In the treatment of post-stroke depression (PSD), acupuncture has emerged as a therapeutic option; however, the exact mechanisms underlying its efficacy remain unclear. Prior research suggests acupuncture may improve PSD symptoms by regulating M1/M2 microglial polarization, reducing the release of inflammatory factors and inflammatory-associated damage. The aim of the present study was to explore whether manual acupuncture (MA) can mediate microglial polarization via the silence information regulator/nuclear factor κB (Sirt1/NF-κB) pathway, thereby reducing inflammatory responses in the brains of rats exhibiting PSD and improving depressive behavior. Thirty male rats were divided into a middle cerebral artery occlusion (MCAO) group, PSD group, PSD + MA group, PSD + MA + Sirt1 inhibitor group, and PSD + MA + NS (normal saline) group. Acupuncture was applied 6 days a week for 4 weeks at GV26, GV20 and bilateral PC6 and SP6. In the PSD + MA + Sirt1 inhibitor group, nicotinamide (NAM), a specific inhibitor of Sirt1, was slowly injected into the frontal lobe with a stereotactic injector 1 h before acupuncture. Behavioral tests were conducted after modeling and intervention, including the sucrose preference test (SPT) and open field test (OFT), and body weight was monitored. Following the tests, specimens of the dorsolateral frontal lobe were taken to evaluate molecular markers. Immunofluorescence staining was employed to determine the expression levels of M1 microglial markers CD16/Iba1 and M2 microglial markers CD206/Iba1 in the dorsolateral prefrontal cortex. mRNA expression of CD16/intrinsic nitric oxide synthase (iNOS) and CD206/arginase (Arg)-1 was detected by q-RT-PCR. Western blot analysis was used to quantify protein expression of Sirt1, total p65 and phosphorylated p65 (p-p65) proteins. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF)-α levels were quantified using ELISA. Depression-like behavior of PSD model rats was reduced by MA. Acupuncture promoted transformation of microglia from M1 to M2 in the prefrontal lobe, thereby decreasing expression of pro-inflammatory factors (IL-1β, IL-6 and TNF-α) and increasing expression of anti-inflammatory IL-10 after PSD. In addition, expression of Sirt1 in the prefrontal lobe increased following MA, while expression of p65/p-p65 was reduced, indicating activation of the Sirt1/NF-κB pathway. These findings suggest that M1 to M2 microglial polarization was closely related to Sirt1/NF-κB pathway activation following MA. MA promoted the transformation of microglia from M1 to M2 in the prefrontal lobe of PSD rats, reduces the inflammatory response and improves depression-like behavior in rats. These effects were associated with activation of the Sirt/NF-κB pathway.
Acupuncture may alleviate both the motor and depressive symptoms of Parkinson's disease (PD); however, the underlying mechanism has not yet been elucidated. In this study, on the basis of previous findings that acupuncture improves depressive behaviors in a rat model of depression in Parkinson's disease (DPD), we investigated whether manual acupuncture (MA) has a modulatory effect on the phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway, autophagy and prefrontal cortical synaptic repair proteins in a rat model of DPD. We screened 6-hydroxydopamine (6-OHDA)-induced DPD model rats and divided them into four groups: DPD group, DPD + MA group, DPD + PI3K group and DPD + MA + PI3K group. The latter two groups were injected with the PI3K inhibitor LY294002. A sham group injected with normal saline was also included. Twenty-eight days after the end of treatment, the expression of phosphorylated (p)-PI3K, p-Akt, p-mTOR, p-p70S6K (70 kDa ribosomal protein S6 kinase), p-4E-BP-1 (4E binding protein 1), p62, Beclin-1, Synapsin I and postsynaptic density protein (PSD)95 in the prefrontal cortex was determined by Western blotting. We used transmission electron microscopy (TEM) to study neuronal damage and evaluate the effect of MA on neurons and autophagy in the prefrontal cortex of DPD model rats. MA upregulated the expression of p-PI3K, p-Akt, p-mTOR, p-p70S6K, p-4E-BP-1, p62, Synapsin I and PSD95, and decreased expression levels of Beclin-1, in the prefrontal cortex of DPD model rats. Acupuncture attenuated neuronal damage and reduced the number of autophagosomes in the prefrontal cortex of DPD model rats. Acupuncture may serve as a treatment for DPD by activating the PI3K/Akt/mTOR pathway to inhibit the process of autophagy and repair damaged synapses.
