correlation between the neuroimaging outcomes and the clinical language scales.

Conclusion

In this systematic review, we found that the mechanism of acupuncture's effect might be associated with the activation and functional connectivity of language-related brain areas, such as brain areas around Broca's area and Wernicke's area in the left inferior temporal gyrus, supramarginal gyrus, middle frontal gyrus, and inferior frontal gyrus. However, these studies were still in the preliminary stage. Multicenter randomized controlled trials (RCT) with large sample sizes were needed to verify current evidence, as well as to explore deeply the neuroimaging mechanisms of acupuncture's effects.

Resting-State fMRI in Studies of Acupuncture

Research exploring the mechanism of acupuncture has been a hot topic in medicine. Resting-state functional magnetic resonance imaging (rs-fMRI) research is a noninvasive and extensive method, which is aimed at the research of the mechanism of acupuncture. Researchers use fMRI technologies to inspect the acupuncture process. The authors reviewed the application of rs-fMRI in acupuncture research in recent 10 years from the aspects of studying acupoints, subjects, acupuncture methods, and intensities. The results found that the application of rs-fMRI in acupuncture research mainly includes research on the onset mechanism of acupuncture treatment; visual evidence of diagnosis and treatment of dominant diseases; efficacy assessments; physiological mechanism of acupoint stimulation; and specific visualization of acupoints.

Scalp acupuncture for patients with vascular dementia: A protocol for systematic review and meta-analysis of randomized controlled trails

BACKGROUND

Vascular dementia (VD) is a kind of acquired intelligence impairment syndrome caused by a series of cerebrovascular factors leading to brain tissue damage. Scalp acupuncture is widely used to treating VD. However, there is no a systematic review has been used to assess the efficacy and safety of scalp acupuncture therapy for VD. Therefore, the purpose of this paper is to systematically evaluate the effects of scalp acupuncture on VD.

METHODS

We will search the following databases from their inception to July 2020: PubMed, Chinese National Knowledge Infrastructure (CNKI), Wan Fang Database, Embase, Medline, Chinese Biomedical Literature Database (CBM), EBSCO, Web of Science, Technology Periodical Database (VIP), the Chongqing VIP Chinese Science and Cochrane Library. At the same time, we will retrieve other resources including conference articles, and gray literature. The randomized controlled trials (RCTs) in English or Chinese associated with scalp acupuncture for VD will be included. Our study data collection and analysis will be conducted independently by 2 reviewers, and Rev Man V.5.3.5 statistical software will be used to performing meta-analysis.

RESULTS

This review research will provide a high-quality synthesis to evaluate the efficacy and safety of scalp acupuncture for patients with VD.

CONCLUSION

This study will provide available evidence to judge whether scalp acupuncture is an effective and safe intervention for patients with VD. It also will provide reliable evidence for its widespread application.

ETHICS AND DISSEMINATION

This systematic review will provide convincing evidence for both patients and clinicians. It does not require ethical approval and the results will be published in a peer-reviewed journal.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/7CYZR.

Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia: A study protocol for a randomized controlled trial

BACKGROUND

Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone.

METHOD

The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP).

DISCUSS

A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.

Abnormal brain activity in adolescents with Internet addiction who attempt suicide: an assessment using functional magnetic resonance imaging

Internet addiction is associated with an increased risk of suicidal behavior and can lead to brain dysfunction among adolescents. However, whether brain dysfunction occurs in adolescents with Internet addiction who attempt suicide remains unknown. This observational cross-sectional study enrolled 41 young Internet addicts, aged from 15 to 20 years, from the Department of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, China from January to May 2018. The participants included 21 individuals who attempted suicide and 20 individuals with Internet addiction without a suicidal attempt history. Brain images in the resting state were obtained by a 3.0 T magnetic resonance imaging scanner. The results showed that activity in the gyrus frontalis inferior of the right pars triangularis and the right pars opercularis was significantly increased in the suicidal attempt group compared with the non-suicidal attempt group. In the resting state, the prefrontal lobe of adolescents who had attempted suicide because of Internet addiction exhibited functional abnormalities, which may provide a new basis for studying suicide pathogenesis in Internet addicts. The study was authorized by the Ethics Committee of Chongqing Medical University, China (approval No. 2017 Scientific Research Ethics (2017-157)) on December 11, 2017.

Altered Brain Regional Homogeneity Following Contralateral Acupuncture at Quchi (LI 11) and Zusanli (ST 36) in Ischemic Stroke Patients with Left Hemiplegia: An fMRI Study

OBJECTIVE

To study the effect of contralateral acupuncture (CAT) at acupoints of Quchi (LI 11) and Zusanli (ST 36) on the unaffected limbs of ischemic stroke patients with left hemiplegia based on regional homogeneity (ReHo) indices.

METHODS

Ten ischemic stroke patients with left hemiplegia received CAT on right side at LI 11 and ST 36. Functional magnetic resonance imaging (fMRI) was performed before and after acupuncture. A ReHo analytical method was used to compare brain responses of patients before and after CAT operated by REST software.

RESULTS

The stimulation at both LI 11 and ST 36 on the unaffected limbs produced significantly different neural activities. CAT elicited increased ReHo values at the right precentral gyrus and superior frontal gyrus, decreased ReHo value at right superior parietal lobule, left fusiform gyrus and left supplementary motor area.

CONCLUSIONS

Acupuncture at one side could stimulate bilateral regions. CAT could evoke the gyrus which was possibly related to motor recovery from stroke. A promising indicator of neurobiological deficiencies could be represented by ReHo values in post-stroke patients.