Publications by authors named "Fanrong Liang"

136 Publications

Immediate Analgesic Effect of Acupuncture in Patients With Primary Dysmenorrhea: A fMRI Study.

Front Neurosci 2021 24;15:647667. Epub 2021 May 24.

Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Primary dysmenorrhea (PDM) is a common gynecological disease characterized by lower abdominal pain. Acupuncture is considered a good alternative therapy for PDM. However, the central mechanism of the analgesic effect of acupuncture is largely unknown. In this study, eligible patients were randomized into the real and sham acupuncture groups using a computer-generated, permuted block randomization method. The study cohort comprised 34 patients: 19 in the real acupuncture group and 15 in the sham acupuncture group. The clinical characteristics of the patients during their menstrual period were collected, and imaging scans were performed during the first 3 days of the patients' menstrual period. We analyzed task and resting functional magnetic resonance imaging (fMRI) data to investigate the potential central mechanism of the immediate effect of acupuncture intervention on the intensity of PDM pain. The task fMRI study found that the rostral anterior cingulate cortex (rACC) and right supplemental motor area were activated during real acupuncture. Using the resting-state functional connectivity (FC) method, we found a post- versus pre-treatment change in the FC of the rACC and left precentral gyrus in the comparison of real acupuncture versus sham acupuncture. In addition, the FC of the rACC-left precentral gyrus at baseline was negatively correlated with short-term analgesia, while the change in the FC of the rACC-left precentral gyrus was positively correlated with short-term analgesia after acupuncture treatment. These findings support the importance of rACC-left precentral gyrus resting-state FC in the modulation of the intensity of PDM pain through acupuncture, which may shed light on the central mechanism of acupuncture in the treatment of PDM.
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http://dx.doi.org/10.3389/fnins.2021.647667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180846PMC
May 2021

Revealing the Neural Mechanism Underlying the Effects of Acupuncture on Migraine: A Systematic Review.

Front Neurosci 2021 20;15:674852. Epub 2021 May 20.

Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Migraine is a chronic neurological disorder characterized by attacks of moderate or severe headache and various neurological symptoms. Migraine is typically treated by pharmacological or non-pharmacological therapies to relieve pain or prevent migraine attacks. Pharmacological therapies show limited efficacy in relieving headache and are often accompanied by adverse effects, while the benefits of acupuncture, a non-pharmacological therapy, have been well-documented in both the treatment and prevention of acute migraine attacks. However, the underlying mechanism of the effect of acupuncture on relieving migraine remains unclear. Recent advances in neuroimaging technology have offered new opportunities to explore the underlying neural mechanism of acupuncture in treating migraine. To pave the way for future research, this review provides an overview neuroimaging studies on the use of acupuncture for migraine in the last 10 years. Using search terms about acupuncture, neuroimaging and migraine, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure from January 2009 to June 2020 for neuroimaging studies that examined the effect of acupuncture in migraine. All published randomized and non-randomized controlled neuroimaging studies were included. We summarized the proposed neural mechanism underlying acupuncture analgesia in acute migraine, and the proposed neural mechanism underlying the sustained effect of acupuncture in migraine prophylaxis. A total of 619 articles were retrieved. After removing reviews, meta-analyses, animal studies and etc., 15 articles were eligible and included in this review. The methods used were positron emission computed tomography (PET-CT; = 2 studies), magnetic resonance spectroscopy ( = 1), and functional magnetic resonance imaging (fMRI; = 12). The analyses used included the regional homogeneity (ReHo) method (n = 3), amplitude of low frequency (ALFF) method ( = 2), independent component analysis (ICA; = 3), seed-based analysis (SBA; = 1), both ICA and SBA ( = 1), Pearson's correlation to calculate functional connectivity (FC) between brain regions ( = 1), and a machine learning method ( = 1). Five studies focused on the instant effect of acupuncture, and the research objects were those with acute migraine ( = 2) and migraine in the interictal phase ( = 3). Ten studies focused on the lasting effect of acupuncture, and all the studies selected migraine patients in the interictal phase. This review included five task-based studies and 10 resting-state studies. None of the studies conducted a correlation analysis between functional brain changes and instant clinical efficacy. For studies that performed a correlation analysis between functional brain changes and sustained clinical efficacy, the prophylactic effect of acupuncture on migraine might be through regulation of the visual network, default mode network (DMN), sensory motor network, frontoparietal network (FPN), limbic system, and/or descending pain modulatory system (DPMS). The neural mechanism underlying the immediate effect of acupuncture analgesia remains unclear, and the neural mechanism of sustained acupuncture treatment for migraine might be related to the regulation of pain-related brain networks. The experimental design of neuroimaging studies that examined the effect of acupuncture in migraine also have some shortcomings, and it is necessary to standardize and optimize the experimental design. Multi-center neuroimaging studies are needed to provide a better insight into the neural mechanism underlying the effect of acupuncture on migraine. Multi-modality neuroimaging studies that integrate multiple data analysis methods are required for cross-validation of the neuroimaging results. In addition, applying machine learning methods in neuroimaging studies can help to predict acupuncture efficacy and screen for migraineurs for whom acupuncture treatment would be suitable.
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http://dx.doi.org/10.3389/fnins.2021.674852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172773PMC
May 2021

Acupuncture Treatment for Cough-Variant Asthma: A Meta-Analysis.

Evid Based Complement Alternat Med 2021 2;2021:6694936. Epub 2021 Apr 2.

Chengdu University of Traditional Chinese Medicine, Chengdu 6100752, Sichuan, China.

Background: In recent years, there have been many clinical reports on acupuncture treatment of cough-variant asthma, but no researcher has objectively analysed and evaluated the efficacy and safety of acupuncture treatment of cough-variant asthma from the perspective of evidence-based medicine.

Objective: To systematically evaluate the clinical efficacy and safety of acupuncture in treating cough-variant asthma and to provide reference values for clinical decision-making.

Methods: The comprehensive computer retrieval Chinese journal full-text database (CNKI), Chinese science and technology periodical database (VIP), ten thousand data knowledge service platform (WanFang Data), PubMed, Embase, and the Cochrane Library were used to collect literature for relevant randomized controlled trials (RCT) of acupuncture treatment of cough-variant asthma, as well as to retrieve papers and add reference retrieval after literature review, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager5.3 software recommended by Cochrane.

Results: A total of 11 randomized controlled clinical studies were screened and included, comprising 929 patients. The results of the meta-analysis showed that, compared with the control group, acupuncture intervention on CVA could enhance the total clinical effectiveness rate, reduce the relapse rate of drug withdrawal, relieve symptoms of cough, phlegm, and diaphragmatic congestion, and improve lung function-related indicators and immune inflammation indicators. There were statistically significant differences in all efficacy evaluation criteria.

