Effect of electroacupuncture stimulation of "Sibai"(ST2) and "Quanliao"(SI18) on excitatory neurons of sensorimotor cortex in mice

OBJECTIVES

To observe the activation state and neuronal types of somatosensory cortex and the primary motor cortex induced by electroacupuncture (EA) stimulation of "Sibai" (ST2) and "Quanliao" (SI18) acupoints in mice.

METHODS

Male C57BL/6J mice were randomly divided into blank control and EA groups, with 6 mice in each group. Rats of the EA group received EA stimulation (2 Hz, 0.6 mA) at ST2 and SI18 for 30 minutes. Samples were collected after EA intervention, and immunofluorescence staining was performed to quantify the expression of the c-Fos gene (proportion of c-Fos positive cells) in the somatosensory cortex and primary motor cortex. The co-labelled cells of calcium/calmodulin-dependent protein kinase Ⅱ (CaMKⅡ) and gamma-aminobutyric acid (GABA) in the somatosensory cortex and primary motor cortex were observed and counted by using microscope after immunofluorescence staining. Another 10 mice were used to detect the calcium activity of excitatory neurons in the somatosensory cortex and primary motor cortex by fiber photometry.

RESULTS

In comparison with the blank control group, the number of c-Fos positive cells, and the proportion of c-Fos and CaMKⅡ co-labelled cells in both the somatosensory cortex and primary motor cortex were significantly increased after EA stimulation (P<0.05). No significant changes were found in the proportion of c-Fos and GABA co-labeled cells in both the somatosensory cortex and primary motor cortex after EA. Results of fiber optic calcium imaging technology showed that the spontaneous calcium activity of excitatory neurons in both somatosensory cortex and primary motor cortex were obviously increased during EA compared with that before EA (P<0.01), and strikingly reduced after cessation of EA compared with that during EA (P<0.05).

CONCLUSIONS

Under physiological conditions, EA of ST2 and SI18 can effectively activate excitatory neurons in the somatosensory cortex and primary motor cortex.

Advances in the study of endocannabinoid receptors in experimental acupuncture analgesia

The endocannabinoid system, an important biological network for maintaining and balancing various functions of the human body, is involved in many physiological functions such as pain, emotion, learning and memory, etc. Among which the endocannabinoid receptors ［including type I (CB1) and type II (CB2) receptors］ play an important role in the regulation of pain and have become an important target in the mechanism research of acupuncture analgesia. CB1 is mainly distributed in the central nervous system, including the spinal cord, cerebral cortex, amygdala, insular cortex, and basal ganglia, etc. CB2 is mainly distributed in peripheral immune tissues, such as spleen, bone, skin, etc. In the central and peripheral nervous systems, acupuncture can activate CB1 and CB2 receptors respectively, which is involved in the transmission of central nociceptive signals and related transmitters as well as the peri-pheral pro-nociceptive inflammatory response, thereby alleviating the nociceptive hypersensitivity in animal models. In this paper, we systematically summarize the roles of the above mechanisms in different types of animal models (inflammatory pain, neuropathological pain, visceral pain, etc.), so as to provide new ideas for the study of the underlying mechanisms of acupuncture analgesia.

Effects of electroacupuncture preconditioning on microglial cells and serum inflammatory factors in the early stage of ischemic stroke

OBJECTIVES

To investigate the effects on the motor function, cortex blood flow perfusion, microglial cells, and the contents of serum inflammatory factors, i.e. interleukin-1β (IL-1β), transforming growth factor-β (TGF-β), and interleukin-10 (IL-10) after electroacupuncture (EA) preconditioning at "Baihui" (GV20) and "Dazhui" (GV14) in the mice with ischemic stroke, so as to explore the mechanism of EA preconditioning for improving motor function after ischemic stroke.

METHODS

C57BL/6 mice were randomly divided into sham-operation group, model group, and EA preconditioning group (EA group), with 15 mice in each group. A photothrombotic method was used to induce the model of unilateral ischemic stroke and motor impairment. The mice in the EA group received EA preconditioning, 20 min each time, once daily for 7 consecutive days before modeling. The motor function of mice was evaluated by the grid-walking test and cylinder test before and after modeling. Laser speckle blood flow video monitoring system was employed to assess the cerebral blood flow perfusion in the primary motor cortex of mice. The contents of IL-1β, TGF-β, and IL-10 in the serum were measured by ELISA, and the expressions of microglial cell and M2 subtype cell marker in the primary motor cortex were detected using immunofluorescence staining.

RESULTS

After modeling, compared with the sham-operation group, the grid error rate and the dragging rate of the affected limb were increased (P<0.01)；the utilization rate of the affected limb and percentage of the blood perfusion in the affected cortex to healthy side were decreased (P<0.01)；the contents of serum IL-1β, TGF-β, and IL-10 were increased (P<0.01, P<0.05)；and the microglia in the primary motor cortex on the affected side showed ameboid, the fluorescence intensity of ionized calcium-binding adapter molecule 1 (IBA1) and CD206 was increased (P<0.01) in the model group. In the EA group, when compared with the model group, the grid error rate and the dragging rate of affected limb were decreased (P<0.01)；the utilization rate of affected limb and the percentage of blood perfusion were increased (P<0.05)；the content of serum IL-1β was decreased (P<0.01), while the contents of TGF-β and IL-10 were increased (P<0.01)；and the microglia in the primary motor cortex on the affected side got more round and were distributed more densely, the fluorescence intensity of IBA1 and CD206 was increased (P<0.01).

CONCLUSIONS

Electroacupuncture preconditioning at "GV20" and "GV14" can up-regulate the expression of microglial cells, especially the M2 subtype cell marker, and increase the contents of the anti-inflammatory factors and decrease that of the pro-inflammatory factors in the serum, thereby alleviate the inflammatory reaction.

Study on after-effect of electroacupuncture with different time intervals on corticospinal excitability in primary motor cortex

OBJECTIVES

To compare the effects of electroacupuncture (EA) with different time intervals on corticospinal excitability of the primary motor cortex (M1) and the upper limb motor function in healthy subjects and observe the after-effect rule of acupuncture.