To investigate the role and mechanism of the dorsal motor nucleus of the vagus nerve (DMV) in the effects of electroacupuncture (EA) at HT7 in a mouse model of chronic heart failure (CHF). A CHF model was established in male C57 mice by ligating the anterior descended branch of the left coronary artery. In part I of the experiment, mice were randomly divided into Control, untreated model (CHF) and EA-treated model (CHF + EA) groups (n = 6 each). In part II, mice were randomly divided into the following groups (n = 6 each): EA-treated model group (CHF + EA); EA-treated model group receiving cholinergic neuron promoter chemogenetic activating virus encoding human M4 muscarinic (hM4) receptor (hM4D) and clozapine-N-oxide (CNO) (CHF + hM4D + CNO + EA); EA-treated model group additionally receiving "empty" virus encoding enhanced green fluorescence protein (EGFP) and CNO (CHF + EFGP + CNO + EA); EA-treated model group receiving hM4D only (CHF + hM4D + EA); and EA-treated model group receiving CNO only (CHF + CNO + EA). All mice except those in the Control and CHF groups were treated with bilateral EA at HT7 (frequency 2 Hz, intensity 2mA, pulse width 0.2 ms ± 20%) once a day (20 min each time) for 7 days. Left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), scar area and serum inflammatory factor levels were evaluated using a Doppler ultrasound imaging system, Masson staining, ELISA and other methods. Compared with the Control group, LVEF/LVFS in the CHF group decreased (p < 0.001), the scar area was larger, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and interleukin (IL)-6 levels increased significantly, and acetylcholine (ACh) decreased significantly (p < 0.001) in the CHF group. Compared with the CHF group, LVEF/LVFS increased (p < 0.001), scar area was smaller, ANP, BNP and IL-6 decreased significantly and ACh increased significantly (p < 0.001) in the CHF + EA group. Compared with the CHF + EA group, the CHF + hM4D + CNO + EA group exhibited a decrease in LVEF/LVFS (p < 0.001), a larger scar area, a significant increase in ANP, BNP and IL-6, and a significant decrease in ACh (p < 0.001),while there was no significant difference in each index between the CHF + CNO + EA and CHF + hM4D + EA groups (p > 0.05). Compared with the CHF + hM4D + CNO + EA group, the CHF + EGFP + CNO + EA exhibited an increase in LVEF/LVFS (p < 0.001), a smaller scar area, a significant decrease in ANP, BNP and IL-6, and a significant increase in ACh (p < 0.001). Electroacupuncture at (HT7) may activate DMVAch and reduce myocardial fibrosis, thereby improving CHF, in a mouse model.
The aim of this study was to investigate the effects of acupuncture on a rat model of chronic migraine (CM) and explore the underlying mechanism of action from the perspective of the gut-brain axis. A total of 24 male Sprague-Dawley (SD) rats were randomly allocated into control, model and acupuncture groups (n = 8 each). The CM model was established by intraperitoneal injection of nitroglycerin (NTG). Acupuncture was administered at GV20 and bilateral PC6/LR3/ST36 for rats in the acupuncture group once a day for 9 days. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of 5-hydroxytryptamine (5-HT), calcitonin gene-related peptide (CGRP) and vasoactive intestinal peptide (VIP) in plasma. A combination of 16S rDNA sequencing and liquid chromatography-mass spectrometry (LC-MS) metabolomics was adopted to investigate the role of the gut-brain axis in migraine chronification and the effect of acupuncture on CM. Acupuncture treatment significantly attenuated hyperalgesia in CM model rats and regulated serum levels of brain-gut peptides, including 5-HT, CGRP and VIP. Furthermore, the gut microbial community structure and metabolic profile changed in CM rats and acupuncture impacted the changes. Notably, acupuncture modulated 10 gut microbial genera and 13 fecal metabolites. These findings suggest that the gut-brain axis may play an important role in the chronification of migraine, and the regulation of gut microbiota and metabolites may be one of the mechanisms underlying the analgesic effect of acupuncture in CM.
