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Brain functional changes following electroacupuncture in a mouse model of comorbid pain and depression:A resting-state functional magnetic resonance imaging study 被引量:1
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作者 Xuan Yin Xiao-ling Zeng +5 位作者 Jing-jing Lin Wen-qing Xu Kai-yu Cui Xiu-tian Guo Wei Li Shi-fen Xu 《Journal of Integrative Medicine》 2025年第2期159-168,共10页
Objective:Comorbid pain and depression are common but remain difficult to treat.Electroacupuncture(EA)can effectively improve symptoms of depression and relieve pain,but its neural mechanism remains unclear.Therefore,... Objective:Comorbid pain and depression are common but remain difficult to treat.Electroacupuncture(EA)can effectively improve symptoms of depression and relieve pain,but its neural mechanism remains unclear.Therefore,we used resting-state functional magnetic resonance imaging(rs-fMRI)to detect cerebral changes after initiating a mouse pain model via constriction of the infraorbital nerve(CION)and then treating these animals with EA.Methods:Forty male C57BL/6J mice were divided into 4 groups:control,CION model,EA,and sham acupuncture(without needle insertion).EA was performed on the acupoints Baihui(GV20)and Zusanli(ST36)for 20 min,once a day for 10 consecutive days.The mechanical withdrawal threshold was tested3 days after the surgery and every 3 days after the intervention.The depressive behavior was evaluated with the tail suspension test,open-field test,elevated plus maze(EPM),sucrose preference test,and marble burying test.The rs-fMRI was used to detect the cerebral changes of the functional connectivity(FC)in the mice following EA treatment.Results:Compared with the CION group,the mechanical withdrawal threshold increased in the EA group at the end of the intervention(P<0.05);the immobility time in tail suspension test decreased(P<0.05);and the times of the open arm entry and the open arm time in the EPM increased(both P<0.001).There was no difference in the sucrose preference or marble burying tests(both P>0.05).The fMRI results showed that EA treatment downregulated the amplitude of low-frequency fluctuations and regional homogeneity values,while these indicators were elevated in brain regions including the amygdala,hippocampus and cerebral cortex in the CION model for comorbid pain and depression.Selecting the amygdala as the seed region,we found that the FC was higher in the CION group than in the control group.Meanwhile,EA treatment was able to decrease the FC between the amygdala and other brain regions including the caudate putamen,thalamus,and parts of the cerebral cortex.Conclusion:EA can downregulate the abnormal activation of neurons in the amygdala and improve its FC with other brain regions,thus exerting analgesic and antidepressant effects.Please cite this article as:Yin X,Zeng XL,Lin JJ,Xu WQ,Cui KY,Guo XT,Li W,Xu SF.Brain functional changes following electroacupuncture in a mouse model of comorbid pain and depression:A restingstate functional magnetic resonance imaging study. 展开更多
关键词 PAIN DEPRESSION ELECTROACUPUNCTURE FMRI AMYGDALA
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Effects of acupuncture combined with bone-setting therapy to treat tourette syndrome:a three-arm randomized controlled trial
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作者 LANG Jiawang JIN Lingqing +1 位作者 LUO Jianchang LANG Boxu 《Journal of Traditional Chinese Medicine》 2025年第1期176-183,共8页
OBJECTIVE:To explore the efficacy and safety of acupuncture combined with atlantoaxial joint bone-setting therapy for the treatment of Tourette syndrome.METHODS:We randomly divided 600 patients at a ratio of 1∶1∶1 i... OBJECTIVE:To explore the efficacy and safety of acupuncture combined with atlantoaxial joint bone-setting therapy for the treatment of Tourette syndrome.METHODS:We randomly divided 600 patients at a ratio of 1∶1∶1 into three groups:group A(acupuncture combined with atlantoaxial joint bone setting therapy group),group B(acupuncture group),and group C(tiapride group).After two months of treatment,the Yale global tic severity scale(YGTSS)score reduction,improvement in social function impairment,clinical efficacy,and long-term efficacy in the three groups were compared.RESULTS:After treatment,in the analysis of YGTSS score reduction,social function impairment improvement,the clinical control rate,and long-term efficacy,the results were all Group A>Group B>Group C,with a statistically significant difference(P<0.05).However,the total clinical efficacy of treatment in group A(94.9%)was not significantly different from that in group B(91.8%).Adverse reactions did not occur in groups A and B,and several adverse reactions occurred in 29%(n=58)of the group C patients.CONCLUSION:Compared with traditional drug therapy,acupuncture combined with atlantoaxial joint bone setting therapy has better clinical and long-term efficacy.This treatment strategy can improve the social function of children and prevent adverse reactions to drugs. 展开更多
