Analysis on the location of scalp acupuncture lines based on the 2021 version of Standardized Manipulations of Acupuncture and Moxibustion--Part 2： Scalp Acupuncture

In order to better promote the popularization and application of the national standard of Standardized Manipulations of Acupuncture and Moxibustion--Part 2： Scalp Acupuncture (GB/T 21709.2-2021), and to provide reference for the improvement and formulation of the next version, in the present paper, the differences about the position descriptions of two scalp acupuncture lines Dingnie Qianxiexian (anterior oblique line of vertex-temporal, MS6) and Dingpangxian 1 (lateral line 1 of vertex, MS8) between the new (GB/T 21709.2-2021) and old (GB/T 21709.2-2008) versions of the national standards as well as the International Standard Proposal of Scalp Acupuncture Point were compared, and the disputes still existing in the 2021 version were discussed. Although the 2021 version has made relevant amendments in some controversial or non-standard contents in the 2008 version, there are still some inappropriate contents. Firstly, only the relevant revision in the attached figure 3 was mentioned in the preface, without mention of the word revision about MS6 in both English and Chinese, but actually "Chengguang" (BL6) has been changed to "Tongtian" (BL7). Secondly, The attached figure does not match the word description. There is a revision in the attached figure and text at the same time, in which the text description of Qianding (GV21) of the MS6 has not been revised, but the front Shencong (EX-HN1) in the attached figure has been changed to GV21, which is obviously inconsistent with the positioning of the MS6 according to the WHO international standard, and the basis for the revision is not known. These revisions of the 2021 version of national standard on the position of the two scalp acupoint lines in the 2008 version are inconsistent, which may make many colleagues in the acupuncture field confused. Thus, further revision is necessary.

Clinical observation on treatment of Alzheimer's disease with Sun's scalp-abdominal acupuncture combined with donepezil hydrochloride

OBJECTIVES

To observe the effect of scalp-abdominal acupuncture combined with donepezil hydrochloride on cognition and life ability of patients with Alzheimer's disease (AD), so as to evaluate its clinical efficacy.

METHODS

Sixty AD patients were collected and randomly divided into control group (30 cases) and observation group (30 cases). Patients in the control group were treated with oral donepezil hydrochloride (5 mg, once daily). Patients in the observation group were treated with scalp-abdominal acupuncture at Baihui (GV20), Yintang (GV24+), Sishencong (EX-HN1), "emotional area", Shenting (GV24), "abdominal area 1""abdominal area 8", and bilateral Fengchi (GB20), Taixi (KI3), Xuanzhong (GB39), Zusanli (ST36) on the basis of control group, and electroacupuncture (10 Hz/50 Hz, 0.5 to 5.0 mA) was applied to EX-HN1, "emotional area""abdominal area 1" and "abdominal area 8", once daily, 30 min each time. Four weeks as a course of treatment, both the two groups were treated for two consecutive courses. Before and after treatment, the mini-mental state examination (MMSE), AD assessmennt scale-cognitive subscale (ADAS-Cog) and activity of daily living scale (ADL) were evaluated. The clinical efficacy index was calculated and safety was evaluated.

RESULTS

After treatment, the MMSE and ADL scores were higher (P<0.05) and the ADAS-Cog score was lower (P<0.05) than those before treatment in both groups. Compared with the control group, the MMSE and ADL scores were increased (P<0.05) and ADAS-Cog score was decreased (P<0.05) in the observation group. The total effective rate of the observation group (26/30, 86.67%) was higher (P<0.05) than that of the control group (23/30, 76.67%). No adverse reactions occurred in both groups during the treatment.

CONCLUSIONS

Scalp-abdominal acupuncture combined with donepezil hydrochloride can effectively improve the cognitive ability and daily living ability of AD patients, and the efficacy is better than that of oral donepezil hydrochloride alone.

Effectiveness and safety of scalp acupuncture for treating migraine: A systematic review and meta-analysis

OBJECTIVE

Migraine is a prevalent and disabling neurological disorder affecting a significant proportion of the global population. Although medications are the primary treatment option, their efficacy remains unclear. Thus, alternative therapies such as scalp acupuncture have gained momentum; however, evidence for the effectiveness of scalp acupuncture remains insufficient. Therefore, this review provides evidence regarding the effectiveness and safety of scalp acupuncture for the treatment of migraines.

DESIGN

PubMed, EMBASE, CENTRAL, Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System, Korean Medical Database, NDSL, Citation Information by NII, and China National Knowledge Infrastructure were searched from their inception to September 2022 to identify randomised controlled trials (RCTs) without language restrictions. Data were collected and analysed independently by two reviewers. The RoB 2.0 tool was used to evaluate the risk of bias, and a meta-analysis was conducted using RevMan software (V5.4).

SETTING

Eight RCTs including 874 patients were selected.

RESULTS

Scalp acupuncture had a higher total effective rate (relative risk [RR]:1.24; 95% confidence interval [CI]:1.08-1.43; P < 0.01) than that of ordinary acupuncture. The headache index decreased significantly (standardised mean differences [SMD]:-1.27; 95% CI:-2.06 to -0.48; P < 0.01), and the total effective rate was higher (RR:1.20; 95% CI:1.06-1.37; P < 0.01) with scalp acupuncture than with medications. However, evidence supporting the effectiveness of scalp acupuncture was not robust. No adverse events were reported.

CONCLUSION

Scalp acupuncture appears to be more effective than other treatments for migraines. However, their safety remains uncertain.

PROSPERO REGISTRATION NUMBER

CRD42022348879.

Scalp Acupuncture on the Immediate and Prolonged Motor Recovery in Spinal Cord Injury: a Case Report

Spinal cord injury (SCI) is one of the main causes of lifelong motor impairment and is associated with important secondary complications. Thus, multifaceted treatments are needed for early functional recovery. Currently, in cases of SCI, surgery, stem cell treatment, medication, and physical therapy are used to repair and restore neuronal activity. Additionally, encouraging results have been reported on the use of acupuncture to modulate neuronal plasticity. Here, we present an SCI case involving a burst fracture at the L3 level, which was treated for 21 days using scalp acupuncture with residential physical therapy. Activation of the motor area was observed after the 1st day of treatment, with the patient completely regaining power and range of motion in the knees, Additionally, over 21 days, the patient exhibited markedly improved motor recovery and functional outcomes, which had not been observed over the previous six months. This report highlights the importance of complementing scalp acupuncture with intensive physical therapy for better motor recovery.