METHODS

Self-comparison before and after intervention design was adopted. Fifteen healthy subjects were included and all of them received three stages of trial observation, namely EA0 group (received one session of EA), EA6h group (received two sessions of EA within 1 day, with an interval of 6 h) and EA48h group (received two sessions of EA within 3 days, with an interval of 48 h). The washout period among stages was 1 week. In each group, the needles were inserted perpendicularly at Hegu (LI 4) on the left side, 23 mm in depth and at a non-acupoint, 0.5 cm nearby to the left side of Hegu (LI 4), separately. Han's acupoint nerve stimulator (HANS-200A) was attached to these two needles, with continuous wave and the frequency of 2 Hz. The stimulation intensity was exerted higher than the exercise threshold (local muscle twitching was visible, and pain was tolerable by healthy subjects, 1-2 mA ). The needles were retained for 30 min. Using the single pulse mode of transcranial magnetic stimulation (TMS) technique, before the first session of EA (T0) and at the moment (T1), in 2 h (T2) and 24 h (T3) after the end of the last session of EA, on the left first dorsal interosseous muscle, the amplitude, latency (LAT), resting motor threshold (rMT) of motor evoked potentials (MEPs) and the completion time of grooved pegboard test (GPT) were detected. Besides, in the EA6h group, TMS was adopted to detect the excitability of M1 (amplitude, LAT and rMT of MEPs) before the last session of EA (T0*).

RESULTS

The amplitude of MEPs at T1 and T2 in the EA0 group, at T0* in the EA6h group and at T1, T2 and T3 in the EA48h group was higher when compared with the value at T0 in each group separately (P<0.001). At T1, the amplitude of MEPs in the EA0 group and the EA48h group was higher than that in the EA6h group (P<0.001, P<0.01); at T2, it was higher in the EA0 group when compared with that in the EA6h group (P<0.01); at T3, the amplitude in the EA0 group and the EA6h group was lower than that of the EA48h group (P<0.001). The LAT at T1 was shorter than that at T0 in the three groups (P<0.05), and the changes were not obvious at the rest time points compared with that at T0 (P > 0.05). The GPT completion time of healthy subjects in the EA0 group and the EA48h group at T1, T2 and T3 was reduced in comparison with that at T0 (P<0.001). The completion time at T3 was shorter than that at T0 in the EA6h group (P<0.05); at T2, it was reduced in the EA48h group when compared with that of the EA6h group (P<0.05). There were no significant differences in rMT among the three groups and within each group (P>0.05).

CONCLUSIONS

Under physiological conditions, EA has obvious after-effect on corticospinal excitability and upper limb motor function. The short-term interval protocol (6 h) blocks the after-effect of EA to a certain extent, while the long-term interval protocol (48 h) prolongs the after-effect of EA.

[Discussion on "sugar needle - comfortable acupuncture and moxibustion"]

The cases of feeling comfort during acupuncture and moxibustion treatment in literature were summarized and its biological basis was explored. A simple classification of comfort was made, and the importance of obtaining comfort in acupuncture treatment was pointed out. Considering the pursuit of less pain and harmlessness in modern clinical treatment, sugar needle should be advocated and popularized in current clinical practice of acupuncture and moxibustion.

Combined effect of transcutaneous auricular vagus nerve stimulation and 0.1 Hz slow-paced breathing on working memory

Background

Previous research has found that transcutaneous auricular vagus nerve stimulation (taVNS) can improve working memory (WM) performance. It has also been shown that 0.1 Hz slow-paced breathing (SPB, i.e., breathing at a rate of approximately 6 breaths/min) can significantly influence physical state and cognitive function via changes in autonomic afferent activity. In the present study, we investigated the synergistic effects of taVNS and SPB on WM performance.

Methods

A total of 96 healthy people participated in this within-subjects experiment involving four conditions, namely taVNS, SPB, combined taVNS with SPB (taVNS + SPB), and sham. Each participant underwent each intervention for 30 min and WM was compared pre- and post-intervention using the spatial and digit n-back tasks in a random order four times. Permutation-based analysis of variance was used to assess the interaction between time and intervention.

Results

For the spatial 3-back task, a significant interaction between time and intervention was found for the accuracy rate of matching trials (mACC, p = 0.03). Post hoc analysis suggested that both taVNS and taVNS + SPB improved WM performance, however, no significant difference was found in the SPB or sham groups.

Conclusion

This study has replicated the effects of taVNS on WM performance reported in previous studies. However, the synergistic effects of combined taVNS and SPB warrant further research.

[Empirical analysis on lumbar disc herniation treated with "sinew-bone three needling technique" of Chinese medicine]

The paper presents professor WU Han-qing's experience in treatment of lumbar disc herniation (LDH) with "sinew-bone three needling technique" of Chinese medicine. Based on the theory of meridian sinew, the points are located by "three-pass method" in terms of the distribution of meridian sinew and syndrome/pattern differentiation. The cord-like muscles and adhesion are relieved by relaxing technique to work directly on the affected sites and alleviate the local compression to the nerve root. The needle technique is operated flexibly according to the affected regions involved, due to which, the needling sensation is increased while the safety ensured. As a result, the meridian qi is enhanced, the mind and qi circulation is regulated; and the clinical effect is improved.

[Improving acupuncture research: progress, guidance, and future directions]

This paper makes an interpretation of the collection Acupuncture: how to improve the evidence base published by BMJ & BMJ Open. Studies show that the quality of randomized controlled trial (RCT) of acupuncture is low, and multivariable Meta-regression analysis fails to confirm most factors commonly believed to influence the effect of acupuncture. The methodological challenges in design and conduct of RCT in acupuncture were analyzed, and a consensus on how to design high-quality acupuncture RCT was developed. The number of acupuncture systematic reviews was huge but the evidence was underused in clinical practice and health policy, and a large number of western clinical practice guidelines recommended acupuncture therapy, but the usefulness of recommendations needed to be improved. In view of the problems in clinical research on acupuncture mentioned in this collection, combined with the analysis of the purpose of clinical research on acupuncture, perspectives, study types, as well as the relationship between evidence and clinical decision-making, a five-stage study paradigm of clinical research on acupuncture is proposed.

[WU Han-qing's theory and clinical application of "three regions, nine needles and twelve methods"]

The paper introduces the theory and the clinical application of "three regions, nine needles and twelve methods" summarized by professor WU Han-qing. On the basis of traditional nine needles and in association with taiji longguan needling technique handed down from family generations, WU Han-qing innovated "three regions, nine needles and twelve methods". According to the treating location and anatomical structure, the needling techniques are classified in terms of three regions, i.e. the needling technique of cutaneous region, that of sinew region and that of periosteum region. Nine kinds of needle devices are developed, including two categories, i.e. miniature sinew-bone needle and grand sinew-bone needle. Based on the three-region needling techniques, 12 acupuncture methods are summarized for different areas and layers of diseases. This acupuncture technique is applicable for the treatment of chronic pain such as injury of sinews, pain in the neck, shoulder, lumbar region and leg and sequela of apoplexy.