Conclusion: The clinical curative effect of acupuncture treatment for cough-variant asthma is precise and has certain advantages in relieving symptoms and reducing the recurrence rate. However, the low quality of the evaluation in the RCT research literature is a problem, and more high-quality clinical randomized controlled trials are needed to further verify the comprehensive clinical efficacy and safety of this treatment. Registration number: PROSPERO (no. CRD42020155244) (https://www.crd.york.ac.uk/prospero/).
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http://dx.doi.org/10.1155/2021/6694936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034997PMC
April 2021

The Altered Functional Connectivity With Pain Features Integration and Interaction in Migraine Without Aura.

Front Neurosci 2021 4;15:646538. Epub 2021 Mar 4.

Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Introduction: Migraine without aura (MwoA) is a primary type of migraine, a common disabling disorder, and a disabling neurological condition. The headache is a complex experience, a common form of pain, in which multiple sensory information dimensions are combined to provide a unified conscious event. Migraine ictal have unique neuroimage biomarkers, but the brain is also affected during the inter-ictal phase. According to the current studies, a hypothesis was constructed that the altered integration of pain spatial and intensity information impacts headache intensity in the inter-ictal period.

Methods: In this study, we applied theory-based region-to-region functional connectivity (FC) analyses to compare the differences in resting-state FC between MwoA participants and healthy controls with the pain integration hypothesis. After the correlation matrices between FC edges and clinical symptoms were constructed, the moderating effect and simple slope tests were investigated to explain whether and how the dysfunction of pain features discrimination affects the clinical symptoms.

Results: Functional connectivity analyses showed significantly decreased FC edges between the left dorsolateral superior frontal gyrus (SFGdor) and left insula, and an increased FC edge between the left SFGdor and bilateral angular gyrus. The correlation matrix showed no significant correlation between significantly altered FC edge and headache duration, frequency, Zung self-rating anxiety scale, and Zung self-rating depression scale. Only one significantly altered edge in the MwoA condition was significantly correlated with headache intensity. Moderating Module 1 and 2 manifested the moderator variable (altered rs-FC edge) moderated the link between the normal edges and headache intensity.

Conclusion: The pain features integration processes in migraineurs vary from HCs, related to the clinical symptoms during a migraine attack. Moreover, the clinical symptoms will be affected by one or more discrimination modules. And the spatial or intensity discrimination modules have a higher impact when combined with another module on clinical symptoms than the single module.
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http://dx.doi.org/10.3389/fnins.2021.646538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969893PMC
March 2021

Acupuncture for biliary colic: a systematic review protocol.

BMJ Open 2021 01 17;11(1):e041931. Epub 2021 Jan 17.

Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China

Introduction: Biliary colic (BC) is a severe pain associated with nausea and vomiting, which is the most common symptom among the gallstone population. This protocol proposes a methodology for conducting a systematic review and meta-analysis that aims to assess the benefits and safety of acupuncture in patients with BC.

Methods And Analysis: Clinical trials will be identified through nine databases from inception to December 2020, using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Allied and Complementary Medicine Database (AMED), CINAHL, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database and Wanfang Database. Search words will be used for the BC and acupuncture. The analysis would include randomised, controlled, clinical trials of adults with BC that were published in either Chinese or English. The primary outcome is to measure pain relief. Two or three reviewers should be in charge of study selection, data extraction and evaluating the risk of bias. RevMan software (V.5.4) will be used to perform the assessment of the risk of bias and data synthesis.

Ethics And Dissemination: Ethics approval will not be required for this review, as it will only involve the collection of literature previously published. The results of this meta-analysis will be disseminated in a peer-reviewed journal or relevant conference, through publication.

Trial Registration Number: CRD42020167510.
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http://dx.doi.org/10.1136/bmjopen-2020-041931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813305PMC
January 2021

Acupuncture for Radiation-Induced Xerostomia in Cancer Patients: A Systematic Review and Meta-Analysis.

Integr Cancer Ther 2020 Jan-Dec;19:1534735420980825

Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

Background: Radiation-induced xerostomia is one of the most common symptoms experienced by cancer patients. The aim of our study is to evaluate the preventive and therapeutic effect of acupuncture for radiation-induced xerostomia in cancer patients.

Methods: Eight databases were searched for all published randomized clinical trials (RCTs) on acupuncture for radiation-induced xerostomia in cancer patients up to December 31, 2019. Manual searching included other conference abstracts and reference lists. Meta-analysis was conducted using Revman V.5.3, and risks of bias for included studies was assessed following the Cochrane Handbook.

Results: Eight clinical trials (725 participants) were analyzed, and 3 were included in a meta-analysis. All included trials had a high risk of bias, such as selection, performance, and detection bias. Analysis indicated favorable effects of acupuncture regarding the improvement of xerostomia symptoms (MD -3.05,  = 0.02, 95% CI -5.58 to -0.52), compared with sham acupuncture. There were no significant differences between real acupuncture and sham acupuncture regarding the stimulated salivary flow rate (MD 0.37,  = 0.08, 95% CI -0.05 to 0.79) and unstimulated salivary flow rate (MD 0.09,  = 0.12, 95% CI -0.02 to 0.21), which were whole salivary flow rate. Compared with no acupuncture (standard oral care, usual care, or no treatment), acupuncture produced a significant improvement in patient-reported xerostomia, without causing serious adverse effects. However, a Grading of Recommended Assessments analysis revealed that the quality of all acupuncture outcome measures was low.

Conclusion: The present meta-analysis and systematic review suggests that acupuncture is effective at improving xerostomia symptoms in cancer patients but not at objective salivary flow measurements. The evidence is still limited due to the low quality of the published studies.
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http://dx.doi.org/10.1177/1534735420980825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739209PMC
December 2020

Concurrent brain structural and functional alterations in patients with migraine without aura: an fMRI study.

J Headache Pain 2020 Dec 7;21(1):141. Epub 2020 Dec 7.

Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China.

Objectives: To explore the possible concurrent brain functional and structural alterations in patients with migraine without aura (MwoA) patients compared to healthy subjects (HS).

Methods: Seventy-two MwoA patients and forty-six HS were recruited. 3D-T1 and resting state fMRI data were collected during the interictal period for MwoA and HS. Voxel-based morphometry (VBM) for structure analysis and regional homogeneity (Reho) for fMRI analysis were applied. The VBM and Reho maps were overlapped to determine a possible brain region with concurrent functional and structural alteration in MwoA patients. Further analysis of resting state functional connectivity (FC) alteration was applied with this brain region as the seed.