Efficacy of scalp acupuncture combined with conventional therapy in the intervention of post-stroke depression: A systematic review and meta-analysis

BACKGROUND

Post-stroke depression (PSD) is a common complication following a stroke, significantly impacting patients' quality of life and mental well-being. Currently, two primary approaches are employed to treat PSD: drug therapy and non-drug therapy. Among these, acupuncture, specifically scalp acupuncture (SA), has gained attention due to its cost-effectiveness and broad social benefits. SA is a precise and direct form of acupuncture that has been utilized in the treatment of PSD. Although several randomized controlled trials (RCTs) have demonstrated the efficacy of SA in treating PSD, there is a lack of comprehensive systematic reviews. Given the limitations of existing evidence, we conducted a systematic evaluation to assess the effectiveness of SA in combination with conventional therapy (CT) for intervening in PSD.

METHODS

We systematically searched five databases for articles published up until May 31, 2023, pertaining to SA treatment of PSD. A team of researchers meticulously screened and assessed these articles to identify the final included studies. After extracting relevant information and outcome indicators from the selected articles, we employed RevMan5.3 software to evaluate their quality and perform statistical analysis. Throughout our research, we strictly adhered to the PRISMA 2020 guidelines.

RESULTS

A total of 11 articles were included, and a meta-analysis was conducted to evaluate the effectiveness of SA combined with CT for treating PSD. The results revealed that SA combined with CT can effectively improve the treatment's success rate for PSD and reduce the severity of depressive symptoms measured by the Self-Rating Depression Scale. However, SA combined with CT did not show significant reductions in depressive symptoms assessed by the Hamilton Rating Scale for Depression, which may be related to the inclusion of high heterogeneity articles. Importantly, the combination treatment did not lead to an increase in adverse reactions among PSD patients.

CONCLUSION

While the effectiveness of SA combined with CT in treating PSD still requires further validation through rigorous randomized double-blind trials, this study provides a comprehensive collection of studies that meet the criteria for SA combined with CT in PSD treatment. It objectively and systematically evaluated the impact of SA combined with CT on PSD. Consequently, the findings of this study hold certain clinical significance.

Scalp acupuncture and computer assisted cognitive rehabilitation for stroke: A meta-analysis of randomised controlled trials

Objective

To assess the clinical effectiveness of scalp acupuncture and computer assisted cognitive rehabilitation in the treatment of cognitive impairment in stroke patients.

Methods

The literatures published before August 2021 in the following databases were included: PubMed, Chinese Biomedical Database, Wanfang Database, China National Knowledge Infrastructure, Database of Chinese sci-tech periodicals (VIP), EBSCO Information Services, MEDLINE and Web of Science. Only randomised controlled trials (RCTs) were included. Primary outcomes were the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) and Montreal Cognitive Assessment (MoCA). Our secondary outcome was Modified Barthel Index Score (MBI). The quality of all included trials was evaluated according to the Cochrane Collaboration. This protocol was registered in PROSPERO (CRD42016048528).

Results

Sixteen articles were selected including 1333 patients. The result of the meta analysis showed that the combination of scalp acupuncture and computer assisted cognitive rehabilitation had a significant improvement in the cognitive impairments. The analysis of LOTCA showed the improvement on the LOTCA (p < 0.0001, n = 410, I2 = 86%, mean difference 8.31). The meta-analysis of the MOCA showed a weighted mean difference of 3.76 and 95% confidence intervals (CI) of 2.90-4.62 (p < 0.0001, n = 301). Besides, it was showed that the combination therapy played an important role in the improvement of the score of MBI with a weighted mean difference of 9.30 and 95% confidence intervals (CI) of 5.87-12.672 (p < 0.0001, n = 278).

Conclusions

Scalp acupuncture and computer assisted cognitive rehabilitation appears to be effective for stroke patients with respect to certain outcomes. However, the evidence thus far is inconclusive. Further high-quality RCTs following standardized guidelines with a low risk of bias are needed to confirm the effectiveness of acupuncture for postpartum depression.

[A new idea to study the target of scalp acupuncture stimulation]

Scalp acupuncture, an important modern acupuncture branch that combines acupuncture stimulation and neuroscience, is gaining popularity in the clinic. It is believed that scalp acupuncture can modulate the function of certain brain areas through stimulation of specific scalp areas corresponding to the related cortical areas, thereby providing therapeutic benefits for a wide scope of diseases. In recent decades, there has been remarkable progress in our understanding of the brain circuitry of many brain-related disorders through cutting-edge brain imaging techniques. Unfortunately, these findings have not been incorporated into scalp acupuncture protocols. Thus, identifying surface cortical regions associated with these disorders would expand stimulation target selections of scalp acupuncture. In this manuscript, we aim to 1) propose the idea and methods to incorporate neuroimaging findings and scalp acupuncture; and 2) introduce scalp acupuncture stimulation targets for some psychological and neurological disorders based on recent brain imaging findings. We hope this manuscript can inspire innovation on this topic to help further develop scalp acupuncture.

[Scalp acupuncture regulates hypothalamic V1aR/CaMKⅡ/AQP4 signaling pathway in rats with focal cerebral ischemia]

OBJECTIVE

To observe the effect of scalp acupuncture on the expression of argarginine vasopressin receptor-1a(V_1aR), phosphorylated calmodulin-dependent protein kinase Ⅱ(p-CaMKⅡ), and aquaporin 4(AQP₄) at hypothalamus in middle cerebral artery occlusion (MCAO) rats, so as to explore the molecular mechanisms of scalp acupuncture reducing encepha-ledema in acute ischemic stroke.

METHODS

A total of 96 male SD rats were randomly divided into normal， model, inhibitor and scalp acupuncture groups, with 24 rats in each group. The MCAO model was established by thread occlusion method. The inhibitor group was intraperitoneally injected with V_1aR inhibitor (30 μg/kg)，once a day for 7 consecutive days. In the scalp acupuncture group, acupuncture was applied to bilateral "parietal and temporal anterior oblique line", with rapid insertion of 2 needles at 15° to 20°, twisting at 100 r/min for 1 min, and retaining the needles for 30 min, once a day for 7 consecutive days. The neurologic deficit score (NDS) and neurological score (NS) were evaluated before and after intervention. The positive expression of p-CaMKⅡ and AQP₄ proteins in hypothalamus was detected by immunohistochemistry. The water content of left brain tissue was determined by BIIiot method. The expression of V_1aR mRNA in hypothalamus was detected by real-time PCR.

RESULTS

Compared with the normal group, the NDS, NS, hypothalamic V_1aR mRNA expression, water content of the brain tissue, and hypothalamic p-CaMKⅡ and AQP₄ positive expression levels were significantly increased (P<0.01) in the model group. Compared with the model group, the NDS, NS, hypothalamic V_1aR mRNA expression, water content of the brain tissue, and hypothalamic p-CaMKⅡ and AQP₄ positive expression levels were significantly decreased (P<0.01) in the inhibitor and scalp acupuncture groups.

CONCLUSION

Regulating the signaling pathway of V_1aR/CaMKⅡ/AQP₄ in hypothalamus may be one of the molecular mechanisms of scalp acupuncture reducing encephaledema in acute ischemic stroke.