关键词 Tourette syndrome ACUPUNCTURE atlanto-axial joint tiapride hydrochloride bone setting randomized controlled trial
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Targeted neurotransmitter metabolomics-based evaluation of the effects of electroacupuncture on diabetic peripheral neuropathy in mice
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作者 Zhu Jin Wen Li +3 位作者 Qiu-Yue Wang Jin-Ling Dai Shuetling Chung Jie Tu 《Integrative Medicine Discovery》 2025年第23期1-10,共10页
Background:Diabetic peripheral neuropathy(DPN)is a prevalent and debilitating complication of diabetes mellitus,lacking effective treatment options.Despite unclear underlying mechanisms,electroacupuncture(EA)shows pro... Background:Diabetic peripheral neuropathy(DPN)is a prevalent and debilitating complication of diabetes mellitus,lacking effective treatment options.Despite unclear underlying mechanisms,electroacupuncture(EA)shows promise in relieving DPN symptoms.Neurotransmitter dysregulation is central to DPN pathophysiology.This study aimed to investigate EA’s effects on DPN via targeted neurotransmitter metabolomics.Methods:A streptozotocin-induced mouse model of DPN was developed,and EA treatment was administered for two weeks to assess the therapeutic potential of EA.Following the collection of sciatic nerve samples,LC-MS-based targeted metabolomics analyses investigations were performed to examine alterations in DPN-associated neurotransmitter metabolism brought on by EA therapy.Multivariate statistical analyses were employed to assess metabolite expression patterns,using cluster heatmaps to display neurotransmitter expression results.KEGG pathway analyses were also used to explore the functional classifications of these neurotransmitters and associated metabolic pathways.Results:Targeted neurotransmitter-focused metabolomics analyses led to the identification of 34 putative biomarkers associated with EA treatment,of which 5 showed significant changes,such as beta-alanine(increased by 80.37%,P=0.0004)and kynurenine(decreased by 29.36%,P=0.0163).KEGG pathway analysis indicated that changes in the abundance of these metabolites were associated with the cAMP signaling pathway,neuroactive ligand-receptor interactions,the synaptic vesicle cycle,and other pathways.Conclusion:The results indicate that EA can efficiently regulate neurotransmitter metabolism and restore peripheral nerve function,suggesting a feasible non-pharmacological strategy for DPN treatment and warranting clinical translation. 展开更多
关键词 diabetic peripheral neuropathy ELECTROACUPUNCTURE targeted metabolomics NEUROTRANSMITTERS metabolite profiling
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Impact of laser acupuncture on gastrointestinal function recovery in patients after acute appendicitis surgery:A retrospective clinical study
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作者 Hai-Zhou Ying 《World Journal of Gastrointestinal Surgery》 2025年第6期196-205,共10页
BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recover... BACKGROUND Laparoscopic surgery has emerged as the preferred treatment for acute appendicitis,a common acute abdominal condition.Despite surgical advances,postoperative gastrointestinal dysfunction and delayed recovery continue to negatively impact rehabilitation outcomes and patient quality of life.Laser acupuncture represents a promising emerging complementary therapy with potential benefits for promoting functional recovery.AIM To evaluate the clinical efficacy of laser acupuncture in enhancing gastrointestinal function recovery following laparoscopic appendectomy and to investigate its potential applications in postoperative rehabilitation.METHODS This retrospective controlled clinical study selected 120 acute appendicitis patients who underwent laparoscopic appendectomy from January 2022 to December 2023 at a tertiary hospital.Patients were randomly divided into two groups:Routine treatment group(n=60)and laser acupuncture intervention group(n=60).There were no significant statistical differences in baseline characteristics(age,gender,body mass index,appendicitis severity)between the two groups.The routine treatment group received standard postoperative care,while the laser acupuncture intervention group received additional laser acupuncture treatment on top of standard care.Key observation indicators included time to first exhaust,time to first