[Effect of electroacupuncture on renal vascular microcirculation in diabetic mice based on in vivo two-photon microscopy imaging]

OBJECTIVE

To investigate the protective effect of electroacupuncture (EA) at "Zusanli"(ST36)and "Weiwanxiashu"(EX-B3) on capillary function around the renal tubule and renal tubule structure in diabetic mice based on two-photon microscopy (TPM) imaging, so as to providing visualizable evidence for the regulatory effect of EA on diabetic renal vascular microcirculation.

METHODS

Spontaneous type Ⅱ diabetes mellitus mice (db/db) were employed for this study. Twenty db/db mice were randomly divided into model group (n=10) and EA group (n=10), and 10 db/m mice used as the control group. EA was applied to bilateral ST36 and EX-B3 for 20 min/time, 6 times a week for 6 weeks. The body weight was recorded and the fasting blood glucose measured before and after the intervention. The urine production and water consumption of mice in each cage were recorded after EA. The renal in vivo imaging method based on TPM was established to display the morphological structure of renal tubules, and the mouse renal blood flow velocity was detected by injecting 500 kDa dextran-fluorescein into femoral vein after the intervention.

RESULTS

Compared with the control group, the proportion of mice with decreased body mass in the model group was increased, accounting for 40%, while that in the control group was 0%; and fasting blood glucose, urine production and water consumption were significantly increased in the model group (P<0.001, P<0.000 1). A renal in vivo imaging method based on TPM was successfully established, which can be applied to quantitatively analyze the renal blood flow and renal tubular diameter of mice. Based on this method, the results showed that compared with the control group, the blood flow velocity of peritubular capillary in the model group was significantly decreased (P<0.000 1, P<0.001), renal tubular cells were slightly exfoliated and the diameter of renal tubular was significantly increased (P<0.000 1). Compared with the model group, EA reduced the body weight loss ratio from 40% to 0%, and significantly decreased the fasting blood glucose, urine production and water consumption (P<0.01, P<0.000 1, P<0.001), and the blood flow velocity of peritubular capillary in the EA group was significantly increased (P<0.001, P<0.05) and tubule dilatation significantly alleviated (P<0.0 1).

CONCLUSION

EA at ST36 and EX-B3 can ameliorate renal vascular microcirculation disorder to relieve the renal structure damage and improve renal function in diabetes mice.

Evidence mapping and overview of systematic reviews of the effects of acupuncture therapies

OBJECTIVE

To provide a route map regarding systematic reviews (SRs) of acupuncture therapies that will meet two goals: (1) to identify areas in which more or better evidence is required and (2) to identify acupuncture applications that, although proven effective, remain underused in practice, and thus warrant more effective knowledge dissemination.

ELIGIBILITY CRITERIA

We included SRs that conducted meta-analyses (MAs) of randomised controlled trials (RCTs) for this overview.

INFORMATION SOURCES

We searched for SRs without language restrictions from January 2015 to November 2020 in four Chinese electronic databases and Epistemonikos database. And we also searched for newly published RCTs that were eligible for selected best SRs in PubMed, Medline, Cochrane Central Register of Controlled Trials, Embase and four Chinese electronic databases from its lasted search dates to November 2020.

SYNTHESIS OF RESULTS

We reanalysed the selected MAs if new primary studies were added. We used random-effect model to calculate the overall effect.

RESULTS

Our search identified 120 SRs published in the last 5 years addressing acupuncture therapies across 12 therapeutic areas and 77 diseases and conditions. The SRs included 205 outcomes and involved 138 995 participants from 1402 RCTs. We constructed 77 evidence matrices, including 120 SRs and their included RCTs in the Epistemonikos database. Seventy-seven SRs represented the effect estimate of acupuncture therapies. Finally, we system summarised the areas of possible underutilisation of acupuncture therapies (high or moderate certainty evidence of large or moderate effects), and the areas of warranting additional investigation of acupuncture therapies (low or very low certainty evidence of moderate or large effects).

CONCLUSION

The evidence maps and overview of SRs on acupuncture therapies identified both therapies with substantial benefits that may require more assertive evidence dissemination and promising acupuncture therapies that require further investigation.

Characteristics and quality of clinical practice guidelines addressing acupuncture interventions: a systematic survey of 133 guidelines and 433 acupuncture recommendations

OBJECTIVE

To systematically summarise acupuncture-related Clinical Practice Guidelines (CPGs)'s clinical and methodological characteristics and critically appraise their methodology quality.

DESIGN

We summarised the characteristics of the guidelines and recommendations and evaluated their methodological quality using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.

DATA SOURCES

Nine databases were searched from 1 January 2010 to 20 September 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included the latest version of acupuncture CPGs, which must have used at least one systematic review addressing the benefits and harms of alternative care options to inform acupuncture recommendations.

DATA EXTRACTION AND SYNTHESIS

Reviewers, working in pairs, independently screened and extracted data. When there are statistical differences among types of CPGs, we reported the data by type in the text, but when not, we reported the overall data.

RESULTS

Of the 133 eligible guidelines, musculoskeletal and connective tissue diseases proved the most commonly addressed therapeutic areas. According to the AGREE II instrument, the CPG was moderate quality in the domain of clarity of scope and purpose, clarity of presentation, the rigour of development, stakeholder involvement and low quality in editorial independence, and applicability. The study identified 433 acupuncture-related recommendations; 380 recommended the use of acupuncture, 28 recommended against the use of acupuncture and 25 considered acupuncture but did not make recommendations. Of the 303 recommendations that used Grading of Recommendations Assessment, Development and Evaluation to determine the strength of recommendations, 152 were weak recommendations, 131 were strong recommendations, of which 104 were supported by low or very low certainty evidence (discordant recommendations).

CONCLUSION

In the past 10 years, a large number of CPGs addressing acupuncture interventions exist. Although these guidelines may be as or more rigorous than many others, considerable room for improvement remains.

Low-frequency electroacupuncture improves disordered hepatic energy metabolism in insulin-resistant Zucker diabetic fatty rats via the AMPK/mTORC1/p70S6K signaling pathway

BACKGROUND AND AIM

Disordered hepatic energy metabolism is found in obese rats with insulin resistance (IR). There are insufficient experimental studies of electroacupuncture (EA) for IR and type 2 diabetes mellitus (T2DM). The aim of this study was to probe the effect of EA on disordered hepatic energy metabolism and the adenosine monophosphate (AMP)-activated protein kinase (AMPK)/mammalian target of rapamycin complex 1 (mTORC1)/ribosomal protein S6 kinase, 70-kDa (p70S6K) signaling pathway.