Feasibility and positive effects of scalp acupuncture for modulating motor and cerebral activity in Parkinson's disease: A pilot study

BACKGROUND

A variety of acupuncture therapies have shown efficacy in Parkinson's disease (PD).

OBJECTIVE

To evaluate scalp acupuncture (SA) effects on motor and cerebral activity by using gait equipment and resting-state functional magnetic resonance imaging (rs-fMRI).

METHODS

Twelve patients with PD received SA. They underwent the first functional-imaging scan after tactile stimulation and the second scan following needle removal. Gait test and local sensation assessment were performed immediately after each functional scan. Gait parameter differences between pre- and post-SA were analyzed using a paired t-test and altered brain areas in degree centrality (DC) and fractional amplitude of low-frequency fluctuation (fALFF) were identified between the two scans.

RESULTS

Eight patients completed the experiment. Stride length, maximum ankle height, maximum ankle horizontal displacement, gait speed, and range of shank motion significantly increased post-treatment (P <  0.05). fALFF in left middle frontal gyrus and DC in left cerebellum (corrected) increased, while fALFF in left inferior parietal lobule (corrected) during SA decreased, compared with those in tactile stimulation. A positive correlation was observed between right limb swings and both fALFF areas.

CONCLUSIONS

Differences in gait and brain analyses presented modulation to motor and brain activity in PD, thus, providing preliminary evidence for SA efficacy.

Therapeutic effect of scalp-based acupuncture and moxibustion as an adjunctive treatment on children with cerebral palsy comparing to conventional rehabilitation therapy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Cerebral palsy (CP) in children is a predominantly congenital developmental disease with complex causes and diverse symptoms. Chinese medicine mainly uses acupuncture for the treatment of CP; as the disease site is in the brain, emphasis is placed on scalp acupuncture therapy. There were studies about the treatment but different studies had very different results. In this study, we performed a systematic review and meta-analysis of the recent reports on scalp acupuncture in the treatment of CP in children, providing evidence for clinical diagnosis and treatment.

METHODS

The databases of PubMed, Chinese Biomedical Literature (CBM), China National Knowledge Infrastructure (CNKI), and VIP were searched for randomized controlled trials (RCTs) on scalp acupuncture treatment of pediatric CP published from January 2000 to December 2021. The inclusion criteria of studies were made according to the Participants, Intervention, Control, Outcomes, Study design (PICOS) principles. The Cochrane risk of bias 2.0 was used to evaluate the bias of the included literature. Meta-analysis was performed using the effective rate, Mental Development Index (MDI), Psychological Development Index (PDI), and Gross Motor Function Measure (GMFM-88 scale) as outcome indicators for the efficacy, and the safety of scalp acupuncture was assessed.

RESULTS

Initially, 332 articles were retrieved; after screening, 11 articles were included in the selection, including a total of 731 children, with 369 and 362 children for the experimental group and control group respectively. Meta-analysis showed that scalp acupuncture significantly improved the symptoms of children with CP [odds ratio (OR) =3.73, 95% confidence interval (CI): 2.49-5.58, Z=6.41, P<0.00001], could significantly improve their mental development [mean difference (MD) =15.58, 95% CI: 11.74-19.43, Z=7.95, P<0.00001] and psychological development (MD =13.23, 95% CI: 6.17-20.28, Z=3.67, P=0.0002) of children, and significantly improved the motor ability of CP children (MD =17.45, 95% CI: 8.19-26.72, Z=3.69, P=0.0002).

DISCUSSION

The curative effect of scalp acupuncture is better than that of conventional rehabilitation. Scalp-based acupuncture therapy can effectively improve the symptoms of pediatric CP, promote the mental and psychological development of children, and improve their gross motor function, the treatment is safe.

Perioperative Analgesic Efficacy of Yamamoto New Scalp Acupuncture for Canine Mastectomy Combined with Ovariohysterectomy: a Randomized, Controlled Clinical Trial

Background

Yamamoto New Scalp Acupuncture (YNSA) is a therapy based on the stimulation of points on the scalp and applied to treat different states of pain.

Objectives

To investigate the analgesic efficacy of YNSA for dogs undergoing radical unilateral mastectomy with ovariohysterectomy.

Methods

Twenty-four dogs were randomly distributed into two treatments (n = 12, per group): bilateral stimulation of basic B, D, and E points (YNSA group) and no application of acupuncture (control group). All dogs were sedated with morphine; anesthesia was induced with propofol and maintained with isoflurane. Fentanyl was intraoperatively administered to control cardiovascular responses to surgical stimulation. Postoperative pain was assessed using an interactive visual analog scale (IVAS) and the short-form of the Glasgow Composite Pain Scale (CMPS-SF). Morphine was administered as rescue analgesia. Data were analyzed using t-tests, Fisher's exact test, Mann-Whitney U test, and Friedman test (p < 0.05).

Results

Intraoperatively, the number of dogs requiring supplemental analgesic and the number of doses of fentanyl were lower in the YNSA group than in the control group (p = 0.027-0.034). The IVAS pain scores recorded from 0.5 h to 1 h post-extubation in the YNSA group were lower than those in the control group (p = 0.021-0.023). Postoperative rescue analgesia and CMPS-SF pain scores did not differ between the groups.

Conclusion

YNSA decreases intraoperative fentanyl requirements and provides minimal postoperative analgesic benefits to dogs undergoing unilateral mastectomy with ovariohysterectomy.

[Comparison and analysis on different academic schools of scalp acupuncture]

The scalp acupuncture therapy, an important component of the microneedle system of the acupuncturology, is effective in the treatment of multiple types of diseases. In the present paper, we made a comparative analysis about the theoretical basis, acupoint location and main clinical indications of the ten academic schools of scalp-acupuncture, including FANG Yun-peng's Scalp Acupuncture, JIAO Shun-fa's Scalp Acupuncture, ZHU Ming-qing's Scalp Acupuncture, etc. which are widely used in clinic at present after collecting the related articles published in recent 60 years from databases of CNKI, Wanfang and VIP, and relevant books. These nine academic schools are similar in clinical indications (such as neurological disorders, brain-derived di-seases) and in needle inserting angle and depth, and different in the needling manipulations, needlingmethods, needle retaining time, theoretical basis, attending diseases of the same one stimulated region, and the position and yin or yang of holograms. The main problems facing the scalp acupuncture are non-uniform positioning method, non-uniform needling method, and non-uniform indications of the same scalp acupoint. Up to now, it remains unclear that which academic school is better in the therapeutic efficacy, thus, we should strengthen clinical research to find out its inherent law in diagnosis and treatment, constantly optimize the needle scheme, determine the best scalp-acupoint position and best needling manipulations, quantize and standardize the related issues, and accelerate the integration of the different academic schools, so as to improve clinical curative effect and to further promote the application and popularization, serving the patients in a better way.