Metformin (Met) is a first-line pharmacological treatment for type 2 diabetes mellitus (T2DM). The potential effect of combining electroacupuncture (EA) at ST25 (Tianshu) with Met in ameliorating intestinal injury remains largely unexplored. We established wild-type (Control) and diabetic model groups that remained untreated (Model), received EA only (EA), received Met treatment only (Met) or received EA combined with Met (EA + Met), and compared markers of intestinal injury and insulin resistance, as well as effects on signal transducer and activator of transcription (STAT) proteins and microRNAs. EA and Met treatment (alone and in combination) had positive effects on fasting plasma glucose, fasting insulin levels, Homeostatic Model Assessment-insulin resistance (HOMA-IR) indices and stool number, while fecal water content was positively impacted by EA treatment (with or without concurrent Met) but not Met alone. Hematoxylin-eosin staining demonstrated that both EA alone and EA in combination with Met appeared to repair intestinal damage in the jejunum, ileum and colon. In addition, enzyme-linked immunosorbent assay revealed that serum interleukin 10 levels were restored in all treatment groups. Furthermore, quantitative real-time polymerase chain reaction (PCR) analysis revealed that EA at ST25 resulted in the activation of STAT5A in the jejunum, as well as STAT5A, STAT5B and STAT6 in the ileum. Notably, in the EA + Met group, there was a specific enhancement of STAT2, STAT3 and STAT5B in the colon, indicating segment-specific activation within distinct regions of the intestine. EA at ST25 may ameliorate intestinal injury via the Janus kinase (Jak)/STAT signaling pathway and is closely related to jejunal and ileal segments. These findings provide a theoretical basis for EA combined with medication.
Intestinal inflammatory responses are a key pathological feature of inflammatory bowel disease (IBD) and the nucleotide oligomerization domain (NOD)-like receptor protein 3/cysteine aspartate protease-1/apoptosis-associated speck-like protein (NLRP3/caspase-1/ASC) signaling pathway plays a key role in mediating these responses. The aim of this study was to investigate how electroacupuncture (EA) affects inflammation-related protein levels, including NLRP3, caspase-1 and ASC, in a mouse model of IBD and explore the underlying mechanisms of action. Forty-eight mice were randomly assigned to control, model, EA and NLRP3 inhibitor groups. IBD was induced using dextran sodium sulfate (DSS). After 1 week of EA treatment, fecal occult blood tests were performed and disease activity index (DAI) scores were recorded. In addition, hematoxylin-eosin staining was performed to evaluate the histopathological changes in the colon. Serum interleukin (IL)-1β, IL-18 and tumor necrosis factor (TNF)-α levels were measured using enzyme-linked immunosorbent assay, and protein expression of NLRP3, caspase-1, ASC, gasdermin D (GSDMD), N-terminal GSDMD (N-GSDMD), IL-1β and IL-18 in colonic tissues was assessed using Western blotting. IBD resulted in alterations in general condition and colonic morphology, a significant increase in serum IL-1β, IL-18 and TNF-α levels, and a significant increase in protein expression of NLRP3, caspase-1, ASC, GSDMD, N-GSDMD, IL-1β and IL-18 in the colonic tissues (p < 0.01 or p < 0.001). EA and NLRP3 inhibition reversed these pathological changes and reduced the expression of inflammatory proteins induced by intestinal inflammatory responses (p < 0.05 or p < 0.01). The NLRP3/caspase-1/ASC signaling pathway appears to play a role in mediating the therapeutic effects of EA in IBD.
Incisional pain, which is the most commonly observed postoperative complication, is closely related to the release of inflammatory mediators and cytokines. Although electroacupuncture (EA) has been demonstrated to reduce incisional pain, its analgesic mechanisms remain unclear. We aimed to investigate whether EA alleviates incisional pain in rats by regulating the expression of interleukin (IL)-6 and procalcitonin (PCT) in the astrocytes and neurons of the spinal cord dorsal horn. Forty-six healthy male Sprague-Dawley rats were included, of which n = 8 were assigned to the control group. The remaining 38 rats were used to establish the incisional pain model. Finally, 32 successfully modeled rats were obtained and randomly divided into model, sham EA, 2 Hz and 20/100 Hz EA groups. Mechanical pain withdrawal threshold (MPWT) was measured before modeling, 6 h after modeling, and 3 days after EA intervention. Enzyme-linked immunosorbent assay, Western blotting and immunofluorescence were used to detect IL-6 and PCT protein and mRNA expression, as well as their co-expression with glial fibrillary acidic protein (GFAP, a marker of astrocytes) and NeUN (a marker of neurons) in the spinal dorsal horn of rats in each group after 3 days of EA intervention. Reduced IL-6 and PCT levels in the astrocytes and neurons were observed in the spinal dorsal horn of the incisional pain model after EA intervention, and incisional pain was also significantly relieved. Both 2 Hz and 20/100 Hz EA appear to relieve incisional pain in rats and these effects may be related to inhibition of IL-6 and PCT expression in the spinal dorsal horn.