METHODS

Zucker Diabetic Fatty (ZDF) rats were randomly divided into three groups: EA group receiving EA treatment; Pi group receiving pioglitazone gavage; and ZF group remaining untreated (n = 8 per group). Inbred non-insulin-resistant Zucker lean rats formed an (untreated) healthy control group (ZL, n = 8). Fasting plasma glucose (FPG), fasting insulin (FINS), C-peptide, C-reactive protein (CRP) and homeostatic model assessment of insulin resistance (HOMA-IR) indices were measured. Hematoxylin-eosin (H&E) staining was used to investigate the liver morphologically. The mitochondrial structure of hepatocytes was observed by transmission electron microscopy (TEM). Western blotting was adopted to determine protein expression of insulin receptor substrate 1 (IRS-1), mTOR, mTORC1, AMPK, tuberous sclerosis 2 (TSC2) and p70S6K, and their phosphorylation. RT-PCR was used to quantify IRS-1, mTOR, mTORC1, AMPK and p70S6K mRNA levels.

RESULTS

Compared with the ZF group, FPG, FINS, C-peptide, CRP and HOMA-IR levels were significantly reduced in the EA group (p < 0.05, p < 0.01). Evaluation of histopathology showed improvement in liver appearances following EA. Phosphorylation levels of AMPK, mTOR and TSC2 decreased, and IRS-1 and p70S6K increased, in hepatocytes of the ZF group, while these negative effects appeared to be alleviated by EA.

CONCLUSIONS

EA can effectively ameliorate IR and regulate energy metabolism in the ZDF rat model. AMPK/mTORC1/p70S6K and related molecules may represent a potential mechanism of action underlying these effects.

Per1 gene polymorphisms influence the relationship between brain white matter microstructure and depression risk

BACKGROUND

Circadian rhythm was involved in the pathogenesis of depression. The detection of circadian genes and white matter (WM) integrity achieved increasing focus for early prediction and diagnosis of major depressive disorder (MDD). This study aimed to explore the effects of PER1 gene polymorphisms (rs7221412), one of the key circadian genes, on the association between depressive level and WM microstructural integrity.

MATERIALS AND METHODS

Diffusion tensor imaging scanning and depression assessment (Beck Depression Inventory, BDI) were performed in 77 healthy college students. Participants also underwent PER1 polymorphism detection and were divided into the AG group and AA group. The effects of PER1 genotypes on the association between the WM characteristics and BDI were analyzed using tract-based spatial statistics method.

RESULTS

Compared with homozygous form of PER1 gene (AA), more individuals with risk allele G of PER1 gene (AG) were in depression state with BDI cutoff of 14 (χ² = 7.37, uncorrected p = 0.007). At the level of brain imaging, the WM integrity in corpus callosum, internal capsule, corona radiata and fornix was poorer in AG group compared with AA group. Furthermore, significant interaction effects of genotype × BDI on WM characteristics were observed in several emotion-related WM tracts. To be specific, the significant relationships between BDI and WM characteristics in corpus callosum, internal capsule, corona radiata, fornix, external capsule and sagittal stratum were only found in AG group, but not in AA group.

CONCLUSION

Our findings suggested that the PER1 genotypes and emotion-related WM microstructure may provide more effective measures of depression risk at an early phase.

Contralateral S1 function is involved in electroacupuncture treatment-mediated recovery after focal unilateral M1 infarction

Acupuncture at acupoints Baihui (GV20) and Dazhui (GV14) has been shown to promote functional recovery after stroke. However, the contribution of the contralateral primary sensory cortex (S1) to recovery remains unclear. In this study, unilateral local ischemic infarction of the primary motor cortex (M1) was induced by photothrombosis in a mouse model. Electroacupuncture (EA) was subsequently performed at acupoints GV20 and GV14 and neuronal activity and functional connectivity of contralateral S1 and M1 were detected using in vivo and in vitro electrophysiological recording techniques. Our results showed that blood perfusion and neuronal interaction between contralateral M1 and S1 is impaired after unilateral M1 infarction. Intrinsic neuronal excitability and activity were also disturbed, which was rescued by EA. Furthermore, the effectiveness of EA treatment was inhibited after virus-mediated neuronal ablation of the contralateral S1. We conclude that neuronal activity of the contralateral S1 is important for EA-mediated recovery after focal M1 infarction. Our study provides insight into how the S1–M1 circuit might be involved in the mechanism of EA treatment of unilateral cerebral infarction. The animal experiments were approved by the Committee for Care and Use of Research Animals of Guangzhou University of Chinese Medicine (approval No. 20200407009) April 7, 2020.

[Acupoint selection for cancer pain: based on current evidence and Delphi method]

Based on literature research and Delphi expert consensus method, the important acupoints for cancer pain was summarized to provide evidence basis for the formulation of Clinical Practice Guide of Acupuncture in the Treatment of Cancer Pain. Through systematic search of Chinese and English databases, 28 clinical studies regarding acupuncture for cancer pain were included. The acupoint selection methods and high-frequency acupoints were summarized and analyzed. Based on this, a Delphi questionnaire was designed and two rounds of questionnaire survey on 30 experts in acupuncture and tumor related fields in China and abroad were conducted. As a result, it was suggested that the individualized acupoint selection should be adopted for acupuncture treatment of cancer pain, with Zusanli (ST 36), Hegu (LI 4), Taichong (LR 3), Sanyinjiao (SP 6), Yanglingquan (GB 34) and ashi points as the main acupoints. Combined with clinical research evidence and expert consensus, the important acupoints for cancer pain were identified. However, clinical acupoint selection still needed further research and refinement.

Evaluation on the effect of acupuncture on patients with sepsis-induced myopathy (ACU-SIM pilot study): A single center, propensity-score stratified, assessor-blinded, prospective pragmatic controlled trial

BACKGROUND

Sepsis-induced myopathy (SIM) is a disease that causes motor dysfunction in patients with sepsis. There is currently no targeted treatment for this disease. Acupuncture has shown considerable efficacy in the treatment of sepsis and muscle weakness. Therefore, our research aims to explore the effects of acupuncture on the improvement of muscle structure and function in SIM patients and on activities of daily living.

METHODS

The ACU-SIM pilot study is a single-center, propensity-score stratified, assessor-blinded, prospective pragmatic controlled trial (pCT) with a 1-year follow-up period. This study will be deployed in a multi-professional critical care department at a tertiary teaching hospital in Guangzhou, China. Ninety-eight intensive care unit subjects will be recruited and assigned to either the control group or the acupuncture group. Both groups will receive basic treatment for sepsis, and the acupuncture group will additionally receive acupuncture treatment. The primary outcomes will be the rectus femoris cross-sectional area, the Medical Research Council sum-score and time-to-event (defined as all-cause mortality or unplanned readmission to the intensive care unit due to invasive ventilation). The activities of daily living will be accessed by the motor item of the Functional Independence Measure. Recruitment will last for 2 years, and each patient will have a 1-year follow-up after the intervention.