Results: Compared with HS, MwoA patients showed decreased volume in the bilateral superior and inferior colliculus, periaqueductal gray matter (PAG), locus ceruleus, median raphe nuclei (MRN) and dorsal pons medulla junction. MwoA patients showed decreased Reho values in the middle occipital gyrus and inferior occipital gyrus, and increased Reho values in the MRN. Only a region in the MRN showed both structural and functional alteration in MwoA patients. Pearson correlation analysis showed that there was no association between volume or Reho values of the MRN and headache frequency, headache intensity, disease duration, self-rating anxiety scale or self-rating depression scale in MwoA patients. Resting state functional connectivity (FC) with the MRN as the seed showed that MwoA patients had increased FC between the MRN and PAG.

Conclusions: MRN are involved in the pathophysiology of migraine during the interictal period. This study may help to better understand the migraine symptoms.

Trial Registration: NCT01152632 . Registered 27 June 2010.
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http://dx.doi.org/10.1186/s10194-020-01203-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720576PMC
December 2020

Cerebral fractional amplitude of low-frequency fluctuations may predict headache intensity improvement following acupuncture treatment in migraine patients.

J Tradit Chin Med 2020 12;40(6):1041-1051

Acupuncture & Tuina School/The Third Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China.

Objective: To explore how baseline resting-state cerebral function predicts clinical outcomes of acupuncture treatment for migraine.

Methods: One hundred migraine patients and 46 healthy subjects were recruited. Patients were randomized into the acupuncture, sham acupuncture, and waiting list groups. Resting-state functional magnetic resonance imaging data were collected at baseline and after 1 month of longitudinal acupuncture treatments. Fractional amplitude of low-frequency fluctuations (fALFF) calculations were applied to explore the associations between baseline fALFF and changes in clinical variables in the acupuncture treatment group and the waiting list group.

Results: Compared with healthy subjects, migraine patients had lower fALFF in the left rostral ventromedial medulla, right thalamus, left amygdala, and right angular gyrus. Regression analyses revealed that baseline fALFF values in the left middle frontal gyrus, left superior temporal gyrus, and middle temporal gyrus were positively associated with headache intensity changes in the acupuncture treatment group, while baseline fALFF values in the bilateral lingual gyrus and cuneus were negatively associated with headache intensity changes in this group.

Conclusion: The baseline fALFF values of brain regions associated with cognitive pain modulation, but not migraine severity, may predict future headache intensity improvement levels in migraine patients receiving acupuncture treatment.
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http://dx.doi.org/10.19852/j.cnki.jtcm.2020.06.016DOI Listing
December 2020

The Spontaneous Activity Pattern of the Middle Occipital Gyrus Predicts the Clinical Efficacy of Acupuncture Treatment for Migraine Without Aura.

Front Neurol 2020 9;11:588207. Epub 2020 Nov 9.

Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

The purpose of the present study was to explore whether and to what extent the neuroimaging markers could predict the relief of the symptoms of patients with migraine without aura (MWoA) following a 4-week acupuncture treatment period. In study 1, the advanced multivariate pattern analysis was applied to perform a classification analysis between 40 patients with MWoA and 40 healthy subjects (HS) based on the z-transformed amplitude of low-frequency fluctuation (zALFF) maps. In study 2, the meaningful classifying features were selected as predicting features and the support vector regression models were constructed to predict the clinical efficacy of acupuncture in reducing the frequency of migraine attacks and headache intensity in 40 patients with MWoA. In study 3, a region of interest-based comparison between the pre- and post-treatment zALFF maps was conducted in 33 patients with MwoA to assess the changes in predicting features after acupuncture intervention. The zALFF value of the foci in the bilateral middle occipital gyrus, right fusiform gyrus, left insula, and left superior cerebellum could discriminate patients with MWoA from HS with higher than 70% accuracy. The zALFF value of the clusters in the right and left middle occipital gyrus could effectively predict the relief of headache intensity ( = 0.38 ± 0.059, mean squared error = 2.626 ± 0.325) and frequency of migraine attacks ( = 0.284 ± 0.072, mean squared error = 20.535 ± 2.701) after the 4-week acupuncture treatment period. Moreover, the zALFF values of these two clusters were both significantly reduced after treatment. The present study demonstrated the feasibility and validity of applying machine learning technologies and individual cerebral spontaneous activity patterns to predict acupuncture treatment outcomes in patients with MWoA. The data provided a quantitative benchmark for selecting acupuncture for MWoA.
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http://dx.doi.org/10.3389/fneur.2020.588207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680874PMC
November 2020

Acupuncture for postprostatectomy incontinence: a systematic review.

BMJ Support Palliat Care 2020 Nov 25. Epub 2020 Nov 25.

Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China

Background: Postprostatectomy incontinence (PPI) is a clinically significant condition that is caused by surgery of prostate. Study showed that electroacupuncture can reduce urine leakage among women with stress urinary incontinence (SUI), but few was known about its efficacy and safety for men with PPI. This study aims to conduct a systematic review to evaluate efficacy and safety of acupuncture for men with PPI compared with other non-surgical treatment.

Methods: Seven databases were searched for all randomised controlled trials (RCTs) on acupuncture for men with PPI up to August 2020. Risks of bias of included studies were assessed using RevMan V.5.3. Narrative analysis was conducted.

Results: Seven studies with 830 men with PPI were included in the review. Studies showed that acupuncture can significantly improve score of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form for men with urgent urinary incontinence (UUI) when compared with medicine (p<0.05). It showed a significant better overall response rate when acupuncture was combined with solifenacin for men with UUI (p<0.05), or with pelvic floor muscle training (PFMT) (p<0.001), or with PFMT and medicine together for men with UUI or SUI (p<0.01), compared with control groups. No adverse event was reported in the studies. However, the quality of evidences was considered low generally.

Conclusion: The results showed that acupuncture could be beneficial for men with PPI when applied alone or as an adjunction to other conservative therapies and medicines, however, the quality of evidence was considered low and inconclusive in this review.

Prospero Registration Number: This study has been registered at PROSPERO system with ID No. CRD42019091164.
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http://dx.doi.org/10.1136/bmjspcare-2020-002450DOI Listing
November 2020

Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials.

Chin Med 2020 12;15:109. Epub 2020 Oct 12.

School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi Er Qiao Road, Chengdu, 610075 China.

Background: Allergic rhinitis (AR) is a common symptomatic, inflammatory, and immunological disorder of nasal mucosa. Multiple clinical trials and systematic reviews have implicated acupuncture methods as potentially effective treatment strategies for AR, however, considering the great burden of AR, it is crucial to explore the most recent clinical evidence supporting acupuncture in AR. Besides, the methodologies reported in previous studies as well as those commonly applied during clinical practices greatly vary. Herein, we conducted network meta-analysis to compare the effectiveness of diverse acupuncture methods for AR treatment.