Myofasciitis, a prevalent cause of musculoskeletal pain, is associated with thoracolumbar fascial changes. Acupuncture is effective for pain relief, but its role in fascial repair remains unclear. This study examined the effects of electroacupuncture (EA) at BL23 (Shenshu) and BL40 (Weizhong) on fascial tissue repair in a rat model of thoracolumbar fasciitis (TLF). The study involved 42 six-week-old Sprague-Dawley rats divided into control (n = 15) and modeling (n = 27) groups. TLF was induced by injecting complete Freund's adjuvant into the thoracolumbar fascia. Three rats in the control and modeling groups were used for model validation. The remaining 24 modeled rats were split into model and EA groups (n = 12 each). EA was administered at BL23 and BL40 to rats in the EA group for 20 min daily for 9 days. Assessments included skin pain sensitivity, musculoskeletal ultrasound, histological evaluation of fascial thickness, and measurement of inflammatory markers and fibroblast activity. EA-treated rats showed significant improvements, including reduced mechanical pain sensitivity, decreased fascial thickness and lower expression of pro-inflammatory markers (tumor necrosis factor-α, interleukin 1β) and fibroblast activity markers (proliferating cell nuclear antigen, α-smooth muscle actin, and vimentin). There was also a favorable balance in extracellular matrix components (increased type I/III collagen and matrix metalloproteinase (MMP)-1/tissue inhibitor of MMP (TIMP)-1 ratios), which was linked to reduced activity of the transforming growth factor (TGF)-β1/suppressor of mother against decapentaplegic (Smad)2 pathway. EA at BL23 and BL40 reduces inflammation, inhibits fibroblast proliferation and activation, and promotes fascial repair, likely via modulation of the TGF-β1/Smad2 pathway. These findings support the therapeutic potential of EA for the treatment of myofasciitis, potentially aiding in chronic musculoskeletal pain management and fascial tissue repair.
To evaluate the effects of electroacupuncture (EA) on myocardial insulin resistance (IR) in Zucker diabetic fatty (ZDF) rats, an established model for type 2 diabetes mellitus (T2DM). Twenty-four ZDF-Leprfa/fa rats were randomized to: (1) ZDF group (n = 8); (2) ZDF + PIO (pioglitazone) group (n = 8); and (3) ZDF + EA group (n = 8). An additional control group of eight healthy ZDF+/fa rats was included (Lean group). We examined protein and mRNA expression levels of critical insulin signaling pathway intermediates including insulin receptor substrate (IRS)-1, phosphoinositide 3-kinase (PI3K), protein kinase B (Akt), adenosine monophosphate (AMP)-activated protein kinase (AMPK), ribosomal protein S6 kinase (p70S6K), glycogen synthase kinase 3β (GSK3β) and glucose transporter type 4 (GLUT4), as well as serum levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α and C-reactive protein. Echocardiography and cardiac histology were performed. Significant improvements in glucose metabolism, reflected in reduced fasting insulin levels and fasting blood glucose levels, were demonstrated after EA and PIO treatment. EA treatment also led to a notable decrease in inflammatory cytokine levels. In addition, there were marked improvements in myocardial structural integrity, as evidenced by histological analyses. Moreover, increased GLUT4 expression in myocardial tissue suggested improved insulin signaling, further supported by reductions in markers of myocardial injury such as serum troponin T type 2 (TNNT2) and B-type natriuretic peptide (BNP). EA ameliorated myocardial IR in a rat model of T2DM and positively impacted TNNT2 and BNP levels, as well as phosphorylation status and mRNA expression of several genes involved in the insulin signaling pathway. Our findings underscore the potential of EA to modulate multiple therapeutic targets in the treatment of myocardial IR. If these effects can be replicated clinically, EA may represent a promising non-pharmacological option for the management of cardiometabolic risks associated with diabetes.