Scalp Acupuncture Protects Against Neuronal Ferroptosis by Activating The p62-Keap1-Nrf2 Pathway in Rat Models of Intracranial Haemorrhage

Intracerebral haemorrhage (ICH) can be a catastrophic event; even if the initial stages of the pathology were well-managed, a number of patients experience varied residual neurological deficits following the insult. Ferroptosis is a recently identified type of cell demise which is tightly linked to the neurological impairment associated with ICH. In the current work, the prophylactic impact of scalp acupuncture (SA) therapy on autologous blood injection murine models of ICH was investigated in order to establish whether SA could mitigate the secondary damage arising following ICH by moderating ferroptosis. The pathophysiological mechanisms associated with this process were also explored. Ludmila Belayev tests were utilised for the characterisation of neurological damage. Haematoxylin–eosin staining was employed in order to determine the cerebral impact of the induced ICH. Malondialdehyde (MDA) and iron titres in peri-haemorrhagic cerebral tissues were appraised using purchased assay kits. Transmission electron microscopy delineated mitochondrial appearances within nerve cell bodies from the area of haemorrhage. Western blotting techniques were utilised to assay the degree of protein expression of NeuN, sequestosome 1 (p62), nuclear factor erythroid 2-related factor 2 (Nrf2), Kelch-like ECH-associated protein 1 (Keap1), glutathione peroxidase 4 (GPX4) and ferritin heavy chain 1 (FTH1). The frequencies of Nrf2, GPX4 and FTH1 positive cells, respectively, were documented with immunohistochemical staining. The results demonstrated that therapy with SA after ICH mitigated MDA and iron sequestration, diminished the appearance of contracted mitochondria with increased outer mitochondrial membrane diameter within the nerve cell bodies, and suppressed neuronal ferroptosis. The pathways responsible for these effects may encompass amplified p62, Nrf2, GPX4 and FTH1 expression, together with decreased Keap1 expression. Application of SA reduced identified neurobehavioural abnormalities after ICH; no disparities were observed between the consequences of SA therapy and deferoxamine delivery. It can be surmised that intervention with SA enhanced recovery after ICH by triggering the antioxidant pathway, p62/Keap1/Nrf2, and causing FTH1 and GPX4 upregulation, factors that participate in diminishing excess iron and thus in mitigating lipid peroxidation insults arising from ferroptosis following ICH.

Potential scalp stimulation targets for mental disorders: evidence from neuroimaging studies

Mental disorders widely contribute to the modern global disease burden, creating a significant need for improvement of treatments. Scalp stimulation methods (such as scalp acupuncture and transcranial electrical stimulation) have shown promising results in relieving psychiatric symptoms. However, neuroimaging findings haven’t been well-integrated into scalp stimulation treatments. Identifying surface brain regions associated with mental disorders would expand target selection and the potential for these interventions as treatments for mental disorders. In this study, we performed large-scale meta-analyses separately on eight common mental disorders: attention deficit hyperactivity disorder, anxiety disorder, autism spectrum disorder, bipolar disorder, compulsive disorder, major depression, post-traumatic stress disorder and schizophrenia; utilizing modern neuroimaging literature to summarize disorder-associated surface brain regions, and proposed neuroimaging-based target protocols. We found that the medial frontal gyrus, the supplementary motor area, and the dorsal lateral prefrontal cortex are commonly involved in the pathophysiology of mental disorders. The target protocols we proposed may provide new brain targets for scalp stimulation in the treatment of mental disorders, and facilitate its clinical application.

Combination of Scalp Acupuncture with Exercise Therapy Effectively Counteracts Ischemic Brain Injury in Rats

BACKGROUND

Stroke is one of the leading causes of death and disability worldwide. Scalp acupuncture and exercise therapy have been proven as two effective methods for the treatment of stroke. However, their combined action and mechanisms have not been fully elucidated. The present study aimed to investigate the protective effect of scalp acupuncture combined with exercise therapy on neurons in rats with ischemic brain injury.

METHODS

100 rats were randomly divided into 5 groups including sham group, model group, acupuncture group, rehabilitation group, and experimental group (scalp acupuncture combined with exercise therapy). Middle cerebral artery occlusion (MCAO) model in rats was established according to Longa modified suture method to mimic ischemic stroke. The modified Bedexer's neurological function score was used to evaluate the neurological deficits of rats and the brain infarct volume was measured using 2, 3, 5-triphenyl tetrazolium chloride monohydrate (TTC) staining. Moreover, the apoptosis in the hippocampus was detected by western blotting and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. The pro-inflammatory cytokines such as interleukin-1 beta (IL-1β) and tumor necrosis factor-alpha (TNF-α), reactive oxygen species (ROS) and superoxide dismutase (SOD) were determined by corresponding kits. Immunohistochemistry or immunofluorescence was performed to detect the expression of brain-derived neurotrophic factor (BDNF), S100β and glial fibrillary acidic protein (GFAP) in the hippocampi of rats.

RESULTS

The neurological deficit score, the expression levels of apoptotic factors such as cleaved caspase-3 and Bax, and the TUNEL-positive cell rate of the experimental group were significantly lower than those of the acupuncture group and the rehabilitation group. However, apoptosis inhibitor Bcl-2 showed downregulated expression in the MCAO model rats but this trend was reverted by single and combinatorial treatments. In addition, the contents of TNF-α, IL-1β and ROS in the acupuncture group and the rehabilitation group were significantly lower than those in the model group, but higher than the experimental group. While the opposite results were obtained in SOD activity. Furthermore, compared with the model group, the ratios of BDNF, S100β, and GFAP-positive cells in the acupuncture, rehabilitation and experimental groups were significantly increased, and the highest ratios were recorded in the experimental group.

CONCLUSIONS

This study demonstrated that scalp acupuncture combined with exercise therapy effectively counteracts ischemic brain injury via the downregulation of pro-inflammatory mediators and ROS, the increased production of the antioxidant enzyme SOD, neurotrophic factor BDNF and astrocyte activities.

[Effect of scalp acupuncture stimulation on cerebral cortex function and related mechanism]

A literature review was performed to investigate the possible mechanism of scalp acupuncture in stimulating the skin, fascia, muscle, and periosteum and thus affecting cerebral cortex function. The results of literature research show that the effect of scalp acupuncture on cerebral cortex function may be achieved by the stimulation of specific anatomical structures. Stimulation of the skin, fascia, muscle and periosteum can activate the functional areas of the cerebral cortex through the midbrain, thalamus, and brainstem. In addition, different depths of stimulation may affect the deep and shallow sensation of the brain, self-monitoring of the fascia, subcortical central compensation, and cortical discharge. Therefore, exploration of the specific rules and differences in the effect of stimulating different anatomical structures on brain function is the future focus of the clinical and basic research on scalp acupuncture.