bowel movement,time to gastrointestinal function recovery,and postoperative complication rates.RESULTS Patients in the laser acupuncture intervention group showed significantly faster gastrointestinal function recovery compared to the routine treatment group.Specifically,time to first exhaust was significantly shortened(intervention group:12.5±2.3 hours vs control group:18.7±3.1 hours,P<0.05),time to first bowel movement was earlier(intervention group:36.4±4.6 hours vs control group:48.2±5.7 hours,P<0.05),postoperative complication rate was significantly reduced(intervention group:8.3%vs control group:20.0%,P<0.05),postoperative pain score was significantly lower(intervention group:3.2±1.1 vs control group:4.7±1.5,P<0.05),and intestinal motility recovery was faster and more effective.CONCLUSION Laser acupuncture,as an auxiliary treatment method,can significantly promote gastrointestinal function recovery in patients after laparoscopic appendectomy,reduce complications,and improve postoperative comfort.This technique has advantages such as minimal invasiveness,rapid recovery,and few side effects,making it worthy of further clinical promotion and application. 展开更多
关键词 Laser acupuncture Acute appendicitis Laparoscopic surgery Gastrointestinal function Postoperative recovery
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Effects of Duhuo Jisheng Decoction Combined with Warm Acupuncture and Moxibustion on ODI Index and Lumbar Activity of Patients with Lumbar Disc Herniation
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作者 Shugang Peng Youling Huang +3 位作者 Yuan Liu Guosheng Ding Yafei Chen Haiting Ding 《Journal of Clinical and Nursing Research》 2025年第3期126-132,共7页
Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of... Objective:To explore the effect of combining Duhuo Jisheng decoction with warm acupuncture and moxibustion in the treatment of patients with lumbar disc herniation.Methods:Using a random number table method,a total of 100 patients with lumbar disc herniation treated at Xianning Matang Hospital of Traditional Chinese Medicine from January 2021 to December 2023 were divided into a control group of 50 patients treated with Duhuo Jisheng decoction and a study group of 50 patients treated with Duhuo Jisheng decoction combined with warm acupuncture and moxibustion.The TCM syndrome scores,lumbar function,lumbar pain,and lumbar activity were compared between the two groups.Results:After intervention,the TCM syndrome scores,ODI,and VAS scores of both groups showed a decreasing trend compared to before intervention,and the decreasing trend was more significant in the study group(P<0.05).After intervention,the JOA and lumbar activity indicators of both groups showed an increasing trend compared to before intervention,and the increasing trend was more significant in the study group(P<0.05).Conclusion:Duhuo Jisheng decoction combined with warm acupuncture and moxibustion is an effective and safe treatment method for lumbar disc herniation,which can improve lumbar function and activity. 展开更多
关键词 Lumbar disc herniation Lumbar function Warm acupuncture and moxibustion Lumbar activity Duhuo Jisheng decoction
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Acupuncture at Weizhong(BL40)attenuates acetic acid-induced overactive bladder in rats by regulating brain neural activity through the modulation of mast cells and tibial nerves
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作者 Xin Liu Chao-yue Zhang +9 位作者 Xiu-yu Du Shan-shan Li Yu-qing Wang Yi Zheng Han-zhi Deng Xiao-qin Fang Jia-ying Li Zu-qing Wang Shi-fen Xu Yi-qun Mi 《Journal of Integrative Medicine》 2025年第1期46-55,共10页
Objective The present study evaluated the effects of deep acupuncture at Weizhong acupoint(BL40)on bladder function and brain activity in a rat model of overactive bladder(OAB),and investigated the possible mechanisms... Objective The present study evaluated the effects of deep acupuncture at Weizhong acupoint(BL40)on bladder function and brain activity in a rat model of overactive bladder(OAB),and investigated the possible mechanisms around the acupuncture area that initiate the effects of acupuncture.Methods Adult female Sprague-Dawley rats were randomly divided into six groups,comprising a control group,model group,group treated with deep acupuncture at BL40,group treated with shallow acupuncture at BL40,group treated with acupuncture at non-acupoint next to BL40,and group treated with acupuncture at Xuanzhong(GB39).Urodynamic evaluation was used to observe the urination,and functional magnetic resonance imaging was used to observe the brain activation.The mechanism of acupuncture at BL40 in regulating bladder function was explored by toluidine blue staining