To investigate the influence of acupuncture expectancy on fertility outcomes in infertile women with polycystic ovary syndrome (PCOS) receiving active or control acupuncture with or without clomiphene. This study was a secondary analysis of PolyCystic Ovary Syndrome Acupuncture plus Clomiphene Trial (PCOSAct), which was randomized controlled trial that recruited 1000 infertile patients with PCOS and randomly allocated them to receive active acupuncture or control acupuncture with or without clomiphene. Acupuncture expectancy data (measured on a scale from 4 to 20 points) were available in 827 women, who were subdivided into low expectancy and high expectancy groups (with scores <16 or ⩾16 points, respectively) after the third session of active or control acupuncture treatment. Anthropometric and endocrine parameters and fertility outcomes were compared. Kaplan-Meier curves were employed to evaluate the time to ovulation and live birth and a Cox regression model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting by body mass index (BMI) and treatment group allocation in PCOSAct. 373 and 454 patients were identified as having low and high expectancy, respectively. Compared with the low expectancy group, patients with high expectancy had been attempting to conceive for a shorter period (18 vs 24 months) and were more likely to have a prior history of acupuncture treatment (16.7% vs 10.7%). They also had an earlier menarche (13 vs 14 years), a higher BMI (23.8 vs 23.5 kg/m2) and a lower estradiol level (194.5 vs 206.9 pmol/L). There was no interaction between acupuncture and acupuncture expectancy in terms of fertility outcomes. High expectancy was significantly associated with a shorter time to ovulation (35.0 vs 49.0 days) and higher chances of ovulation during the study period (HR: 1.3, 95% CI: 1.1-1.5). After adjusting for confounders, there were no significant between-group differences in any other outcomes, including conception, clinical pregnancy and live birth. High acupuncture expectancy was associated with a shorter time to ovulation and higher chances of ovulation in infertile patients with PCOS receiving active or control acupuncture in the PCOSAct trial. NCT01573858 (ClinicalTrial.gov) and ChiCTR-TRC-12002081 (Chinese Clinical Trial Registry).
To investigate the effects of manual acupuncture (MA) on the signal transduction and activator of transcription (STAT)3 - matrix metalloproteinase (MMP)-2 pathway in a guinea pig model of lens-induced myopia (LIM). A total of 36 male pigmented guinea pigs (aged 2 weeks) were randomly assigned to the normal control (NC) (n = 12), LIM (n = 12) and LIM + MA (n = 12) groups. The NC group received no intervention. To create myopia, the right eyes of the LIM and LIM + MA groups were covered with -6.00 D lenses. The LIM + MA group received 30 min of acupuncture stimulation daily at Taiyang and LI4. The effect of LIM modelling and MA on ocular measurements, expression of STAT3, phosphorylated (p)-STAT3, MMP-2 and tissue inhibitor of MMP-2 (TIMP)-2 expression (as well as histopathology, morphology and immunohistochemistry of the guinea pigs' eyes) were evaluated. Compared with the NC group, the LIM group showed increased expression of STAT3, p-STAT3 and MMP-2, and decreased expression of TIMP-2, as well as an increase in ocular measurements. The eye tissue morphology was disrupted and fibres became thinner in the LIM group. Compared to the LIM group, the LIM + MA group exhibited a noteworthy decline in the expression of STAT3, p-STAT3 and MMP-2, a significant increase in TIMP-2, and a decrease in ocular measurements and tissue morphology, which were similar to that of the NC group. Acupuncture has the potential to decrease STAT3 activation and block the STAT3-MMP-2 pathway in the ocular tissue of guinea pigs with experimental LIM, thereby delaying the development of myopia.
To explore the analgesic effects of electroacupuncture (EA) and its impact on the EphBs-p38 mitogen-activated protein kinase (MAPK) pathway and microglia in a rat model of neuropathic pain (NP). Following adaptive training, 60 male Sprague Dawley (SD) rats were allocated to one of two experiments. In experiment 1, rats received intrathecal SB203580 (p38 MAPK inhibitor), intramuscular EphB1-Fc (EphBs inhibitor) or no injection before undergoing chronic constrictive injury (CCI). In experiment 2, CCI model rats received EA either alone or combined with either anisomycin (p38 MAPK agonist) or EphrinB1-Fc (EphBs agonist) versus minimal acupuncture (MA) as a control intervention. A sham surgery group was included in both experiments as a control for CCI. All groups consisted of n = 6 rats (four in experiment 1 and six in experiment 2). Behavioral hyperalgesia was examined and the spinal L5-6 region was harvested and subjected to enzyme-linked immunosorbent assay to assess tumor necrosis factor (TNF)-α and interleukin (IL)-1β levels. Western blotting and immunofluorescence were used to assess protein expression of B-cell lymphoma (Bcl)-2, Bcl-2 associated X-protein (BAX), EphB1, EphrinB1, p38 MAPK, phosphorylated (p)-p38 MAPK and ionized calcium binding adaptor molecule (Iba)-1. CCI induced behavioral hyperalgesia, as demonstrated by altered paw withdrawal latency (PWL), paw withdrawal threshold (PWT) and cytokine levels, and increased p38 MAPK phosphorylation and microglial activation. However, inhibitors SB203580 and EphB1-Fc reversed these effects. Notably, EA showed similar beneficial effects, but these were counteracted when combined with anisomycin and EphrinB1-Fc. The analgesic effects of EA in this rat model of NP appear to be linked to diminished p-p38 MAPK expression and subsequent microglial deactivation. EA has a potential role as a complementary therapy for NP.