DISCUSSION

There is currently no research on the therapeutic effects of acupuncture on SIM. The results of this study may contribute to new knowledge regarding early muscle atrophy and the treatment effect of acupuncture in SIM patients, and the results may also direct new approaches and interventions in these patients. This trial will serve as a pilot study for an upcoming multicenter real-world study.

TRIAL REGISTRATION

Chinese Clinical Trials Registry: ChiCTR-1900026308, registered on September 29th, 2019.

Astragaloside IV enhances GATA-4 mediated myocardial protection effect in hypoxia/reoxygenation injured H9c2 cells

BACKGROUND AND AIM

The transcription factor GATA-4 plays an important role in myocardial protection. Astragaloside IV (Ast-IV) was reported with the effects on improving cardiac function after ischemia. In this study, we explored how Ast-IV interacts with GATA-4 to protect myocardial cells H9c2 against Hypoxia/Reoxygenation (H/R) stress.

METHODS AND RESULTS

H9c2 cells were cultured under the H/R condition. Various cell activity and morphology assays were used to assess the rates of apoptosis and autophagy. In these H/R injured H9c2 cells, increased apoptosis (P < 0.01) and autophagosome number (P < 0.01) were observed, and the addition of Ast-IV ameliorated this tendency. Mechanistically, we used the RT-qPCR and Western blot to evaluate the expressions of various molecules. The results showed that Ast-IV treatment upregulated gene expression of GATA-4 (P < 0.01) and the survival factors (Bcl-2, P < 0.05; p62, P < 0.01), but suppressed apoptosis and autophagy related genes (PARP, Caspase-3, Beclin-1, and LC3-II; All P < 0.01). Furthermore, overexpressing of GATA-4 by its agonist phenylephrine can also protect H/R injured H9c2 cells, and the addition of Ast-IV further enhanced this protection of GATA-4. In contrast, silencing GATA-4 expression abolished the H/R protection of Ast-IV, which demonstrated that the myocardial protection of Ast-IV is mediated by GATA-4. Lastly, along with GATA overexpression, enhanced interactions between Bcl-2 and Beclin-1 were detected by Chromatin immunoprecipitation (P < 0.01).

CONCLUSION

Ast-IV rescued the H/R injury induced apoptosis and autophagy in H9c2 cells. Ast-IV treatment can stimulate the overexpression of GATA-4, and further enhanced the myocardial protection effect of GATA-4.

[Professor YI Wei's clinical experience in treatment of infertility of ovulation disturbance with acupuncture-moxibustion therapy]

The characteristics of syndrome differentiation and the experience of professor YI Wei were briefly introduced for the treatment of infertility of ovulation disturbance, including three aspects, named the thought of diagnosis and treatment, the therapeutic method and the acupoint prescription, as well as the clinical case report. Academically, professor YI Wei is deeply influenced by professor JIN Rui, the acupuncture master of Xin'an school and Lingnan school. Regarding the treatment of gynecological diseases, the academic thought of professor LUO Song-ping and ZHANG Yu-zhen is contributed. Professor YI attaches the importance to the syndrome differentiation based on meridian and collateral, supplemented by the syndrome differentiation of zangfu, yinyang, qi and blood, cold and heat, as well as the deficiency and excess. In clinical treatment, the acupoints are selected specially from the conception vessel, the governor vessel, the thoroughfare vessel and the belt vessel. The extra meridians are equally important as the regular ones in the treatment, especially the belt vessel. Additionally, the treatment focuses on communicating the congenital qi with the acquired one, regulating the liver and benefiting the kidney, as well as adjusting the heart, the spleen and the stomach to ease the uterus. Simultaneously, the great consideration is paid to the menstruation regulation so as to promote pregnancy.

[Clinical therapeutic effect of hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies]

OBJECTIVE

To compare the differences in clinical effects on hyperlipidemia of turbid phlegm obstruction pattern/syndrome treated with the different Jin's three-needle therapies so as to provide a new approach and theoretic evidence for the clinical optimal scheme of acupuncture on hyperlipidemia.

METHODS

A total of 90 patients were randomly divided into education group, electroacupuncture group and catgut embedding group (30 cases in each). The routine health education was given to the education group. On the base of the treatment as the education group, electroacupuncture was applied to the electroacupuncture group for 30 min each time, twice a week; and the catgut embedding was applied to the catgut embedding group at the same acupoints as the electroacupuncture group, once a week. The treatment was given consecutively for 8 weeks in each group. Before and after treatment, the obesity indices [weight, waistline, body mass index (BMI)], blood lipid indices[serum total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)] and insulin resistance indices [fasting blood glucose(FBG), fasting plasma insulin(FINS), homeostasis model assessment-estimated insulin resistance (HOMA-IR)] were observed in the three groups before and after treatment.

RESULTS

After treatment, in the electroacupuncture group and the catgut embedding group, the results of the obesity indices, e.g. weight, waistline and BMI, the levels of blood lipid, e.g.TC, TG, LDL-C and the insulin resistance indices, e.g. FINS and HOMA-IR were all obviously decreased compared with those before treatment (P<0.05, P<0.01), and the level of HDL-C apparently increased than that before treatment (P<0.01). In the catgut embedding group, FBG was obviously decreased after treatment as compared with that before treatment (P<0.01). After treatment, the improvements in LDL-C and HDL-C in the catgut embedding group were superior to those in the electroacupuncture group (P<0.05). Regarding the obesity indices and insulin resistance indices, the differences were not statistically significant in comparison between the catgut embedding group and the electroacupuncture group (all P>0.05). The total effective rate was 90.0% in the catgut embedding group (27/30) and it was 83.3% (25/30) in the electroacupuncture group, either of them was better than 60.0% (18/30) in the education group , indicating the statistical significance (P<0.01, P<0.05).

CONCLUSION

On the base of health education, either the catgut embedding therapy or electroacupuncture of Jin's three-needle treatment achieves the positive regulation on the abnormal lipid metabolism and insulin resistance. The hypoglycemic effect and the impro-ving effect in LDL-C and HDL-C of the catgut embedding therapy are superior to electroacupuncture.