Methods: We conducted a literature search for relevant reports published from inception to 1 July 2020 in several scientific databases, including PubMed, Embase, Cochrane library, Web of Science, CNKI, WF, VIP, CBM, AMED as well as related registration platforms. Primary outcomes as reported in the identified studies were assessed using nasal symptoms. All Meta-analyses were performed with RevMan, ADDIS, and STATA software. To ensure consistency among our reviewers, the intra-class correlation coefficient was used.

Results: Exactly 39 studies with 3433 participants were covered in this meta-analysis. The meta-analysis demonstrated that all acupuncture types were superior to sham acupuncture in terms of total nasal symptom score and rhinoconjunctivitis quality of life questionnaire. Moxibustion was recommended as the most effective intervention as it reduced nasal symptoms in 6 treatments. On the other hand, manual acupuncture plus conventional medicine was recommended as the most effective intervention in improving the quality of life in 9 treatments. Notably, moxibustion was recommended as the most effective intervention that changed the content of IgE in 9 treatments. Moreover, adverse events of these interventions were acceptable.

Conclusion: Our findings revealed that all acupuncture methods are effective and safe for AR. Moreover, either moxibustion or manual acupuncture plus conventional medicine are potentially the most effective treatment strategies for AR. Based on these findings, it is evident that acupuncture therapy is not inferior to pharmacologic therapy. Therefore, for AR patients who are either unresponsive to conventional medicine or are intolerant to adverse events, acupuncture therapy should be administered. However, the quality of these included trials was mainly ranked as moderate quality, we recommend additional well-designed RCTs with larger sample sizes to validate these findings.
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http://dx.doi.org/10.1186/s13020-020-00389-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7552548PMC
October 2020

Resting-State Functional Connectivity Patterns Predict Acupuncture Treatment Response in Primary Dysmenorrhea.

Front Neurosci 2020 8;14:559191. Epub 2020 Sep 8.

Brain Research Center, Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Primary dysmenorrhea (PDM) is a common complaint in women throughout the menstrual years. Acupuncture has been shown to be effective in dysmenorrhea; however, there are large interindividual differences in patients' responses to acupuncture treatment. Fifty-four patients with PDM were recruited and randomized into real or sham acupuncture treatment groups (over the course of three menstrual cycles). Pain-related functional connectivity (FC) matrices were constructed at baseline and post-treatment period. The different neural mechanisms altered by real and sham acupuncture were detected with multivariate analysis of variance. Multivariate pattern analysis (MVPA) based on a machine learning approach was used to explore whether the different FC patterns predicted the acupuncture treatment response in the PDM patients. The results showed that real but not sham acupuncture significantly relieved pain severity in PDM patients. Real and sham acupuncture displayed differences in FC alterations between the descending pain modulatory system (DPMS) and sensorimotor network (SMN), the salience network (SN) and SMN, and the SN and default mode network (DMN). Furthermore, MVPA found that these FC patterns at baseline could predict the acupuncture treatment response in PDM patients. The present study verified differentially altered brain mechanisms underlying real and sham acupuncture in PDM patients and supported the use of neuroimaging biomarkers for individual-based precise acupuncture treatment in patients with PDM.
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http://dx.doi.org/10.3389/fnins.2020.559191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506136PMC
September 2020

Acupuncture for knee osteoarthritis with sensitized acupoints: results from a pilot, feasibility randomized controlled trial.

Pilot Feasibility Stud 2020 28;6:144. Epub 2020 Sep 28.

Chinese Evidence-based Medicine Center and Cochrane China Center, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041 Sichuan China.

Background: Although previous clinical studies suggest possible benefits of acupuncture for knee osteoarthritis (KOA), the value of acupuncture at sensitized points is uncertain. We aimed to preliminarily assess the feasibility of performing a definitive randomized controlled trial to explore the effectiveness of acupuncture for KOA with highly sensitized acupoints.

Methods: In this randomized, single-blind, parallel, pilot trial, 36 participants with KOA were randomly assigned to receive acupuncture at highly sensitized acupoints (high-sensitization group) or at low/non-sensitized points (low/non-sensitization group) by a computer-generated random sequence. Both groups received three treatment sessions per week for four consecutive weeks (12 sessions in total). Assessments were performed at screening and at 4, 8, 12, and 16 weeks after randomization. Primary feasibility outcomes were patient recruitment, retention rate, and adherence to group treatment. Secondary outcomes included the change of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score from baseline to 16 weeks, the change of Short Form (SF)-12 health survey score, and safety outcomes.

Results: Patient recruitment of 36 patients took 2 months, achieving the recruitment target. Retention rates were similar between the treatment groups, 14 (77.8%) patients in the high-sensitization group completed the 16-week follow-up and compared to 14 (77.8%) patients in low/non-sensitization group, but the result was lower than expected. All patients received at least ten treatment sessions in total. The WOMAC total score and the pain, stiffness, and physical function score in the high-sensitization group were lower or very close to those in the control group at each assessment point. Similar results were observed on quality of life. No adverse events occurred.

Conclusion: This trial has presented preliminary data on the feasibility of conducting a large trial to test the effectiveness of acupuncture at sensitized points in KOA patients.

Trial Registration: ClinicalTrials.gov, NCT03008668. Registered on 26 December 2016-retrospectively registered.
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http://dx.doi.org/10.1186/s40814-020-00687-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520975PMC
September 2020

Acupuncture for the treatment of marrow suppression after chemotherapy: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2020 Aug;99(34):e21876

Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Background: Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear.

Objective: This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials.

Methods And Analysis: The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers.

Result: This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy.

Conclusion: The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy.

Prospero Registration Number: PROSPERO CRD42020163336.
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http://dx.doi.org/10.1097/MD.0000000000021876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447328PMC
August 2020

Acupuncture for the Postcholecystectomy Syndrome: A Systematic Review and Meta-Analysis.

Evid Based Complement Alternat Med 2020 30;2020:7509481. Epub 2020 Jul 30.

School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Background: Postcholecystectomy syndrome (PCS) has become a common postoperative syndrome that requires systematic and comprehensive therapy to achieve adequate clinical control. Acupuncture and related therapies have shown clinical effects for PCS in many studies. However, systematic reviews/meta-analyses (SRs/MAs) for them are lacking.

Objective: To evaluate the efficacy and safety of acupuncture in the treatment of PCS using randomized controlled trials (RCTs).

Methods: Potentially eligible studies were searched in the following electronic databases up to 1 February 2020: PubMed, Embase, Cochrane Library, Web of Science (WoS), Chinese databases (Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and China Science and Technology Journal Database (VIP)), and other sources (WHO ICTRP, ChiCTR, Clinical Trials, and Grey Literature Database). The RevMan 5.3 was employed for analyses. The Cochrane Collaboration' risk of bias tool was used to assess the risk of bias (ROB). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence.