and enzyme-linked immunosorbent assay,and the mechanism was verified by stabilizing mast cells(MCs)or blocking tibial nerve.Results Deep acupuncture at BL40 significantly increased the intercontraction interval in OAB rats and enhanced the mean amplitude of low frequency fluctuation of primary motor cortex(M1),periaquaductal gray matter(PAG),and pontine micturition center(PMC).It also increased the zero-lag functional connectivity between M1 and PAG and between PAG and PMC.Shallow acupuncture at BL40 and acupuncture at non-acupoint or GB39 had no effect on these indexes.Further studies suggested that deep acupuncture at BL40 increased the number and degranulation rate of MCs as well as the contents of 5-hydroxytryptamine,substance P,and histamine in the tissues around BL40.Blocking the tibial nerve by lidocaine injection or inhibiting MC degranulation by sodium cromoglycate injection obstructed the effects of acupuncture on restoring urinary function and modulating brain activation in OAB rats.Conclusion Deep acupuncture at BL40 may be more effective for inhibiting OAB by promoting degranulation of MCs around the acupoint and stimulating tibial nerve,thereby regulating the activation of the brain area that controls the lower urinary tract. 展开更多
关键词 ACUPUNCTURE Overactive bladder Mast cell Tibial nerve Functional magnetic resonance imaging
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Electroacupuncture versus conventional acupuncture of scalp motor area for post-stroke wrist dyskinesia and its effect on muscle function: a randomized, controlled clinical trial
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作者 ZHENG Ruwen DONG Xu +7 位作者 WANG Tianyi FENG Liyuan ZHANG Hongyan HUO Hong ZHANG Ying ZHANG Qianshi ZHU Xingyan WANG Dongyan 《Journal of Traditional Chinese Medicine》 2025年第4期852-859,共8页
OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)at scalp motor area for treating post-stroke wrist dyskinesia and its influence on the function of wrist movement-related agonistic muscles.METHODS:A randomi... OBJECTIVE:To evaluate the efficacy of electroacupuncture(EA)at scalp motor area for treating post-stroke wrist dyskinesia and its influence on the function of wrist movement-related agonistic muscles.METHODS:A randomized,single-blind,controlled clinical trial was conducted.Sixty-six patients undergoing post-stroke wrist dyskinesia were enrolled and randomized 1:1 to EA or control group.Patients in the control group received manual acupuncture in the scalp motor area(MS 6)on the lesion side.The same acupoint was selected to accept EA stimulation in the EA group.All patients were treated six times a week for three weeks.The primary outcome was the Chinese Stroke Scale(CSS)score.The secondary outcomes included upper limb-related Barthel Index(BI)score,active range of motion(AROM)of the wrist joint,and root mean square(RMS)of the four agonistic muscles associated with wrist motion on the hemiplegic side of patients,i.e.,the extensor carpi radialis longus(ECRL),extensor digitorum(ED),flexor carpi radialis(FCR)and flexor carpi ulnaris(FCU).The above indicators were measured before and after three weeks of treatment.RESULTS:After 3-week treatment,the CSS score and AROM of wrist dorsiflexion of the EA group were better than those in the control group(P=0.038,P=0.047).The differences between the two groups of BI scores and AROM of wrist flexion were not significant(P>0.05).All RMS of the EA group were higher than those in the control group(ECRL:P=0.047,ED:P=0.048,FCR:P=0.049,FCU:P=0.047).The total effective rate in the EA group was 87.50%(28/32),which was higher than that in the control group(77.42%,24/31,P=0.048).CONCLUSION:EA stimulation of the scalp motor area can promote the recovery of the strength and function of the agonistic muscles related to wrist movement and effectively improve post-stroke wrist dyskinesia. 展开更多
关键词 stroke wrist joint movement disorders ELECTROACUPUNCTURE ELECTROMYOGRAPHY randomized controlled trial
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Effects of electroacupuncture on gut microbiota in a rat model of urticaria
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作者 Xianjun Xiao Peiwen Xue +6 位作者 Haiyan Qin Di Qin Lu Wang Rongjiang Jin Ying Li Yunzhou Shi Juan Li 《Acupuncture and Herbal Medicine》 2025年第1期103-114,共12页