Acupuncture was shown to be efficacious for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in a prior randomized controlled trial (RCT). The purpose of this secondary analysis was to evaluate the efficacy of acupuncture in the subgroup of CP/CPPS patients with a sedentary lifestyle and to compare outcomes between sedentary and non-sedentary participants in the group receiving acupuncture. In the original RCT, 440 patients with moderate to severe CP/CPPS received 20 sessions of acupuncture or sham acupuncture (SA) over 8 weeks and were followed up for 24 weeks after the treatment was completed. The primary outcome was the proportion of sustained responders, defined as those with a reduction of at least six points in the National Institute of Health-chronic prostatitis symptom index (NIH-CPSI) total score at weeks 8, 20 and 32. In this secondary analysis, we compared n = 147 participants in the acupuncture group with a sedentary lifestyle group: (1) n = 148 participants with a sedentary lifestyle in the SA group ; and (2) n = 62 participants with a non-sedentary lifestyle in the acupuncture group. Among those with a sedentary lifestyle, the proportion of sustained responders was 38.3% in the acupuncture group versus 20.1% in the SA group (odds ratio (OR) 2.52 [95% confidence interval (CI) 1.45-4.10]; P = 0.001). However, among those receiving verum acupuncture, response rates were higher in non-sedentary compared with sedentary participants at 56.9% vs 38.3% (OR 1.32 [95% CI 1.19- 3.49]; P = 0.044). Acupuncture appears to be an efficacious for the treatment of CP/CPPS patients with a sedentary lifestyle. However, compared with a non-sedentary population, sedentary patients are less likely to achieve a significant/sustained treatment response following acupuncture.
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common elective surgical procedures that are often associated with significant post-operative pain, commonly leading to opioid use. Acupuncture has been studied as a non-invasive approach to alleviate post-operative pain and reduce opioid consumption. Our aim was to review the literature to assess the efficacy of pre-operative and intra-operative acupuncture as an analgesic adjunct for arthroplasty patients. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement guidelines. A comprehensive search was conducted in multiple databases to identify studies that utilized acupuncture in primary THA and TKA patients from their inception to June 2023. Inclusion criteria included full-text availability and publication in the English language. Eight studies were included in the final analysis, comprising seven randomized controlled trials and one prospective cohort study. Meta-analysis was not feasible due to the heterogeneity of study design and outcome measures. Acupuncture use led to a significant reduction in total intra-operative fentanyl and post-operative patient-controlled analgesia (PCA) use in THA and TKA patients. Patients who received acupuncture reported fewer analgesic-related side effects. However, patient-reported outcome measures (PROMs) varied among studies, with no consistent trend observed. The incorporation of pre- and intra-operative acupuncture into arthroplasty protocols may help reduce opioid usage and minimize analgesia-related side effects. It appears, based on the available literature, that acupuncture has the potential to improve pain management in arthroplasty patients. Although the number of studies remains limited, the cost-effectiveness and ease of implementation of acupuncture suggest that it could be an advantageous adjunct in the peri-operative setting. Further research is needed to establish best practices and guide healthcare professionals on the use of acupuncture in arthroplasty patients.