Results: A total of 14 RCTs with 1593 participants were included in this SR. MA showed that acupuncture in combination with conventional medicine (CM) did not show statistical differences in reduction in pain. However, acupuncture in combination with CM significantly reduced the incidence of postoperative nausea and vomiting (PONV) (RR, 0.71; 95% CI, 0.55-0.92) and improved gastrointestinal function recovery compared to the CM group. Acupuncture combined with traditional Chinese medicine and CM, and acupuncture as monotherapy may improve gastrointestinal function recovery with acceptable adverse events.

Conclusion: Acupuncture may be an effective and safe treatment for PCS. However, this study lacks conclusive evidence due to poor quality evidence, limited data, and clinical heterogeneity of acupuncture methods in the included studies.
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http://dx.doi.org/10.1155/2020/7509481DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7414376PMC
July 2020

Does the Acupoint Specificity Exist? Evidence from Functional Neuroimaging Studies.

Curr Med Imaging 2020 ;16(6):629-638

Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China.

Background: Using functional neuroimaging techniques to explore the central mechanism of acupoint specificity, the key of acupuncture theory and clinical practice, has attracted increasing attention worldwide. This review aimed to investigate the current status of functional neuroimaging studies on acupoint specificity and explore the potential influencing factors for the expression of acupoint specificity in neuroimaging studies.

Methods: PubMed database was searched from January 1st, 1995 to December 31st, 2016 with the language restriction in English. Data including basic information, methodology and study results were extracted and analyzed from the eligible records.

Results: Seventy-nine studies were finally enrolled. 65.8% of studies were performed in China, 73.4% of studies were conducted with healthy subjects, 77.2% of studies chose manual acupuncture as the intervention, 86.1% of studies focused on the instant efficacy and 89.9% of studies used functional magnetic resonance imaging as scanning technique. The average sample size was 16 per group. The comparison of verum acupoints and sham acupoints were the main body of acupoint specificity researches. 93.7% of studies obtained the positive results and favored the existence of acupoint specificity.

Conclusion: This review affirmed the existence of acupoint specificity and deemed that the acupoint specificity was relative. Multiple factors such as participants, sample size, acupoint combinations, treatment courses, and types of acupoint could influence the expression of acupoint specificity.
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http://dx.doi.org/10.2174/1573405615666190220113111DOI Listing
January 2020

Differences in topological properties of functional brain networks between menstrually-related and non-menstrual migraine without aura.

Brain Imaging Behav 2021 Jun;15(3):1450-1459

College of Acupuncture, Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, 37 Shi'er Qiao Rd, Chengdu, 610075, Sichuan, China.

Menstrually-related migraine without aura refers to a specific type of migraine that is associated with the female ovarian cycle. Compared with non-menstrual migraine without aura, in menstrually-related migraine without aura, there are additional attacks of migraine outside of the menstrual period. Menstrually-related migraine without aura tends to be less responsive to acute treatment and more prone to relapse than non-menstrual migraine without aura. Currently menstrually-related migraine without aura is treated no differently from any other migraine but, the differences in the central mechanisms underlying menstrually-related migraine without aura and non-menstrual migraine without aura remain poorly understood. Here, using resting-state functional magnetic resonance imaging and graph theory approaches, we aimed to explore the differences in topological properties of functional networks in 51 menstrually-related migraine without aura patients and 47 non-menstrual migraine without aura patients. The major finding of our study was that significant differences in topological properties between the two groups were mainly evident in the nodal centrality of the inferior frontal gyrus and the thalamus. Nodal centrality in inferior frontal gyrus was negatively correlated with Headache Impact Test questionnaire scores in the menstrually-related migraine without aura patients. Partial least squares correlation analysis revealed enhanced correlations of inferior frontal gyrus to pain-related behavior in the non-menstrual migraine without aura group, while within the menstrually-related migraine without aura group these effects were non-significant. These results indicate that the regulatory mechanisms in the central nervous system may differ between the two subtypes of migraine. The results provide novel insights into the pathophysiology of different subtypes of migraine, and could help us to enhance their clinical diagnosis and treatment.
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http://dx.doi.org/10.1007/s11682-020-00344-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286221PMC
June 2021

Acupuncture and related therapies for stress urinary incontinence: A protocol for systematic review and network meta-analysis.

Medicine (Baltimore) 2020 Jul;99(28):e21033

Chengdu University of Traditional Chinese Medicine.

Background: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting patients' quality of life and sexual function. Lots of Clinical trials suggested that acupuncture is beneficial for SUI and various acupuncture methods have been widely used in clinic. However, the comparative efficacy and safety of these acupuncture methods remains unclear. Clinicians are confused to select the optimal way to treat SUI. This review aims to gather solid evidence in order to provide reliable reference in establishing guidelines for acupuncture treatment of SUI.

Methods: Relevant databases including MEDLINE, Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wanfang Database, the Chongqing VIP Chinese Science and Technology Periodical Database will be retrieved from their inception to April 2020. The quality of the included studies will be evaluated by the risk of bias tool and the evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation System. Network meta-analysis will be conducted by using software R3.5.1. The primary outcome is the number of patients with self-reported continence and number of patients with self-reported improvement in SUI.

Results: The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication.

Conclusion: the results may be useful for patients, clinicians, and guideline-makers to choose the optimal acupuncture method for SUI treatment.
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http://dx.doi.org/10.1097/MD.0000000000021033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360201PMC
July 2020

Effectiveness and safety of acupuncture and moxibustion for defecation dysfunction after sphincter-preserving surgery for rectal cancer: protocol for systematic review and meta-analysis.

BMJ Open 2020 05 6;10(5):e034152. Epub 2020 May 6.

Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China

Introduction: Defecation dysfunction (DD) is one of the most common complications following sphincter-preserving surgery for rectal cancer. And there is no effective treatment of DD after sphincter-preserving surgery for rectal cancer. Although some studies suggested that acupuncture and moxibustion (AM) is effective and safe for DD after sphincter-preserving surgery for rectal cancer, lacking strong evidence, for instance, the relevant systematic review, meta-analysis and randomised controlled trial (RCT) of a large, multicentre sample, makes the effects and safety remain uncertain. The present protocol is described for a systematic review and meta-analysis to investigate the effectiveness and safety of AM for DD after sphincter-preserving surgery for rectal cancer.