[Therapeutic effect of scalp acupuncture combined with rehabilitation training on balance dysfunction in children with spastic hemiplegia]

OBJECTIVE

To investigate the therapeutic effect of scalp acupuncture and rehabilitation training on balance dysfunction in children with spasmodic hemiplegia so as to provide the reference to the optimization of treatment scheme.

METHODS

A total of 60 children with spastic hemiplegia were divided into a routine group and a scalp acupuncture group, 30 cases in each one according to random number table. In the routine group, the rehabilitation training was provided, including exercise training, balance training, spasmotherapy apparatus, electromyography biofeedback apparatus and orthoses. In the scalp acupuncture group, on the base of the treatment as the routine group, scalp acupuncture was supplemented at motor area, foot motor sensory area, equilibrium area and parietal temporal anterior oblique line. Separately, before the treatment, after 3 months treatment and after 6 months treatment, the dimension D and E of the gross motor function measure-88 (GMFM-88) and Berg balance scale (BBS) were adopted to evaluate balance related motor functions and equilibrium function. The differences in the above 3 indicators at different time stages were compared in children between the two groups.

RESULTS

Compared with the score before the treatment, BBS score was obviously increased after 3 and 6 months treatment in the patients of the two groups respectively (P<0.05). The score in the dimension D and E after 6-month treatment was increased significantly as compared with the score before treatment and after 3-month treatment in the same group respectively (P<0.05). Compared with the routine group, the score of dimension D and E of GMFM-88 as well as BBS score were all increased obviously in the scalp acupuncture group after 3 and 6 months treatment (P<0.05).

CONCLUSION

On the base of routine rehabilitation training, scalp acupuncture can improve balance function of children with spastic hemiplegia better.

Regulation of gene expression after combined scalp acupuncture and transcranial magnetic stimulation in middle cerebral artery occlusion mice

BACKGROUND

The effect of combined repetitive transcranial magnetic stimulation (rTMS) and scalp acupuncture stimulation (SAS) on middle cerebral artery occlusion (MCAO) mice has not yet been reported. The regulation of gene expression after combined stimulation remains unclear.

OBJECTIVE

To analyze gene expression patterns through ribonucleic acid (RNA) sequencing.

METHODS

Thirty-six 8-weeks-old C57BL/6J male mice weighing 50-60 grams were used for this experiment. The MCAO was induced with 60-min occlusion and subsequent reperfusion of the middle cerebral artery. Experimental mice were randomly assigned to four groups, with nine mice in each group, as follows: control group (no treatment), SAS group (10 minutes SAS), rTMS group (1 Hz rTMS), and combined group (1 Hz rTMS and SAS). Stimulation was performed from the 3rd day to the 7th day after the induction of MCAO. All mice were sacrificed, and brain tissues were taken from the motor area of the MCAO lesion. We analyzed their gene expression profiles using RNA sequencing technology.

RESULTS

After stimulation, the grip strength increased in the SAS and rTMS group compared to the control and combined group. The nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB) was the key up-regulated protein in the SAS group while src homologus and collagene gene (SHC) and p90 ribosomal protein S6 kinases (p90RSK) were key up-regulated proteins in the rTMS group. However, the C-terminal src kinase-homologous kinase (CHK) was down-regulated whereas p90RSK was up-regulated in the combined group based on the RNA sequencing analysis.

CONCLUSIONS

Each stimulation method showed different patterns with neurotrophin signaling pathway including NFκB, SHC, p90RSK, and CHK. These can be used in further mechanistic studies about gene expression related to neurorecovery.

[Effect of scalp acupuncture stimulation on expression of pentraxin 3 in striatum in acute ische-mic cerebrovascular disease rats]

OBJECTIVE

To observe the influence of scalp-acupuncture on the expression of pentraxin 3 (PTX3), Interleukin (IL)-1β, zonula occludens-1(ZO-1) mRNA and Occludin mRNA in striatum in acute ischemic cerebrovascular disease (AICD) rats, so as to investigate its mechanisms underlying improvement of AICD.

METHODS

Forty-eight male SD rats were randomly allocated to control, model, IL-1Ra and IL-1Ra+scalp-acupuncture groups (n=12 rats in each group). The AICD model was established by occlusion of the middle cerebral artery (MCAO). Rats of the IL-1Ra group and IL-1Ra+scalp-acupuncture group received intraperitoneal injection of IL-1Ra (0.05 mg·kg^-1·d^-1), once daily for 6 days. Scalp acupuncture stimulation was applied to bilateral "Dingnieqianxiexian" (MS6) once daily for 6 days for rats in IL-1Ra+scalp-acupuncture group. Before and after intervention, the neurologic deficit score (NDS) was evalua-ted according to Longa's method. The expression of striatum PTX3 and IL-1β was detected by immunohistochemistry, and ZO-1 mRNA and Occludin mRNA in the striatum tissue were detected by fluorescence quantitative real-time PCR. The Evans Blue (EB) tracer method was used to monitor the degree of blood-brain barrier (BBB) damage.

RESULTS

Following modeling, the NDS, EB content and the expression of PTX3 and IL-1β in the striatum tissue were significantly increased, and the ZO-1 mRNA and Occludin mRNA expression was considerably decreased in the model group compared with the control group (P<0.05). After the interventions and compared with the model group, the NDS, EB content in both IL-1Ra and IL-1Ra+scalp acupuncture groups, and PTX3 in the IL-1Ra group were significantly down-regulated (P<0.05), while the striatum ZO-1 mRNA and Occludin mRNA expression in both IL-1Ra and IL-1Ra+scalp acupuncture groups, and PTX3 in the IL-1Ra+scalp acupuncture group were obviously up-regulated (P<0.05), and the expression of IL-1β was obviously down-regulated in the IL-1Ra+scalp acupuncture group (P<0.05) rather than in the IL-1Ra group (P>0.05). The effects of scalp acupuncture combined with IL-1Ra were obviously superior to that of IL-1Ra in down-regulating NDS, EB content and IL-1β expression level, and in up-regulating PTX3, ZO-1 mRNA and Occludin mRNA expression levels (P<0.05).

CONCLUSION

Scalp acupuncture can improve neurological function and reduce the degree of BBB injury in AICD rats, which may be associated with its function in up-regulating the expression of PTX3 and in promoting the expression of ZO-1 mRNA and Occludin mRNA.

[Effect of scalp acupuncture stimulation on cerebral infarct volume and expression of IL-10, IL-6 and IL-1β in para-hippocampal gyrus in acute ischemic cerebrovascular disease rats]

OBJECTIVE

To observe the influence of scalp acupuncture on cerebral infarct size and expression of IL-10, IL-6, and IL-1β in the para-hippocampal gyrus in acute ischemic cerebrovascular disease(AICD) rats, so as to investigate its mechanisms underlying improvement of AICD.