Objective:Growing evidence suggests a strong link between gut microbiota and the pathogenesis of urticaria,positioning the gut-skin axis as a novel therapeutic target.Despite the efficacy of acupuncture in alleviating... Objective:Growing evidence suggests a strong link between gut microbiota and the pathogenesis of urticaria,positioning the gut-skin axis as a novel therapeutic target.Despite the efficacy of acupuncture in alleviating urticaria symptoms,the underlying mechanisms remain poorly understood.We investigated the effects of electroacupuncture on gut microbiota in a rat model of urticaria.Methods:Sprague-Dawley rats were randomly divided into three groups:control,model,and electroacupuncture.An urticaria model was established by combining active systemic and passive cutaneous allergic reactions.Electroacupuncture treatment was administered for 7 days,during which the number of scratches,the diameter of skin sensitization blue spots,and degranulation rate of mast cells were recorded.Inflammation in the sensitized skin was assessed using hematoxylin and eosin staining,and the composition of the gut microbiota was analyzed using 16S rRNA gene sequencing.Results:Electroacupuncture significantly reduced the frequency of scratching,the diameter of sensitized blue spots,and the degranulation rate of mast cells in rats.The staining results revealed that electroacupuncture decreased inflammatory cell infiltration and fibrous tissue proliferation in the sensitized skin.The 16S rRNA gene sequencing demonstrated that electroacupuncture adjusted the ratio of Firmicutes to Bacteroidetes.Receiver operating characteristic(ROC)curve analysis identified Parabacteroides johnsonii as a potential biomarker for diagnosing urticaria(AUC=0.8516,where AUC stands for the area under the curve)and Lactobacillus reuteri and Limosilactobacillus as potential biomarkers for predicting the effectiveness of acupuncture treatment(AUC=0.8281).Conclusion:Electroacupuncture may alleviate urticaria symptoms by modulating the gut microbiota,providing new theoretical and practical directions for acupuncture treatment of urticaria. 展开更多
关键词 ELECTROACUPUNCTURE Firmicutes/bacteroidetes ratio Gut microbiota Gut-skin axis URTICARIA
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Effects on the receptivity of thin endometrium treated with acupuncture therapy for menstruation regulation and pregnancy promotion:A pragmatic randomized controlled exploratory study
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作者 Chen-si ZHENG Hui-sheng YANG +2 位作者 Ming-zhao HAO Si-yu LIU Yi-gong FANG 《World Journal of Acupuncture-Moxibustion》 2025年第1期50-57,共8页
Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmati... Objective:This study aimed to explore the clinical effect of acupuncture therapy for menstruation regu-lation and pregnancy promotion on thin endometrium in the real world.Design:This study is a single-center pragmatic randomized controlled trial blinded to the statisticians.Using the“blockrand”software package,based on the age(≥35,<35),37 patients were randomized into an intervention group(19 cases)and a control group(18 cases).After reassignment regarding patient preference,21 patients were included in the intervention group and 16 in the control group.Setting:The trial was executed in the Specialty Outpatient Clinic,Acupuncture-Moxibustion Hospital of China Academy of Chinese Medical Sciences,from March 1,2019,to September 30,2020.Participants:The study included 37 patients with thin endometrium and without previous acupuncture treatment.Intervention:The intervention group was administered acupuncture for menstruation regulation and pregnancy promotion and a small-dose of progynova(2 mg daily),while the control group was adminis-tered a large-dose of progynova(4 mg daily).Interventions started from Day 5 of menstruation until the end of ovulation under B-ultrasound monitoring.The intervention lasted for three menstrual cycles.Measurements:Primary outcomes were changes in endometrial thickness between baseline and after intervention completion and the difference between the two groups after intervention.The secondary outcomes were endometrial and subendometrial blood flow,serum estradiol levels,menstrual conditions,and adverse reactions.Results:(1)Comparison of each indicator before and after intervention completion in the two groups:in the intervention group,the differences were significant in endometrial thickness,menstrual score,estra-diol(E2)level in ovulatory period,the pulsatility index(PI)and resistance index(RI)of uterine artery,the ratio of peak systolic velocity to end-diastolic velocity(S/D),the endometrial vascular index(VI),flow index(FI),and vascular flow index(VFI)and volume(P<0.01).In the control group,significant changes were observed in endometrial thickness,menstrual score,and E2 before and after the interven-tion(P<0.05),and no differences were observed in uterine artery PI,RI,S/D and endometrial VI,FI,VFI,and volume(P>0.05).Compared with the control group,the intervention group showed significant differences in endometrial thickness,menstrual score,E2,uterine artery PI,RI,S/D,and endometrial VI,FI,VFI,and volume after intervention(P<0.01).No adverse reactions were reported in the intervention group.In contrast,the control group had two cases of nausea and gastrointestinal discomfort after med-ication,eight cases of breast distention during medication,and one case of breast nodules enlarged by 1 cm after trial completion. 展开更多