Methods And Analysis: We will search nine online databases from inception to 1 October 2019; the language of included trials will not be restricted. This study will include RCTs that performed AM as the main method of the experimental group for patients with DD after sphincter-preserving surgery for rectal cancer. Two of the researchers will independently select the studies, conduct risk of bias assessment and extract the data. We will use the fixed-effects model or random-effects model of RevMan V.5.2 software to analyse data synthesis. The risk ratios with 95% CIs and weighted mean differences or standardised mean differences with 95% CIs will be used to present the data synthesis outcome of dichotomous data respectively and the continuous data. Evidence quality of outcome will be assessed by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Ethics And Dissemination: Ethical approval is not required in this secondary research evidence, and we will publish the results of this study in a journal or concerned conferences.

Trial Registration Number: CRD42019140097.
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http://dx.doi.org/10.1136/bmjopen-2019-034152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223156PMC
May 2020

The cardiovascular risk of celecoxib for knee osteoarthritis: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2020 May;99(18):e19976

The Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine.

Objective: The aim of this systematic review and meta-analysis is to assess the cardiovascular (CV) risk of celecoxib on knee osteoarthritis (KOA) patients compared with the risk in those prescribed other non-selective non-steroidal anti-inflammatory drugs (NSAIDs), no intervention or placebo-controlled patients.

Methods: The following databases will be searched: MEDLINE, EMBASE, the Cochrane Library, Web of Science, Chinese Biomedical Literature Database, Chinese Nation Knowledge Infrastructure, Wanfang Database, and the Chongqing VIP from inception to April 1, 2020. All randomized controlled trials (RCTs) of celecoxib that presented data on serious cardiovascular events among KOA patients will be included. Study selection, data extraction, quality assessment, and assessment of risk bias will be performed by 2 reviewers independently. Odds ratios and correlative 95% confidence intervals will be calculated to present the association between the celecoxib and CV risk using Review Manager version 5.3 when there is sufficient available data.

Ethics And Dissemination: This review does not require ethical approval. The results of this review may be published in a peer-reviewed journal or disseminated at relevant conferences.

Prospero Registration Number: CRD42020166721.
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http://dx.doi.org/10.1097/MD.0000000000019976DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440337PMC
May 2020

Acupuncture for ocular myasthenia gravis: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2020 Apr;99(17):e19901

The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

Background: The aim of this systematic review with meta-analysis is to determine the efficacy and security of acupuncture in treatment of ocular myasthenia gravis and find out whether or not the quick short-term efficacy of acupuncture exists.

Methods: The following electronic databases will be searched by 2 independent reviewers: PubMed, Cochrane Library, EMBASE, Springer, China National Knowledge Infrastructure, Wanfang, and Chinese Biomedical Literature Database. All randomized controlled trials on acupuncture for ocular myasthenia gravis published in electronic databases from inception to March 1, 2020, with language restricted in Chinese and English will be included in the study.Methodologic quality is assessed by 2 blinded reviewers independently screen and score the articles using the PEDro scale and the Cochrane Collaboration risk of bias tool. A meta-analysis was performed when there is sufficient clinical homogeneity in at least 2 studies. The Grading of Recommendations Assessment, Development and Evaluation approach is used to rate the body of evidence in each meta-analysis. When the quantitive evaluation is not available, a qualitative description of the results of single study is provided.

Results: An evidence of variety of acupuncture treatment methods for treating ocular myasthenia gravis will be illustrated using subjective reports and objective measures of performance. The primary outcomes consisted of effective rate, MGFA PIS, QMG, and MG-composite. Secondary outcomes involve clinical absolute and relative score, titers of AchR antibodies, and the side effects. The treatment frequency and courses will be measured.

Conclusion: This protocol will present the evidence of whether acupuncture is an effective and safe intervention for ocular myasthenia gravis.

Trial Registration Number: CRD42019141325.
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http://dx.doi.org/10.1097/MD.0000000000019901DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440349PMC
April 2020

Effectiveness of Acupuncture for Lateral Epicondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pain Res Manag 2020 20;2020:8506591. Epub 2020 Mar 20.

The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, GuangDong 518033, China.

Objective: This study aimed at assessing the clinical effectiveness of acupuncture for lateral epicondylitis (LE).

Methods: The following databases were systematically searched: China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wan Fang database, Chinese Biomedicine Literature, PubMed, EMBASE, and Cochrane Library from inception to May 2019. Randomized controlled trials (RCTs) meeting the inclusion criteria were included. RevMan 5.3 software was used to conduct meta-analyses. The study quality was evaluated with the Cochrane risk of bias.

Results: Ten RCTs involving 796 individuals were included in this meta-analysis. Three studies reported randomized methods with a specific description. For the analyses of the clinical efficacy rate, acupuncture outperformed sham acupuncture (two RCTs,  = 130, =0.15), medicine therapy (two RCTs,  = 124, =0.02), and blocking therapy (four RCTs,  = 427, =0.0001). For the analyses of the visual analog scale, acupuncture outperformed sham acupuncture (two RCTs,  = 92, =0.18), medicine therapy (two RCTs,  = 144, < 0.00001), and blocking therapy (two RCTs,  = 132, =0.03). The subgroup analyses comparing acupuncture with sham acupuncture therapy revealed heterogeneities. The follow-up information and adverse reactions were not analyzed because of the insufficient number of studies.

Conclusions: Acupuncture appears to be superior to drug or blocking therapy or sham acupuncture therapy for LE. However, considering the low quality of the available trials, further large-scale RCTs with a low risk of bias are needed in the future.
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http://dx.doi.org/10.1155/2020/8506591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114772PMC
October 2020

Treatment for acute flares of gout: A protocol for systematic review.

Medicine (Baltimore) 2020 Apr;99(14):e19668

The Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine.

Introduction: The current evidence confirms the effectiveness and safety of several drug interventions in the treatment of acute flares of gout, however, the most preferred drugs are still unclear. We, therefore, seek to conduct a network meta-analysis that can systematically compare non-steroidal anti-inflammatory drugs (NSAIDs), COXIBs, colchicine, hormones, or IL-1 receptor antagonists, etc. for acute gout based on the latest evidence.

Methods And Analysis: Nine online databases are searched with inception to September 1, 2019; there will be no language restrictions on the included trials. Randomized controlled trials that include patients with acute flares of gout receiving drug therapy versus a control group will be included. The selection of studies, risk of bias assessment and data extraction will be conducted by 2 independent researchers. Bayesian network meta-analysis is applied using the Markov chain Monte Carlo method with Stata or R. The dichotomous data will be presented as risk ratios with 95% CIs and the continuous data will be presented as weighted mean differences or standardized mean differences with 95% CIs. Evidence quality will be evaluated using the GRADE system.

Ethics And Dissemination: This network meta-analysis will not involve private information from personal or imperil their rights, so, ethical approval is not required. The results of this network meta-analysis may be published in a journal or publicized in concerned conferences.
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http://dx.doi.org/10.1097/MD.0000000000019668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440275PMC
April 2020

A Multimodal Meta-Analysis of Structural and Functional Changes in the Brain of Tinnitus.