[Brain science promotes the development of acupuncture in treating brain diseases]

Brain science is the "ultimate territory" for human beings to understand the nature. In the present paper, the authors introduce the current state of brain science research projects in the USA, European countries, Japan and China. In recent years, with the continuous innovations of technologies in brain imaging, biosensors, human-computer interaction and big data, the brain science has become an important frontier field with interdisciplinarity and a focus of science and technology strategies in various countries. As a scientific and technological resource with original advantages in China, traditional Chinese medicine (TCM) is abundant in knowledge of brain, almost covering all kinds of encephalopathy in modern medicine. At present, TCM is increasingly becoming an effective tool to conquer mental and nervous diseases. With the intersection and penetration of multi-disciplines, an increasing close association between the traditional theory of TCM about prevention and treatment of encephalopathy and modern basic biological research appears, and new ideas, new technologies and new achievements have constantly been coming out, particularly in the field of acupuncture medicine. In the present historical juncture when the development of science and technology in China is changing from the "follower" to the "parallel runner", even the "top runner" in some fields, the progress of brain science research in TCM will make enormous contributions to explore brain disease and exploit cutting-edge technologies of TCM, as well as accelerate the modernization of TCM.

[Construction of the integrative evidence chain in clinical trial of acupuncture and moxibustion]

The research aims to propose the approaches to the clinical trial of acupuncture and moxibustion and provide the methodological guide for the research in this field in terms of the inadequate systematic collection, lack of the specific characteristics of acupuncture-moxibustion treatment and insufficient persuasion in clinical evidences of acupuncture-moxibustion research. Through a systematic review of the registration of acupuncture-moxibustion clinical trials at home and abroad, the distribution of diseases with the recommendation of acupuncture and moxibustion in Cochrane Library database, combined with the evidence grade of the evidence-based medicine and the individual characteristics of clinical practice with acupuncture and moxibustion, some research ideas and framework are proposed for the clinical trial of acupuncture and moxibustion. To take the curative effect as the forerumer, the dominant disease and therapeutic methods of acupuncture and moxibustion should be initially generalized by the case experiences and clinical observation at the first. In view of the potential function of acupuncture and moxibustion in treatment, the rigorous and standardized clinical trial should be carried out to verify their therapeutic effect. Finally, the experimental research is adopted to explore the mechanism of acupuncture and moxibustion. Through the combination of quantitative and qualitative methods, all of the evidences are integrated to form an integrative evidence chain. It is anticipated that the construction of the integrative evidence chain in clinical trial of acupuncture and moxibustion may enhance the promotion of clinical practice with acupuncture and moxibustion and increase the influence of acupuncture-moxibusiton discipline.

[Clinical treatment of chronic nonbacterial prostatitis of kidney-yang deficiency type by acupuncture of Sanhuang points]

OBJECTIVE

To observe the clinical effect of acupuncture stimulation of Sanhuang points in the treatment of chronic nonbacterial prostatitis (CNP) of kidney-yang deficiency type.

METHODS

A total of 60 CNP outpatients were equally randomized into medication(control) group and acupuncture plus medication (acupuncture) group. Patients of the control group were ordered to take Tamsulosin (0.2 mg/d) for successive 8 weeks. On the basis of medication treatment, for patients of the acupuncture group, bilateral Sanhuang points including Tianhuang-fu Point (Shenguan), Dihuang Point and Renhuang Point (at the lower leg) were needled with filiform needles which were manipulated for a while till Deqi, followed by retaining the needles for 30 min. The treatment was conducted once daily for successive 8 weeks. The therapeutic effect was evaluated in reference to the "Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes/Diseases of Traditional Chinese Medicine". The National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) scores were used to assess the severity of chronic prostatitis. Routine examination of the leukocyte count in the prostatic fluid was performed before and after the treatment.

RESULTS

Of the two 30 cases of the control and acupuncture groups, 9 and 19 were cured, 14 and 10 experienced improvement, and 7 and 1 failed in the treatment, with the effective rates being 76.67% and 96.67%, respectively. The effective rate of the acupuncture plus medication was significantly higher than that of the medication (P<0.05). After the treatment, the scores of NIH-CPSI and white blood cell counts in the prostatic fluid in both groups were significantly decreased in comparison with their own pre-treatment (P<0.05). The therapeutic effect of acupuncture plus medication was significantly superior to that of the medication alone in reducing the NIH-CPSI symptom score and the number of leukocytes in the prostatic fluid (P<0.05).

CONCLUSION

Acupuncture at Sanhuang points is effective in improving symptoms of CNP patients of kidney-yang deficiency type, and the therapeutic effect of acupuncture plus medication is superior to that of medication alone.

[Development of research on mechanisms of electroacupuncture intervention underlying improvement of cerebral ischemia rats in recent five years]

In the present paper, we summarized the relevant research literature on the underlying mechanism of electroacupuncture (EA) intervention in improving cerebral ischemia (CI) in middle cerebral artery occlusion (MCAO) model rats in recent 5 years from preconditioning and regular intervention. Outcomes showed that both EA preconditioning and regular intervention could relieve CI by reducing toxicity of excitatory amino acids (glutamate, aspartate) and TLR4/NF-κB-mediated inflammatory cascade reaction to relieve inflammatory injury. Moreover, EA preconditioning also could suppress the expression of pro-apoptosis genes and proteins to relieve apoptosis, regulate activation of microglia, and down-regulate the expression of blood brain barrier integrity-related matrix metalloprotein 9. Regular EA intervention also could promote angiogenesis to increase supply of blood and oxygen, facilitate regeneration, proliferation and differentiation of neural stem cells via triggering activation of Notch and Shh signaling pathways, and promote the secretion of neurotrophin by up-regulating the expression of brain derived neurotrophic factor and nerve growth factor /Trk A receptor, and promote expression of axon growth and synaptic remodeling-related factor (Ephrin B2/Eph B2) and sr-GTPase activating protein 1 and cell division cycle 42 (Cdc42, axon growth and orientated down-stream molecules). However, up to now, the conclusion is still fragmentary and one-sided, and can not explain the specific mechanism of electroacupuncture in MCAO rats, needing further in-depth study.

[Guan's acupuncture technique and the rules of acupoints selection on leg]

Guan's acupuncture technique is a kind of special acupuncture methods developed and improved by GUAN Zheng-zhai. It has unique curative effects on hysterical paralysis, schizophrenia, madness, epilepsy and traumatic paraplegia, etc. This acupuncture technique has the characteristics of "deep" "transparent" "moving" and "sensing". The acupoints selection is different from that of twelve meridian acupoints. The deep insertion of acupuncture needles is applied at acupoints located in the wrist joint, ankle joint and below, while the penetration needling method is applied at acupoints located in the area which has relatively thick muscles, and where yin-meridian and yang-meridian are symmetric with each other. The horizontal and deep connection of acupoints and the adjustment effect of qi-blood and yin-yang are emphasized during treatment.