METHODS

Forty-eight male SD rats were randomly allocated to normal control (control), AICD model, medication, and scalp acupuncture groups (n＝12 per group). The AICD model was established by occlusion of the middle cerebral artery (MCAO). Rats of the medication group received intraperitoneal injection of Ammonium 1-Pyrrolidinedithiocarbamate (APDC, 100 mg•kg^－1•d^－1), once daily for 7 days. Scalp acupuncture stimulation was applied to bilateral "Dingnieqianxiexian" (MS6) once daily for 7 days. Before and after intervention, the neurologic deficit score (NDS) and the neurological score (NS) were evaluated according to Longa's and Schäbitz's methods, respectively. At the end of the intervention, the para-hippocampal gyrus and whole brain were collected respectively. The expression levels of IL-10, IL-6 and IL-1β in the para-hippocampal gyrus tissue were detected by immunohistochemistry, and the cerebral infarct volume of the brain was detected by triphenyltetrazollium chloride (TTC) staining after sectioning.

RESULTS

Following modeling, the NDS, NS and the expression of IL-10, IL-6 and IL-1β in para-hippocampal gyrus were significantly increased in the model group compared with the control group (P<0.01). After the intervention, the NDS, NS and infarct volume, and the expression levels of IL-6 and IL-1β in the para-hippocampal gyrus were significantly decreased in both medication and scalp acupuncture groups compared with the model group (P<0.05), and the expression of IL-10 was further obviously up-regulated in the scalp acupuncture group (P<0.05) rather than in the medication group (P>0.05). The effect of scalp acupuncture was obviously superior to that of medication in up-regulating IL-10 expression level (P<0.05). No significant differences were found between the medication and scalp acupuncture groups in the levels of NDS, NS, infarct volume, IL-6 and IL-1β proteins (P>0.05).

CONCLUSION

Scalp acupuncture can improve neurological function and reduce infarct volume in AICD rats, which may be associated with its function in up-regulating the expression of IL-10 and in inhibiting the expression of IL-6 and IL-1β to reduce inflammation reaction.

Rehabilitation with a combination of scalp acupuncture and exercise therapy in spastic cerebral palsy

PURPOSE

To use Traditional Chinese Medicine (TCM) and Western approaches to improve gross motor function and activities of daily living (ADL) in children with spastic cerebral palsy.

METHODS

Children were randomly divided into a treatment group, which received scalp acupuncture combined with exercise therapy and conventional rehabilitation training, and a control group, which received conventional rehabilitation training alone. Study subjects' gross motor function (gross motor function measure-88 [GMFM-88]) and ADL were evaluated before and after therapy.

RESULTS

GMFM-88 and ADL scores were significantly improved in both groups after therapy, but the within group differences in post- and pre-therapy GMFM-88 and ADL scores were significantly higher in the treatment group compared to the control group.

CONCLUSION

Scalp acupuncture combined with exercise therapy and conventional rehabilitation training can significantly improve gross motor function and the ability to perform ADLs in children with spastic cerebral palsy compared to conventional rehabilitation training alone.

[Scalp-acupuncture Improves Neurological Function by Regulating Expression of NF-κB p 65 mRNA, IκB mRNA and IL-1 β and TNF-α in Parahippocampal Gyrus of Cerebral Ischemia Rats]

OBJECTIVE

To observe the effect of scalp-acupuncture intervention on the expression of parahippocampal factor-κB p 65 mRNA (NF-κB p 65 mRNA), IκB mRNA, interleukin-1 β (IL-1 β) and tumor necrosis factor-α (TNF-α) in rats with cerebral ischemia (CI), so as to investigate its molecular mechanisms underlying improving CI by reducing inflammatory response.

METHODS

A total of 64 SD rats were randomized into normal control, model, medication and scalp-acupuncture groups, with 16 rats in each group. The focal CI model was established by middle cerebral artery occlusion (MCAO). Intraperitoneal injection of Pyrrolidine Dithiocarbamate (100 mg•kg^－1•d^－1) was administrated for rats in the medication group, once a day for 7 days. For rats of the scalp-acupuncture group, the acupuncture needles were rapidly inserted into bilateral Dingnieqianxiexian (MS 6) and Dingniehouxiexian (MS 7), followed by twirling the needles at 200 cycles/min for 1 min, once again every 10 min during 30 min's needle retention. The treatment was conducted once a day for 7 days. The neurologic deficit score (0－5 points, impaired consciousness, death, etc.) and neurological function score (motor, sensory and sensory tests, 0－10 points) were assessed according to Longa's (1989) and Schäbitz's (2004) methods, respectively. The expression levels of NF-κB p 65 mRNA and IκB mRNA in the parahippocampus gyrus tissue were detected by fluorescence quantitative reverse transcription-PCR, and IL-1 β and TNF-α proteins in the parahippocampus gyrus tissue were detected by immunohistochemistry.

RESULTS

After modeling, the neurologic deficit and neurological function scores and the expression levels of NF-κB p 65 mRNA, IL-1 β and TNF-α in the parahip-pocampus were significantly increased in the model group than in the normal group (P<0.01), while the expression of IκB mRNA was considerably down-regulated (P<0.01). Following treatment intervention, the neurologic deficit and neurological function scores as well as NF-κB p 65 mRNA, and IL-1 β and TNF-α protein expression were significantly decreased in both scalp-acupuncture and medication groups compared with the model group (P<0.05, P<0.01), and the decreased expression of IκB mRNA was obviously increased (P<0.05)．.

CONCLUSION

Scalp-acupuncture can improve neurologic function in cerebral ischemic rats, which is related with its effects in up-regulating the expression of IκB to inhibit the dissociation of NF-κB, then decreasing the expression of IL-1 β and TNF-α (reducing inflammatory response) in the parahippocampal gyrus tissue.

Meta-analysis on randomized controlled trials for scalp acupuncture treatment of stroke: A systematic review

OBJECTIVE

To conduct a systematic review to assess the clinical effectiveness of scalp acupuncture (SA) for stroke.

METHODS

Literature searches were performed in 7 databases up to 16 August 2014, and all the randomized controlled trials (RCTs) in which SA therapy was administered to stroke patients were selected. Methodological quality was assessed using the Jadad score, the Cochrane risk of bias assessment, and the Standards for Reporting Interventions in Clinical Trials of Acupuncture.

RESULTS

Of a total of 2086 papers, 21 RCTs were selected. Meta-analysis revealed significant differences in the total efficacy rates of the SA group and the body acupuncture (BA) group vs the medication group (P < 0.002, P < 0.000 001, respectively), the SA plus BA group vs the BA group (P < 0.001); in the motor function of the SA plus BA group vs the BA group (P = 0.077); and in the nerve function of the SA group vs the SA plus BA group (P < 0.0001).

CONCLUSION

The results of our systematic review showed that SA therapy may exhibit effects in treatment efficacy and in the recovery of motor and nervous functions in patients with acute to chronic stroke. However, because of the lack of methodological quality, the thoroughly planned clinical studies are still required.