Front Hum Neurosci 2020 25;14:28. Epub 2020 Feb 25.

The Acupuncture and Tuina School/The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, China.

Brain imaging studies of tinnitus patients have revealed marked changes in brain structure and function, but there are inconsistencies in those findings. In this meta-analysis, we investigated concurrence across studies to clarify those abnormalities in brain structure and function in tinnitus. Neuroimaging studies published up to December 6, 2019 were searched in the PubMed, Web of Science, EMBASE, and Cochrane Library databases, Chinese Nation Knowledge Infrastructure, Chinese Biomedical Literature Database, the Chongqing VIP, and Wanfang Database. Study selection, quality assessment, and data extraction were performed by two independent researchers. Anisotropic effect size signed differential mapping (AES-SDM) was used to perform a multimodal analysis of available studies reporting whole-brain structural or functional data in tinnitus patients. There were 14 studies that met the inclusion criteria. The structural dataset comprised 242 tinnitus patients and 217 matched healthy subjects (HS), while the functional dataset included 130 tinnitus patients and 140 matched HS. Our analysis revealed structural alterations in the superior temporal gyrus, middle temporal gyrus (MTG), angular gyrus, caudate nucleus, superior frontal gyrus, and supplementary motor area, as well as functional differences in the MTG, middle occipital gyrus, precuneus, and right inferior parietal (excluding supramarginal and angular) gyri. The multimodal analysis revealed significant differences in the right MTG of tinnitus patients relative to HS. These findings suggest the involvement of the cortico-striatal circuits in the neuropathology of tinnitus.
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http://dx.doi.org/10.3389/fnhum.2020.00028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053535PMC
February 2020

The functional alterations in primary migraine: A systematic review and meta-analysis protocol.

Medicine (Baltimore) 2020 Mar;99(10):e19019

The Acupuncture and Tuina School, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine.

Introduction: Accumulating neuroimaging studies have found abnormal cerebral activity in migraine patients. However, the findings of studies exist many differences. Hence, this protocol aims to investigate concurrence across the neuroimaging studies to verify the functional cerebral alterations based on the latest evidence.

Methods And Analysis: Functional neuroimaging studies comparing migraineur with healthy subjects will be searched in the 4 online databases (EMBASE, the Cochrane Library, PubMed, and Web of Science) up to June 2019. The selection of studies, quality assessment, and data extraction will be conducted by 2 independent researchers. The Anisotropic effect size version of signed differential mapping (AES-SDM) methods will be used to conduct a coordinate-based meta-analysis. The bias of publication will be confirmed via the P value of Egger test. The quality of studies will be evaluated by the Newcastle-Ottawa Scale (NOS). This study is registered with PROSPERO, number CRD42019129043.

Results: This study will deepen the understanding of functional cerebral alterations of migraine.

Conclusion: The study will provide clear conclusion of the functional cerebral alterations based on the latest evidence.
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http://dx.doi.org/10.1097/MD.0000000000019019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478569PMC
March 2020

The participation of basolateral amygdala in the efficacy of acupuncture with deqi treating for functional dyspepsia.

Brain Imaging Behav 2021 Feb;15(1):216-230

Acupuncture and Tuina School, Acupuncture and Brain Research Center, The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, 37# Shierqiao Road, Chengdu, 610075, Sichuan, China.

Deqi is taken as an indispensable requirement to achieve acupuncture efficacy. This study aimed to explore the central influence of deqi on the efficacy of acupuncture for functional dyspepsia (FD). 70 FD patients were randomized to receive 20 sessions' acupuncture treatment with (n = 35) and without deqi (n = 35). In each group, 25 FD patients randomly selected underwent functional magnetic resonance imaging (fMRI) scans before and after treatment. After group re-division according to deqi response, changes of amygdala subregions-based resting-state functional connectivity (rsFC) were compared between the acupuncture with and without obvious deqi group. The clinical changes of the Nepean Dyspepsia Symptom Index (NDSI) measuring FD symptoms were also used to further assess the correlation with amygdala subregions rsFC in FD patients. The decrease in the NDSI scores (pre-pos) in the obvious deqi group was significantly greater than that in the acupuncture without obvious deqi group (p < 0.05). Compared to the without obvious deqi group, the obvious deqi group showed significantly decreased the left basolateral amygdala (BLA) rsFC with bilateral insular (INS), putamen and middle/posterior cingulate cortex (MCC/PCC), right pallidum and hippocampus (HIPP) after treatment. The changed NDSI scores(pre-post) of all 41 FD patients was significantly positively correlated with their Fisher's transformed z value of the left BLA rsFC with left INS (r = 0.376, FDR corrected p = 0.015), and rsFC with right HIPP (r = 0.394, FDR corrected p = 0.015). The changed NDSI scores(pre-post) of the obvious deqi group was significantly negatively correlated with their Fisher's transformed z value of the right centromedial amygdala (CMA) rsFC with left medial prefrontal cortex (mPFC) (r = -0.463, p = 0.035). The results tested the hypothesis that the advantage of deqi on efficacy is related to affecting the BLA and CMA rsFC. It suggested that deqi might influence the abnormal rsFC within the salience network (SN), and participate in the adaptive modulation of disrupted relationship between the SN and default mode network (DMN).
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http://dx.doi.org/10.1007/s11682-019-00249-7DOI Listing
February 2021

Acupuncture for menstrual migraine: a systematic review.

BMJ Support Palliat Care 2020 Mar 2. Epub 2020 Mar 2.

School of Chinese Medicine, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, China.

Background And Objective: In clinical practice, the evidence of acupuncture used as a treatment for migraine without aura is employed interchangeably to guide treatment for menstrual migraine. However, its effect and safety are not substantiated. This study aimed to assess the efficacy of acupuncture on the frequency and pain intensity of menstrual migraine.

Methods: We searched PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI) and other two Chinese databases from their inception to 1 May 2019. This study included randomised controlled trials of women with menstrual migraine receiving acupuncture or a valid control. Two reviewers independently completed study selection, data extraction and risk of bias assessment. We combined data with a fixed-effect model in RevMan. Clinical outcomes included migraine frequency and duration, headache intensity, and adverse events.

Results: Thirteen studies with 826 subjects were included, 9 of which had data suitable for meta-analyses. Current evidence showed that acupuncture was not superior to sham acupuncture in reducing monthly migraine frequency and duration, average headache intensity, and analgesic use at completion of treatment or follow-up. Pooled data demonstrated a significant improvement in mean headache intensity in the acupuncture group compared with drugs. However, all studies were underpowered and associated with moderate to high risk of bias. No serious adverse event was related to acupuncture treatment.