Role of 5-HT1A in the nucleus of the solitary tract in the regulation of swallowing activities evoked by electroacupuncture in anesthetized rats

Somatic stimulation therapy, such as electroacupuncture (EA), has been widely applied in the clinic to treat dysphagia. However, its underlying mechanism has remained unknown. In the present study, the effect of EA at acupoints Fengfu (DU16) and Lianquan (RN23) on swallowing activities and the involvement of 5-HT_1A in the nucleus of the solitary tract (NTS) were examined in anesthetized rats. EA at DU16 and RN23 significantly evoked myoelectric activity of the mylohyoid muscle, which was attenuated by injection of 10 nmol 5-HT_1A antagonist (WAY-100635) into the NTS. Meanwhile, 5-HT_1A expression in the NTS increased following EA. The results suggested that EA at DU16 and RN23 promotes swallowing activity, and 5-HT_1A in the NTS may play an important role in the excitatory effects.

[Effect of Electroacupuncture on Learning-memory Ability in Rats with Hypoxic-ischemic Encephalopathy]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on changes of learning-memory ability, psychomotor coordination and anxiety-like behavior of cerebral hypoxic-ischemia (CHI) young rats, so as to explore its protective effect on neurons under hypoxic-ischemic conditions.

METHODS

SD rats (aged 7 days) were randomly divided into sham operation (sham, n=12), model (n=11), and EA groups (n=12). In addition, 6 young rats in each group were used for observing the number of dendritic spines after Golgi staining. The CHI model was established by ligation of the left common carotid artery combined with hypoxia in a closed transparent vessel. EA was applied to "Baihui" (GV 20)and "Dazhui" (GV 14) for 20 min, once every other day, for 28 days. The rats' behavior changes were assessed by using rotarod performance (for psychomotor coordination), elevated plus maze (anxiety-like behavior) tests and Morris water maze (learning-memory ability) tests, separately.

RESULTS

After modeling, the average escape latency and average escape distance of location navigation test within 70 seconds were significantly increased (P<0.05), and the average times and average duration of safe-platform quadrant crossing of spacial probing test were markedly reduced relevant to the sham group (P<0.05). After EA treatment, CHI-induced increases of escape latency and escape distance, and the decreased times and duration of platform quadrant crossing were significantly reversed (P<0.05). No significant differences were found among the three groups in the falling latency of rotarod performance test, and in the time of opening and closing arms of elevated plus maze tests (P>0.05). The density of dendritic spines was significantly lo-wer in the model group than in the sham group (P <0.05), and notably higher in the EA group than in the model group (P<0.05).

CONCLUSION

EA can improve the learning-memory ability of CHI young rats, which may be related to its effect in protecting the dendritic spines of CA 1 region of hippocampus from injury.

[Clinical application regularity of Fengfu (GV 16) acupoint: research on ancient Chinese medical literature]

OBJECTIVE

To sum up the application regularity of Fengfu (GV 16) acupoint in clinical practice through studying the ancient literature from the early stage of the Qin Dynasty to the Qing Dynasty.

METHODS

Chinese ancient medical literature relevant to Fengfu (GV 16) was searched to establish a database containing information of clinical indications of GV 16, supplementary acupoints, relevant needling techniques, moxibustion methods, etc.

RESULTS

A total of 277 articles about Fengfu (GV 16) for 61 types of clinical disorders or diseases involving internal medicine, surgery, paediatrics, five sense organs, etc. were obtained from 2,200 ancient Chinese medical books. Fengfu (GV 16) alone was most frequently used for treatment of disorders caused by exogenous factors, such as common cold, neck pain, headache, epilepsy, mania, dizziness, throat dumb, leg-foot problems, etc. , with the auxiliary acupoint being Fengchi (GB 20). In addition, 147 articles relevant to needling and moxibustion stimulation of GV 16 (7 types of methods) were found.

CONCLUSION

Fengfu (GV 16) is mainly used for local problems in the human body, and also for problems occurred along the meridian trace, aiming at the pathogenesis. When employed, GV 16 is often stimulated by acupuncture needle.

Effects of acupuncture treatment on depression insomnia: a study protocol of a multicenter randomized controlled trial

BACKGROUND

More than 70% of patients with depression who see their doctors experience insomnia. Insomnia treatment is a very important link for depression treatment. Furthermore, antidepression treatment is also important for depression insomnia. In acupuncture, LU-7 (Lie Que) and KID-6 (Zhao Hai), which are two of the eight confluence points in meridian theory, are used as main points. An embedded needle technique is used, alternately, at two groups of points to consolidate the treatment effect. These two groups of points are BL-15 (Xin Shu) with BL-23 (Shen Shu) and BL-19 (Dan Shu) with N-HN-54 (An Mian). The effectiveness of these optimized acupuncture formulas is well proven in the practice by our senior acupuncturists in Guangdong Provincial Hospital of TCM. This study has been designed to examine whether this set of optimized clinical formulas is able to increase the clinical efficacy of depression insomnia treatment.

METHODS/DESIGN

In this randomized controlled multicenter trial, all the eligible participants are diagnosed with depression insomnia. All participants are randomly assigned to one of two groups in a ratio of 1:1 and receive either conventional acupuncture treatment or optimized acupuncture treatment. Patients are evaluated using the Pittsburgh Sleep Quality Index(PSQI)and the Hamilton rating scale(HAMD) for depression. The use of antidepression and hypnotics drugs is also considered. Results are obtained at the start of treatment, 1 and 2 months after treatment has begun, and at the end of treatment. The entire duration of the study will be approximately 36 months.

DISCUSSION

A high quality of trial methodologies is utilized in the study, and the results may provide better evidence for the effectiveness of acupuncture as a treatment for depression insomnia. The optimized acupuncture formula has potential benefits in increasing the efficacy of treating depression insomnia.

TRIAL REGISTRATION

The trial was registered in Chinese Clinical Trial Register (ChiCR-TRC-00000481) on 12 August 2009.

[Impacts of acupuncture and moxibustion on outcome indeices of depression patients' subjective reports]

OBJECTIVE

To assess the clinical efficacy of acupuncture and moxibustion on depression in view of the outcome indicators of the patient subjective reports.