The therapeutic effect of scalp acupuncture on natal autism and regressive autism

Background

Autism spectrum disorders (ASD) is a common disease and the incidence has been rising constantly. Acupuncture is one of the most widely used complementary and alternative medicine therapies. Despite studies had been done on the effectiveness of acupuncture on ASD children, how factors such as chronological age and the onset pattern influence the effectiveness of the therapy remains unclear. The aim of this retrospective study is to know how symptomatology of ASD alters upon the introduction of scalp acupuncture and how do age and onset type affect the effectiveness of the therapy.

Methods

ASD children aged 2–11 years old were invited to join the study. In the course of the investigation, they received a total of 30 sessions of scalp acupuncture therapy. They were then evaluated to compare the performance on various aspects before and after the treatment. The influence on the therapeutic effect by factors including chorological age and onset pattern were further taken into consideration and analyzed. In addition, investigation on the relationship between allergies and onset pattern of ASD was performed by statistically analyzing the received epidemiologic data from the participants.

Results

68 children with ASD participated in the study. It is found that the significant effective rate of scalp acupuncture on ASD is 97%. Scalp acupuncture can improve verbal communication problems the most while noise sensitivity improves the least. The therapeutic effectiveness decreases with increasing age and children with natal autism benefit more from acupuncture than those with regressive autism. In the latter part of the study, we observe a positive correlation between the family history of allergy and onset pattern.

Conclusion

Scalp acupuncture is an effective treatment for alleviating the symptomatology of ASD. The therapeutic effectiveness is expected to be higher for those patients with natal or early onset of the disorder, and at a younger age when they receive the therapy. The study result helps to formulate an ideal regimen for ASD patients and allow therapists and parents to make appropriate expectation towards the therapeutic outcome of acupuncture. Early intervention of scalp acupuncture therapy recommended. The relationship between the family history of allergic disorder and the onset type of ASD hints that the etiologies of natal and regressive ASD are discrete. It shows a great significance in differentiating the onset pattern in carrying out clinical assessments or researches on ASD patients.

Trial registration This retrospective study was approved by the Committee on the Use of Human and Animal Subjects in Teaching and Research, Hong Kong Baptist University on 4th Aug 2017. The retrospectively registered number is HASC/Student/17-18/0115

Electronic supplementary material

The online version of this article (10.1186/s13020-018-0189-6) contains supplementary material, which is available to authorized users.

[Data Mining-revealed Characteristics of Clinical Application of Scalp Acupuncture]

OBJECTIVE

To explore the regularity and characteristics of clinical application of scalp acupuncture therapy for different types of clinical conditions so as to provide a reference for clinical practice.

METHODS

In the present study, "head acupuncture" and"scalp acupuncture" were used as the keywords to search papers and academic dissertations having definite standards for diagnosis and therapeutic effect assessment and published in journals and academic conferences collected in database China National Knowledge Internet(CNKI) from January 1 of 1959 to December 31 of 2016, followed by constructing a database after sorting, screening, recording, extracting, and statistical analysis by using a computer. Then, the data mining was conducted for summarizing the indications of disease categories, involved medical departments, needle-insertion methods, needle manipulation techniques, academic schools, and clinical efficacy of scalp acupuncture therapy.

RESULTS

As a result, a total of 587 papers met our including criteria were analyzed. The scalp acupuncture therapy was widely employed in the treatment of various clinical conditions of different departments, with the application frequency being the internal medicine (438 times), surgery (75 times), pediatrics (44 times), etc. Of the indicated 102 types of clinical problems, 55 belong to the internal medicine, constituting of 53.92%, particularly the cerebral apoplexy and its sequelae with the top application frequency being 102 and 115 times, respectively. In terms of needle inserting methods mentioned in partial papers (most papers do not mention), fingernail-pressing-aided needle insertion, needle-twirling insertion, fingers-squeezed-needle insertion, particularly the swiftly rotating needle insertion and rapid needle-propelling insertion were most commonly used.Regarding the needle manipulation method, rapid needle twirling technique was frequently employed, usually at a frequency of approximately 200 times per min. In regard to the academic schools, JIAO Shun-fa's scalp acupuncture system was most frequently used, followed by the international standardized scalp acupuncture. The therapeutic effect of scalp acupuncture is effective in the treatment of different conditions of various departments, especially those of the dermatology and gynecology.

CONCLUSION

Scalp acupuncture has superiority in the treatment disorders of the internal medicine and has been demonstrated to have positive effects for many types of problems, particularly for apoplexy and its sequelae. Rapid needle-propelling insertion and rapid needle-twirling technique are often employed.

Effect of electro-scalp acupuncture on acute ischemic stroke: a randomized, single blind, trial

OBJECTIVE

To determine the clinical efficacy and safety of electro-scalp acupuncture in the treatment of patients with acute ischemic stroke.

METHODS

Totally 74 patients with acute ischemic stroke were enrolled and divided into either body acupuncture (Control) or electro-scalp acupuncture (ESA) groups according to randomized controlled principle. The patients in the control group were given body acupuncture treatment once daily for 28 d, whereas except for the body acupuncture, electro-scalp acupuncture was additional treatment given to the ESA group. Neurological deficits, everyday motor function and muscle strength were evaluated at baseline and the 28th d by NIH Stroke Scale (NIHSS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index Score (MBI), respectively.

RESULTS

There were not obvious between-group differences in the baseline efficacy parameters (NIHSS, FMA and MBI) (all P > 0.05), whereas significant between-group differences were found in post-treatment NIHSS, FMA-UE and MBI scores (all P < 0.05). After acupuncture treatment, systematic within-group improvements were found in the two groups for any of the efficacy parameters assessed (all P < 0.01), and the ESA group showed higher significant improvements in NIHSS, FMA-UE and MBI scores (all P < 0.05).

CONCLUSION

Electro-scalp acupuncture was efficacious in the treatment of acute ischemic stroke, which resulted in meaningful improvements in neurologic function, motor function and activities of daily living of patients.

Assessing the quality of reports about randomized controlled trials of scalp acupuncture combined with another treatment for stroke

BACKGROUND

This study was designed to assess the quality of reporting on randomized controlled trials (RCTs) of scalp acupuncture for the treatment of stroke.

METHODS

The following 8 databases were systematically investigated from their inception to December 2015: PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, National Institute of Informatics Scholarly and Academic Information Navigator, National Digital Science Library, Korean Traditional Knowledge Portal, and Korean Studies Information Service System. RCTs utilizing scalp acupuncture as an intervention for stroke were selected, and the quality of reports was assessed based on the Consolidated Standards of Reporting Trials 2010 statement (CONSORT) and Standards for Reporting Interventions in Controlled Trials of Acupuncture 2010 (STRICTA). For each study, the overall quality score (OQS) of 13 CONSORT items, a combined key methodological index score (MIS) of 5 CONSORT items, and the OQS of 17 STRICTA items were measured.