Electroacupuncture (EA) has been shown to be effective in the treatment of knee osteoarthritis (KOA); however, its underlying mechanism remains unclear. 40 KOA model rats were divided into control, untreated model, EA-treated model and celecoxib-treated model groups (n=10 each). Articular cartilage of the knee joint was stained with hematoxylin and eosin (HE), periodic acid-Schiff (PAS) and Alcian blue (AB)-PAS, and Moran/Mankin scores were used to evaluate articular cartilage injury across groups. Moreover, toll-like receptor (TLR)4/nuclear factor (NF)-κB pathway (TN-P)-related protein levels in the articular cartilage were detected using Western blotting. Oxidative stress and inflammatory biomarkers in the synovial fluid were measured by enzyme-linked immunosorbent assay (ELISA). MicroRNA (miRNA/miR) expression was measured by quantitative real-time polymerase chain reaction (qRT-PCR). Compared with the control group, Moran scores increased and Mankin scores decreased in the KOA model rats. In addition, compared with those in the control group, levels of superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and interleukin (IL)-10 were significantly decreased, while levels of IL-1β, IL-6, tumor necrosis factor (TNF)-α, malondialdehyde (MDA) and nitric oxide (NO) were significantly increased, in the synovial fluid of the KOA model group. Protein levels of TLR4, anti-myeloid differentiation primary response protein 88 (MyD88) and p65 NF-κB phosphorylation were significantly increased in the articular cartilage of the KOA model group. EA and celecoxib treatment reversed the trends of these protein levels. Moreover, expression of miR-15a/127/140/146a/216a-5p and miR-27a-3p in the articular cartilage were markedly increased in KOA rats, while EA and celecoxib treatment reduced their expression. EA reduces inflammation, oxidative stress and cartilage damage in KOA model rats, likely through regulation of the miRNA/TLR4/NF-κB pathway.
The aim of this study was to evaluate the therapeutic effect of electroacupuncture (EA) in a rat model of stress urinary incontinence (SUI) induced by vaginal distension (VD). The potential mechanisms underlying this process were also explored. Virgin Sprague-Dawley rats underwent VD (to model SUI) or a sham operation, followed by EA or no treatment. Cystometry and leak point pressure (LPP) testing were employed to demonstrate the impact of EA on the micturition reflex and urethral closure function. mRNA expression of α1A and α1D adrenoceptors and 5-hydroxytryptamine (5-HT)2C and 5-HT2A receptors were examined in spinal segments using real-time qRT-PCR, Western blotting and immunohistochemistry (IHC). The individual role of 5-HT2A and 5-HT2C receptors were distinguished with selective antagonists (MDL 100907 and SB 242084, respectively). EA treatment successfully reversed the decrease of LPP induced by VD without any significant effect on the micturition reflex in this rat model of SUI. VD did not change bladder basic pressure (BP), voided volume or bladder contraction. Multiple approaches including qRT-PCR, Western blotting and IHC revealed over-expression of 5-HT2C and 5-HT2A receptors but not α1A or α1D adrenoceptors in the L6-S2 spinal cord of these rats. Administration of the 5-HT2C antagonist (SB 242084) largely eliminated EA-mediated mitigation of the decrease in LLP caused by VD, while the 5-HT2A antagonist (MDL 100907) had no effect under these conditions. EA improves impaired urethral closure capacity induced by VD in female rats, and it appears that the 5-HT2C receptor plays a critical role in this effect. It is reasonable to speculate that EA represents a promising treatment for SUI caused by childbirth trauma.
The aim of this study was to investigate the effect of electroacupuncture (EA) on macrophage polarization and bone erosion in a mouse model of collagen-induced arthritis (CIA). C57BL/B6 mice were used to establish a CIA model and were treated with electroacupuncture (EA) at ST36 and SP6. At the end of the experiment, knee joints were harvested for hematoxylin-eosin (H&E) staining to detect knee synovitis. Immunohistochemistry (IHC) was performed to assess the expression of macrophage markers. The degree of bone destruction was evaluated using micro-computed tomography (CT), tartrate-resistant acid phosphatase (TRAP) staining and safranin-O fast green staining. Peripheral blood transcriptome sequencing was performed using Illumina high-throughput sequencing. Synovial membrane proteins were quantitatively analyzed by mass spectrometry. Differentially expressed genes and proteins were identified and the R software package was used to analyze the data. Compared with the model group, the arthritis index (P < 0.05) and inflammatory infiltration decreased (P < 0.05), cartilage destruction was inhibited (P < 0.01), the number of osteoclasts decreased (P < 0.05), knee bone erosion was alleviated and the M1/M2 macrophage ratio decreased (P < 0.01) in the EA group. The results of bioinformatics analysis showed that the differential genes between the EA and model groups were mainly enriched in rheumatoid arthritis (RA) and the peroxisome proliferator-activated receptor (PPAR) signaling pathway. Differentially expressed proteins were mostly enriched in the toll-like receptor (TLR) signaling and autophagy pathways. EA prevents bone erosion, reduces the M1/M2 macrophage ratio in synovial tissue, inhibits the TLR and autophagy pathways and reduces synovial invasion in a mouse model of CIA.