关键词 RECEPTIVITY Thin endometrium Acupuncture Menstruation regulation and pregnancy promotion
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Efficacy of electroacupuncture for cervical spondylosis-related pain in patients with generalized anxiety disorder
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作者 Zhe Li Yu Gao +1 位作者 Dong Yan Yi-Hui Feng 《World Journal of Psychiatry》 2025年第11期168-178,共11页
BACKGROUND Cervical spondylosis(CS)frequently co-occurs with generalized anxiety disorder(GAD),presenting a complex clinical challenge.Managing CS-related pain in patients with GAD is particularly challenging because ... BACKGROUND Cervical spondylosis(CS)frequently co-occurs with generalized anxiety disorder(GAD),presenting a complex clinical challenge.Managing CS-related pain in patients with GAD is particularly challenging because of the bidirectional relationship between pain and anxiety,necessitating integrated treatment strategies.AIM To evaluate the efficacy of electroacupuncture(EA)in treating CS-related pain and anxiety in patients with GAD.METHODS This retrospective cohort study analyzed data from 83 patients with CS-related pain and GAD who received EA treatment over 2-year period.Pain intensity was assessed using the visual analog scale,and anxiety symptoms were measured using the Hamilton Anxiety Rating Scale.Additionally,neuroinflammatory markers,including interleukin-6,tumor necrosis factor-alpha,and high-sensitivity C-reactive protein,were examined.Outcomes were evaluated at baseline,after 4 weeks,and after 8 weeks of treatment.RESULTS EA treatment significantly reduced CS-related pain(mean visual analog scale reduction:3.24±1.18;P<0.001)and improved anxiety symptoms(mean Hamilton Anxiety Rating Scale reduction:7.83±2.65;P<0.001)after 8 weeks of treatment.Neuroinflammatory markers also showed significant reductions,with interleukin-6 and tumor necrosis factor-alpha levels decreasing by 32.7%and 28.5%,respectively(P<0.01).Pain reduction was significantly correlated with improvements in anxiety symptoms(r=0.68;P<0.001)and a decrease in inflammatory markers(r=0.54;P<0.01).CONCLUSION EA demonstrates significant efficacy in reducing CS-related pain in patients with comorbid GAD,along with concurrent improvements in anxiety symptoms and neuroinflammatory profiles.These findings suggest that EA may offer a valuable integrative approach for managing this complex clinical presentation,potentially addressing both pain and anxiety through the modulation of neuroinflammatory pathways. 展开更多
关键词 ELECTROACUPUNCTURE Cervical spondylosis Generalized anxiety disorder NEUROINFLAMMATION Pain management
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Effect of acupuncture on serum levels of hypothalamic-pituitary-adrenal axis related hormones and immune factors in rats with allergic rhinitis
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作者 KANG Jiale DU Zhongming +3 位作者 GUO Wei DU Shuo HAN Guanxiong CHEN Sheng 《Journal of Traditional Chinese Medicine》 2025年第2期359-367,共9页
OBJECTIVE:To explore the correlation between acupuncture treatment for allergic rhinitis(AR) and hypothalamic-pituitary-adrenal(HPA) axis regulation by investigating changes in serum immune factors,HPA axis-associated... OBJECTIVE:To explore the correlation between acupuncture treatment for allergic rhinitis(AR) and hypothalamic-pituitary-adrenal(HPA) axis regulation by investigating changes in serum immune factors,HPA axis-associated hormone levels,activation levels of paraventricular nucleus(PVN) neurons,and the severity of nasal mucosal lesions,in rats with AR before and after acupuncture treatment.METHODS:After establishing the AR rat model,ovalbumin was administered via nasal drip to all groups except the blank control.Each group received continuous treatment for 14 d:the acupuncture,acupuncture + RU-486(mifepristone),and RU-486 groups received acupuncture only,RU486 intraperitoneal injection and acupuncture,and RU-486 intraperitoneal injection only,respectively.Following the intervention period,behavioral scoring was performed on all AR rats,and peripheral blood,nasal mucosa samples,and brains tissue(containing PVN region) were obtained following euthanization.Interleukin(IL-4,IL-5,IL-13),interferon gamma(IFN-γ),corticosterone(CORT),and corticotrophin-releasing hormone(CRH) levels