RESULTS

The original reports of 63 RCTs were ultimately obtained, and the median CONSORT OQS was 7 (minimum 2, maximum 11). Particularly, the items 'trial design', 'sample size', 'ancillary analyses', and 'harms' had a positive rate of less than 10%. The median MIS was 1 (minimum 0, maximum 5), with 'allocation concealment and implementation' and 'intent-to-treat analysis (ITT) analysis' having a positive rate of less than 10%. The median STRICTA OQS was 11 (minimum 6, maximum 14), and only the items 'sample size' and 'intent-to-treat analysis' were reported, with a positive rate of less than 10%. The mean CONSORT OQS increased by approximately 0.81 for each 5-year period in which manuscripts were published (95% confidence interval: 0.43 to 1.19; p < 0.001). No variable was significantly associated with MIS in the ordinal regression model.

CONCLUSION

The quality of reports on RCTs investigating scalp acupuncture treatment for stroke was moderate to low. Furthermore, reporting of some items was either insufficient or inadequate in the majority of studies. In order to improve and standardize the quality of RCTs investigating scalp acupuncture for stroke, CONSORT and STRICTA guidelines should be utilized more frequently.

Assessing the quality of reports about randomized controlled trials of scalp acupuncture treatment for vascular dementia

BACKGROUND

This study aimed to evaluate the quality of reports about randomized controlled trials (RCTs) of scalp acupuncture (SA) for the treatment of vascular dementia (VD).

METHOD

A systematic search of reports published through to December 2015 was performed in eight databases. The quality of RCTs that used SA as an intervention for VD was evaluated based on the 2010 Consolidated Standards for Reporting of Trials (CONSORT) and 2010 Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) guidelines. Thirteen items from the CONSORT guideline were scored to give an overall quality score (OQS, range 0-13), and a combined key methodological index score (MIS) (range 0-5) of five key methodological items was measured. The OQS of 17 items from the STRICTA guideline (range 0-17) was also measured.

RESULTS

In total, 26 reports were evaluated. The median OQS based on the CONSORT guideline was 8 (minimum 5, maximum 11), and "trial design," "sample size," "ancillary analyses," and "harms" had a positive rate of less than 10%. The median MIS was 2 (minimum 0, maximum 5), with "allocation concealment and implementation," "blinding," and "intent-to-treat analysis" having a positive rate of less than 15%. The median OQS based on the STRICTA guideline was 12 (minimum 8, maximum 14), with "extent to which treatment was varied (1c)," "number of needle insertions per subject per session (2a)," and "setting and context of treatment (4b)" having a positive rate of less than 10%.

CONCLUSIONS

The overall quality of reports on RCTs of SA treatment for VD was moderate to low. The quality of methodological items was markedly lower than that of other items. The CONSORT and STRICTA guidelines should be used more frequently to standardize the quality of RCT reports of SA treatment for VD.

Scalp acupuncture attenuates neurological deficits in a rat model of hemorrhagic stroke

BACKGROUND

Hemorrhagic stroke accounts for approximately 15% of all stroke cases, and is associated with high morbidity and mortality. Limited human studies suggested that scalp acupuncture could facilitate functional recovery after cerebral hemorrhage. In the current study, we used an animal model of cerebral hemorrhage to examine the potential effects of scalp acupuncture.

METHODS

Adult male Sprague-Dawley rats received autologous blood (50μL) into the right caudate nucleus on the right side under pentobarbital anesthesia, and then received scalp acupuncture (DU20 through GB7 on the lesion side) or sham acupuncture (1cm to the right side of the acupoints) (n=10 per group). A group of rats receiving autologous blood into the caudate nucleus but no other intervention, as well as a group of rats receiving anesthesia but no blood injection to the brain (n=10 per group) were included as additional controls. Composite neuroscore, corner turn test, forelimb placing test, wire hang task and beam walking were used to evaluate the behavior of rats. Hematoxylin and Eosin (HE) staining was used to observe the histopathological changes. Western blot was used to detect the content of tumor necrosis factor alpha (TNF-α) and nuclear factor-KappaB (NFκB) protein expression.

RESULTS

Scalp acupuncture attenuated neurological deficits (p<0.01 or <0.05 vs. sham acupuncture using a variety of behavioral tests) at 1-7days after the treatment. The brain content of TNF-α and NFκB was decreased (p<0.01 for both).

CONCLUSIONS

Scalp acupuncture could improve neurological deficits in a rat model of hemorrhagic stroke.

Scalp acupuncture and electromagnetic convergence stimulation for patients with cerebral infarction: study protocol for a randomized controlled trial

BACKGROUND

Scalp acupuncture (SA) and repetitive transcranial magnetic stimulation (rTMS) are effective for treating cerebral infarction. This study aims to examine the efficacy and safety of SA and electromagnetic convergence stimulation (SAEM-CS), which was developed through collaboration between conventional medical physicians and doctors who practice traditional Korean medicine. SAEM-CS was designed to improve function in patients with cerebral infarction, compared to the improvement after conventional stroke rehabilitation, SA, and rTMS therapeutic approaches.

METHODS/DESIGN

This study is a prospective, outcome assessor-blinded, randomized controlled clinical trial with a 1:1:1:1 allocation ratio. Participants with motion or sensory disabilities caused by a first-time cerebral infarction (n = 60) that had occurred within 1 month of the study onset will be randomly assigned to control, SA, rTMS, or SAEM-CS groups. All groups will receive two sessions of conventional rehabilitation treatment per day. The SA group will receive SA on the upper limb area of MS6 and MS7 (at the lesional hemisphere) for 20 min, the rTMS group will receive low-frequency rTMS (LF-rTMS) treatment on the hot spot of the M1 region (motor cortex at the contralesional hemisphere) for 20 min, and the SAEM-CS group will receive LF-rTMS over the contralesional M1 region hot spot while receiving simultaneous SA stimulation on the lesional upper limb area of MS6 and MS7 for 20 min. SA, rTMS, and SAEM-CS treatments will be conducted once/day, 5 days/week (excluding Saturdays and Sundays) for 3 weeks, for a total of 15 sessions. The primary outcome will be evaluated using the Fugl-Meyer Assessment, while other scales assessing cognitive function, activities of daily living, walking, quality of life, and stroke severity are considered secondary outcome measures. Outcome measurements will be conducted at baseline (before intervention), 3 weeks after the first intervention (end of intervention), and 4 weeks after intervention completion.

DISCUSSION

This study aims to explore the efficacy and safety of SAEM-CS on cerebral infarction. Collaborative research combined traditional Korean and conventional medicines, which can be useful in developing new treatment technologies.

TRIAL REGISTRATION

KCT0001768 . Registered on 14 January 2016.