Postherpetic neuralgia (PHN) is a prevalent and painful complication following herpes zoster infection, impacting patient quality of life and posing significant treatment challenges. Current pharmacological approaches often result in adverse effects. The aim of this study was to develop a clinical prediction model for selecting PHN patients for electroacupuncture (EA) treatment and to determine the prognostic outcomes after two sessions. We conducted a retrospective observational cohort analysis on adults diagnosed with PHN between 2010 and 2017. All participants had undergone at least two acupuncture sessions. Data analysis included demographic, clinical and treatment variables to identify predictors of treatment outcomes. Treatment success was defined using the numeric rating scale (NRS), with failure characterized by an NRS score >3. Predictive modeling and internal validation employed bootstrap resampling. Among 243 patients included in the study, the treatment failure rate was 20.6%. Key predictive factors for treatment outcome were the presence of diabetes mellitus, use of carbamazepine and high initial NRS scores. The accuracy of the prediction model was reflected by an area under the receiver operating characteristic (ROC) curve of 0.80 after the first session and 0.88 following the third session, indicating a robust predictive capability. In this study, we successfully developed and internally validated a clinical prediction model for EA in PHN patients. We anticipate that this model may guide clinicians in personalized patient care, optimizing the selection process for EA treatment, and predicting treatment response early in the treatment cycle.
Nausea, vomiting and pain are common postoperative complications. The aim of this study was to evaluate the effects of ondansetron combined with acupuncture at bilateral PC6 during the intraoperative period on the incidence of postoperative nausea and vomiting (PONV), severity of nausea/pain and the need for rescue antiemetics in patients undergoing elective one- or two-level lumbar disc herniation (LDH) surgery. In this double-blind randomized controlled trial, 92 patients with American Society of Anesthesiologists (ASA) physical status I-II who were scheduled for elective LDH surgery under general anesthesia were randomized into two groups: the acupuncture group (group A) and the control group (group C). Group A received PC6 acupuncture bilaterally plus ondansetron; group C received ondansetron only. PONV was defined as nausea with a visual analog scale (VAS) score ⩾4, vomiting or need for rescue medication. Persistent nausea (>20 min), unchanged score or repeated vomiting prompted administration of 4 mg intravenous (IV) ondansetron. Pain scores ⩾4 were treated with IV dexketoprofen. Data on 79 patients (n = 40 in group A and n = 39 in group C) were analyzed. The incidence of PONV within 24 h (primary outcome) did not significantly differ in group A versus group C (15.0% vs 33.3%, p = 0.057). However, nausea incidence at 0-24 h, as well as PONV incidence and rescue antiemetic use at 0-2 h, were significantly lower in group A (p < 0.05). Nausea and pain severity were also significantly lower in group A at 0-2 and 2-4 h (p < 0.05). A moderate positive correlation was found between pain and nausea severity over 24 h (p < 0.001). Although this study was negative in its primary endpoint, multiple significant secondary findings suggest that acupuncture with standard antiemetic therapy was associated with lower early PONV and reduced rescue antiemetic use. NCT06669676 (ClinicalTrials.gov).
Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and is associated with significant strain on both patients and healthcare systems. Acupuncture is one of the conservative treatments used for this syndrome, although more evidence is needed regarding the efficacy of this intervention. The aim of this pilot study was to evaluate the effects of electroacupuncture (EA) in patients with CTS through clinical, electrophysiological and ultrasonographical assessments. Seventeen wrists, belonging to a total of 12 patients who had been diagnosed with CTS, were included. Eight EA sessions were performed (twice a week for 4 weeks). The visual analogue scale (VAS), symptom severity scale (SSS) and functional status scale (FSS) of the Boston Carpal Tunnel Questionnaire (BCTQ) were administered, median nerve conduction studies were performed and the cross-sectional area (CSA) of the median nerve was measured by ultrasound. These evaluations were made at baseline and 3-7 days after the last treatment. Following EA, there was a decrease in pain on the VAS scale with a median difference (MD) of -2.45 (p < 0.001), a decrease in the severity of symptoms on the SSS scale (MD -0.60; p = 0.001) and an improvement in the function of the limb on the FSS scale (MD -0.25; p = 0.02). Furthermore, there was a reduction in the CSA of the median nerve at the carpal tunnel inlet (MD -2.00 mm²; p = 0.003). No differences in any median nerve conduction study parameters were found. Side effects (observed in 8% of treatments) were all minimal and self-limiting. Although no firm conclusions can be drawn from this uncontrolled clinical trial, EA appears to be a promising treatment for CTS patients, and herein was associated with an improvement in symptoms and morphological changes in the median nerve. NCT04603274 (ClinicalTrials.gov).