METHODS

One hundred and sixty-three cases of depression being in compliance with the inclusive standards were randomized into a soothing-liver and regulating-mind group, an acupoint-shallow-puncturing group and a non-acupoint-shallow-puncturing group. In the soothing-liver and regulating-mind group, the conventional acupuncture was applied to the four-gate points [Hegu (LI 4) and Taichong (LR 3)], Baihui (GV 20) and Yintang (EX-HN 3), the direct moxibustion with moxa cone was applied to the four-flower points [Geshu (BL 17), Danshu (BL 19)]. Finally, the intradermal needling was used at Xinshu (BL 15) and Ganshu (BL 18). In the acupoint-shallow-puncturing group, the acupoints selected were same as those in the soothing-liver and regulating-mind group. But the needle insertion was shallower and the time of moxibustion was shorter. In the non-acupoint-shallow-puncturing group, the spots that were 10 mm lateral to those acupoints in the soothing-liver and regulating-mind group were selected. The operation was same as that in the acupoint-shallow-puncturing group. The treatment was given twice a week in three groups. Totally, 12 weeks of treatment were required. The score of symptom checklist 90 (SCL-90), the self-report symptom inventory was observed before treatment, 1 month and 3 months after treatment separately so as to assess the corresponding short-term, mid-term and long-term efficacies of the program of acupuncture and moxibustion for soothing the liver and regulating the mind.

RESULTS

In each time-point after treatment, for the scores of somatization, obsessive-compulsive symptom, interpersonal sensitivity, depression, anxiety, hostility, paranoid ideation, psychoticism and the other 8 dimensionalities, in comparison between the soothing-liver and regulating-mind group and the non-acupoint-shallow-puncturing group, the differences were significant statistically (all P < 0.05). For the scores of depression, anxiety and hostility, in comparison between the soothing-liver and regulating-mind group and the acupoint-shallow-puncturing group, the differences were significant statistically (all P < 0.05).

CONCLUSION

Acupuncture and moxibustion can improve the scores of SCL-90 scale for the patients with depression. The outcome indicators of the patient subjective reports can accurately assess the clinical efficacy.

[Effect of electroacupuncture on expression of signal transducer and activator of transcription 3 in focal ischemic cerebral tissue in cerebral ischemia rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) intervention on expression of signal transducer and activator of transcription 3 (STAT 3) in the focal ischemic cerebral tissue, so as to study its mechanism underlying improving ischemic stroke.

METHODS

A total of 150 SD rats were randomized into sham operation (control) group, cerebral ischemia (CI) model (model) group and EA group which were further randomly divided into 2 hour (2 h), 1 day (1 d), 3 d, 1 week (1 W) and 3 W subgroups (n = 6/subgroup for immunohistochemistry, n = 4/subgroup for Western blot). CI model was established by occlusion of the middle cerebral artery with electro-coagulation method. EA (3 Hz/20 Hz, 2-3 V) was applied to "Baihui" (GV 20) and "Dazhui "(GV 14) for 30 min. The expression of cerebral STAT 3 was detected by immunofluorescence histochemistry and laser-confocal microscopy, and Western blot, separately.

RESULTS

Compared with the control group, cerebral STAT 3 immunofluorescence intensity values at the time-points of 2 h, 1 d, 3 d and 1 W, STAT 3 protein expression levels at the time-points of 2 h, 1 d and 3 d in the model group were increased significantly (P < 0.001, P < 0.05). After acupuncture intervention, cerebral STAT 3 immunofluorescence intensity values at the time-points of 1 d, 3 d, 1 W and 3 W, STAT 3 protein expression levels at the time-points of 1 d, 3 d and 3 W in the EA group were down-regulated considerably (P < 0.001, P < 0.01, P < 0.05). No significant differences were found between the control and model groups in STAT 3 immunofluorescence intensity at 3 W, and in STAT 3 protein expression levels at 1 W and 3 W, and between the EA and model groups in STAT 3 immunofluorescence intensity at 2 h, and in STAT 3 protein expression at 2 h, 3 d and 1 W (P > 0.05).

CONCLUSION

EA therapy can down-regulate the expression level of STAT 3 protein in the regional ischemic cerebral tissue in cerebral ischemia rats, which may contribute to its efficacy in the treatment of acute and chronic ischemic stroke.

[Effect of electroacupuncture on astrocytes in the marginal zone of cerebral ischemia locus in rats]

OBJECTIVE

To observe the effect of electroacupuncture (EA) on changes of ultrastructure and proliferation of astrocytes in the marginal zone of the cerebral ischemia locus in rats at different time courses so as to explore its underlying mechanism in the treatment of cerebral ischemia (CI).

METHODS

Ninety Wistar rats were randomized into sham operation (sham), model and electroacupuncture (EA) groups which were further divided into 1 h, 1 d, 3 d, 7 d, and 21 d subgroups, with 6 cases in each. CI model was established by occlusion of the middle cerebral artery with heat-coagulation. EA (4/20 Hz, 2-3 V, 1-3 mA) was applied to "Baihui" (GV 20) and "Dazhui" (GV 14) for 30 min once daily. The ultrastructure changes of astrocytes were observed by using transmission electronic microscope, and glial fibrillary acidic protein (GFAP) expression of astrocytes was displayed by using immuno-fluorescent dyeing and observed under laser confocal scanning microscope (LCSM).

RESULTS

Following CI, the astrocytes were swelling in structure and increased in number in CI model group, while compared with model group, the degree of swelling of astrocytes was decreased obviously in EA group. The mean fluorescence intensity values of GFAP on day 1, day 3, day 7 and day 21 post-modeling in model group increased significantly in comparison with sham group (P < 0.01), while those of GFAP from day 1 to day 21 post-modeling in EA group were significantly lower than those in model group (P < 0.01, P < 0.05), suggesting an inhibitory effect of EA on CI-induced upregulation of GFAP expression.

CONCLUSION

EA of GV 20 and GV 14 can relieve CI-induced ultrastructural injury of astrocytes in the rat, which is closely with its effect in inhibiting CI-induced overexpression of GFAP in astrocytes of the ischemic brain tissue.

[The role of NO/ET and the effect of electroacupuncture on injuried gastric mucosa in rats]

The aim of the present work is to observe changes in endothelium-derived factors--nitric oxide (NO) and endothelin (ET), with special reference to the regulative role of electroacupuncture (EA) in injured gastric mucosa of rat by ethanol. It was found that gastric mucosal blood flow (GMBF), transmucosal potential difference (PD) and the content of NO in the serum all decreased (P < 0.01), while the content of ET in the plasma and the lesion index (LI) of gastric mucosa increased (P < 0.01). After administration of L-Arg and SNP, the content of NO and GMBF increased significantly (P < 0.01), whereas the content of ET and LI decreased (P < 0.01). These effects were enhanced by EA at ZuSanLi (ST-36) points, which, however, were inhibited by NO biosynthetic inhibitor--L-NNA. The latter effect could be reversed by concurrent administration of L-Arg. The above results suggest that NO plays a critical part in protecting gastric mucosa against injury, which is also responsible for the protective effect of EA on injury of gastric mucosa.