Conclusions: There is no convincing evidence to support the use of acupuncture in treating menstrual migraine. Acupuncture cannot yet be recommended to patients with menstrual migraine until more solid evidence is produced.

Trial Registration Number: CRD42019119337.
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http://dx.doi.org/10.1136/bmjspcare-2019-002024DOI Listing
March 2020

Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review.

Medicine (Baltimore) 2020 Feb;99(9):e19334

The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

Primary osteoporosis (PO) is a common disease that was characterized by a systemic impairment of bone mass and microarchitecture that results in fragility fractures and constitutes a pressing public health problem. But the effect of acupuncture or moxibustion treatment for PO is controversial.To provide a comprehensive systematic overview of current evidence from systematic reviews (SR)/Meta-analysis of acupuncture treatment for PO pertaining to risk of bias, quality of evidence and report quality.A total of 9 international and Chinese databases were searched for SR/meta-analysis of randomized controlled trials (RCTs). The risk of bias of SR/meta-analysis was appraised using the risk of bias in systematic reviews (ROBIS) instrument, the quality of the evidence was evaluated via Grading of Recommendations Assessment, Development and Evaluation (GRADE), and the report quality of the included studies are estimated by Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).According to ROBIS, only 2 articles were with risk of low bias; according to PRISMA, and most articles were reported incomplete, mainly in Q2, Q7, Q24, and Q27; according to GRADE, a total of 28 outcome indicators were evaluated under 4 different interventions of experimental group and control group: the evidence quality of bone mineral density (BMD) from treatment of acupuncture and moxibustion/acupuncture and moxibustion plus was high or moderate; Visual Analogue Score (VAS) of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was low or very low; clinical effectiveness of acupuncture plus moxibustion or acupuncture plus moxibustion plus other was uncertain.Acupuncture and moxibustion can improve the BMD of PO patients according to high-quality evidence, and may benefit VAS, pain score, clinical efficacy based on moderate or low-quality evidence. Further research that provides higher quality evidence of SR/RCTs of acupuncture and moxibustion treatment for PO is required.
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http://dx.doi.org/10.1097/MD.0000000000019334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478384PMC
February 2020

An fMRI-based neural marker for migraine without aura.

Neurology 2020 02 21;94(7):e741-e751. Epub 2020 Jan 21.

From the Department of Psychiatry (Y.T., N.M., J.P., C.L., J.K.), Massachusetts General Hospital and Harvard Medical School, Charlestown; The Third Teaching Hospital (F.Z., L.L., Z.L., F.L.), Chengdu University of Traditional Chinese Medicine, Sichuan; Department of Radiology (B.L., J.C.), Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China; Center for Complementary and Integrative Medicine (C.W.), Division of Rheumatology, Tufts Medical Center, Boston, MA; Traditional Chinese Medicine School (G.Y), Ningxia Medical University, Yinchuan; The Acupuncture and Tuina School (M.L.), Hunan University of Traditional Chinese Medicine, Changsha, China; The Mind Research Network (Z.F.), Albuquerque, NM; and School of Biomedical Engineering (Z.Z.), Health Science Center, Shenzhen University, China.

Objective: To identify and validate an fMRI-based neural marker for migraine without aura (MwoA) and to examine its association with treatment response.

Methods: We conducted cross-sectional studies with resting-state fMRI data from 230 participants and machine learning analyses. In studies 1 through 3, we identified, cross-validated, independently validated, and cross-sectionally validated an fMRI-based neural marker for MwoA. In study 4, we assessed the relationship between the neural marker and treatment responses in migraineurs who received a 4-week real or sham acupuncture treatment, or were waitlisted, in a registered clinical trial.

Results: In study 1 (n = 116), we identified a neural marker with abnormal functional connectivity within the visual, default mode, sensorimotor, and frontal-parietal networks that could discriminate migraineurs from healthy controls (HCs) with 93% sensitivity and 89% specificity. In study 2 (n = 38), we investigated the generalizability of the marker by applying it to an independent cohort of migraineurs and HCs and achieved 84% sensitivity and specificity. In study 3 (n = 76), we verified the specificity of the marker with new datasets of migraineurs and patients with other chronic pain disorders (chronic low back pain and fibromyalgia) and demonstrated 78% sensitivity and 76% specificity for discriminating migraineurs from nonmigraineurs. In study 4 (n = 116), we found that the changes in the marker responses showed significant correlation with the changes in headache frequency in response to real acupuncture.

Conclusion: We identified an fMRI-based neural marker that captures distinct characteristics of MwoA and can link disease pattern changes to brain changes.
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http://dx.doi.org/10.1212/WNL.0000000000008962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176301PMC
February 2020

Different types of acupuncture and moxibustion therapy for neurogenic bladder after spinal cord injury: A systematic review and network meta-analysis study protocol.

Medicine (Baltimore) 2020 Jan;99(1):e18558

The Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.

Background: The invasive surgical intervention for neurogenic bladder dysfunction (NBD) following spinal cord injury (SCI) involves permanently altering one's body system and carries many surgical related risks and medication side effects are often seen in long term usage of pharmaceutical medications. Therefore, acupuncture and moxibustion therapies have been recommended due to their efficacy, simplicity of operation, cost effectiveness and safety. This protocol is designed for systematic review and network meta-analysis, which will perform comparisons or rankings of efficacy among the currently available acupuncture and moxibustion techniques and provide evidence to guide the best practice in acupuncture and moxibustion treatments of NBD due to SCI.

Methods/design: The Cochrane Library, EMBASE, PubMed, Web of Science, CENTRAL, CNKI, The VIP Database, The Wanfang database, CDFD, CMFD will be searched from inception to November 1, 2019. All randomized controlled trials containing eligible interventions(s) and outcome(s) will be included. The quality of included trials will be assessed using the "Risk of bias" tool from the Cochrane Handbook (V.5.1.0). Data analysis will be conducted by using STATA software (Version 13.0). Continuous outcome will be indicated as mean difference (MD) or standard mean difference (SMD), and enumeration data will be presented with odds risk (OR) or relative risk (RR).

Results: This systematic review and network meta-analysis study aims to determine the most effective and safe approach in relieving urinary symptoms, and whether it produces better results in urodynamic examination. And a high-quality ranking of the therapeutic classes will be presented. The report will follow the PRISMA checklist for network meta-analysis. Results of the search strategy and the study selection will be presented in a PRISMA compliant flow chart.

Conclusion: This study aims to propose a standard clinical decision-making guideline for acupuncture and moxibustion treatment of NBD after SCI.
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http://dx.doi.org/10.1097/MD.0000000000018558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946264PMC
January 2020
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