were evaluated in peripheral blood samples.Adrenocorticotropic hormone(ACTH) levels were determined using an enzyme-linked immunoassay assay,and hematoxylin and eosin staining was performed on the nasal mucosa samples.The expression levels of c-Fos in PVN neurons following acupuncture treatment were evaluated by immunofluorescent staining.RESULTS:Following the intervention period,the behavioral scores for the blank control group were lower than those of other groups(P < 0.05),while the acupuncture group scores were lower than those in the model control,acupuncture + RU486,and RU486 groups(P < 0.05).The blank control group had lower serum IL-4,IL-5,and IL-13 levels than those in the other groups(P < 0.05).The acupuncture group had lower serum IL-4,IL-5,and IL-13 levels than those in the model control,acupuncture + RU486,and RU486 groups(P < 0.05).The blank control group had the highest serum IFN-γ levels among all groups,followed by the acupuncture group.The serum CORT,CRH,and ACTH levels in the blank control group were lower than those in the remaining groups(P < 0.05).These biomarker levels were also lower in the acupuncture group than those in the model control,acupuncture + RU486,and RU486 groups(P < 0.05).Compared with model,rats in the acupuncture group exhibited an increased c-Fos expression in PVN neurons.CONCLUSION:Acupuncture can alleviate AR symptoms and regulate serum inflammatory factor levels and HPA axis-related hormones in AR rats.Moreover,these effects are inhibited by glucocorticoid antagonists,suggesting that acupuncture may regulate AR symptoms through HPA axis regulation. 展开更多
关键词 allergic rhinitis ACUPUNCTURE hypothalamic-pituitaryadrenal axis immunity GLUCOCORTICOIDS
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Effect of electroacupuncture on hypertensive and sympathetic excitability mechanism mediated by the paraventricular nucleus of the hypothalamus in spontaneous hypertensive rats
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作者 SUN Jiao WANG Yueming +7 位作者 LYU Jian LIU Xin YUE Bingnan LI Yinyin LIU Jipeng SUN Yize LIU Qingguo YAN Liu 《Journal of Traditional Chinese Medicine》 2025年第3期586-596,共11页
OBJECTIVE:To investigate the mechanism of electroacupuncture of sympathetic nerve activity and blood pressure reduction in the hypothalamic paraventricular nucleus(PVN)of spontaneous hypertensive rats(SHRs).METHODS:A ... OBJECTIVE:To investigate the mechanism of electroacupuncture of sympathetic nerve activity and blood pressure reduction in the hypothalamic paraventricular nucleus(PVN)of spontaneous hypertensive rats(SHRs).METHODS:A total of 64 male SHRs were divided into four groups:model,sham-operated(Sham),electroacupuncture(EA),and N-methyl-D-aspartate receptor antagonist and electroacupuncture(NRA+EA).In addition,16 Wistar-Kyoto rats were used as controls.PVN stereotaxic surgery was performed in both the Sham and NRA+EA groups,while the EA and NRA+EA groups received 14 d of electroacupuncture.Blood pressure(BP)and heart rate(HR)were measured the day before the intervention and every other day.After 14 d of intervention,the rats in each group were tested for renal sympathetic nerve activity(RSNA).The associated factor levels were determined using Western blotting,reverse transcription-polymerase chain reaction(RTPCR),enzyme-linked immunosorbent assay(ELISA)and immunofluorescence assays.RESULTS:In comparison to the model group,the EA and NRA+EA groups had significantly lower BP,HR,and RSNA(P<0.01).The expression of N-methyl-Daspartate receptor(NMDAR),angiotensin II(Ang II),angiotensin II type 1(AT1),tumor necrosis factor-α,interleukin-1β,norepinephrine and arginine vasopressin was significantly lower in the EA and NRA+EA groups(P<0.01).Moreover,the antihypertensive effect of NRA+EA group outperformed to the EA group.CONCLUSIONS:Electroacupuncture effectively reduced the BP and sympathetic nerve excitability in SHRs.The mechanism was linked to the inhibition of NMDARmediated Ang II/AT1 and the inflammatory response in PVN. 展开更多
关键词 ELECTROACUPUNCTURE hypertension renal sympathetic nerve activity paraventricular hypothalamic nucleus RECEPTORS N-METHYL-D-ASPARTATE
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Efficacy and safety of acupuncture therapies for adult patients with mild and moderate major depressive disorder:A systematic review and meta-analysis
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作者 Hong-jun Kuang Hui-sheng Yang +9 位作者 Yi-xuan Feng Han Tang Qi Fan Yu-qin Xu Shuo Cui Richard Musil Hedi Luxenburger Yi-xuan Zhang Hong Zhao Yu-qing Zhang 《Journal of Integrative Medicine》 2025年第5期471-491,共21页
Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published s... Background:Acupuncture therapy provides a complementary and alternative approach to treating major depressive disorder(MDD),but its efficacy and safety have still not been comprehensively assessed.Recently published systematic reviews remain confusing and inconclusive.Objective:This systematic review evaluated the efficacy and safety of acupuncture therapy alone or combined with antidepressants for adult patients with mild and moderate MDD.Search strategy:Chinese Biomedical Literature Database,China National Knowledge Infrastructure Database,Wanfang Database,Chinese Science and Technology Journal Database,Pub Med,Embase,and Cochrane Library were searched from their inceptions to March 2025.Inclusion criteria:Randomized controlled trials that compared acupuncture therapy with antidepressants,or acupuncture therapy plus antidepressants with acupuncture therapy or antidepressants for adult patients with mild and moderate MDD were included.Data extraction and analysis:Five reviewers independently extracted data from original literature using a standardized form,and the data were verified by two reviewers to ensure accuracy.Statistical meta-analyses,publication bias analyses,and subgroup analyses were performed by using Review Manager 5.3 software.The Grading of Recommendations Assessment,Development,and Evaluation approach was used to assess the certainty of the evidence.Results:A total of 60 eligible studies including 4675 participants were included.Low-certainty evidence showed that compared with antidepressants,acupuncture therapy(standardized mean difference[SMD]=-0.57;95%confidence interval[CI]=[-0.87,-0.27];I^(2)=86%;P=0.006)or acupuncture therapy plus antidepressants(SMD=-1.00;95%CI=[-1.18,-0.81];I^(2)=77%;P<0.00001)may reduce the severity of depression at the end of treatment.Low-certainty evidence indicated that compared with acupuncture therapy alone,acupuncture therapy plus antidepressants slightly reduced the severity of depression at the end of treatment(SMD=-0.38;95%CI=[-0.61,-0.14];I^(2)=18%;P=0.002).Similar results were also found for acupuncture's relief of insomnia.The reported adverse effects of acupuncture therapy were mild and transient.For most of the subgroup analyses,acupuncture type,scale type,and the course of treatment did not show a significant relative effect.Conclusion:Acupuncture therapy may provide antidepressant effects and relieve insomnia with mild adverse effects for adult patients with mild and moderate MDD.But the certainty of evidence was very low.More high-quality,well designed,large-scale studies with long-term follow-up are needed in the future. 展开更多
关键词 ACUPUNCTURE Major depressive disorder Systematic review META-ANALYSIS
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Current situation of clinical trial registration in acupuncture anesthesia:A scoping review
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作者 Yue Li You-ning Liu +7 位作者 Zhen Guo Mu-en Gu Wen-jia Wang Yi Zhu Xiao-jun Zhuang Li-ming Chen Jia Zhou Jing Li 《Journal of Integrative Medicine》 2025年第3期256-263,共8页
Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specif... Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention. 展开更多
关键词 ACUPUNCTURE Acupuncture anesthesia Clinical trial registration
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Efficacy of electro-acupuncture at “Weizhong” (BL40) on macrophage polarization in rats with injured lumbar multifidus
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作者 TIAN Yuan BU He +5 位作者 WANG Tieshan YANG Dongliang ZHANG Wei LIU Tong ZHANG Li HUO Zejun 《Journal of Traditional Chinese Medicine》 2025年第2期335-347,共13页
OBJECTIVE:To investigate the anti-inflammatory effect of electroacupuncture in rats with bupivacaine-induced lumbar multifidus injury and its underlying regulatory mechanism on macrophage polarization.METHODS:A total ... OBJECTIVE:To investigate the anti-inflammatory effect of electroacupuncture in rats with bupivacaine-induced lumbar multifidus injury and its underlying regulatory mechanism on macrophage polarization.METHODS:A total of seventy-two Sprague-Dawley male rats were randomly divided into control,model,and electroacupuncture groups.Forty-eight rats categorized in model groups were injected 0.5% bupivacaine(BPVC) into the lumbar multifidus at the L4-L5 segment.Rats in the electroacupuncture groups received the intervention for 1,2,3 and 5 d,respectively.The degree of macrophage infiltration and change of M1/M2 polarization were observed based on hematoxylin and eosin staining,immunohistochemistry and immunofluorescence to evaluate the anti-inflammatory effect of electroacupuncture.Meanwhile,exosomal miRNAsequencing and bioinformatics analysis predicted the pathways and biological processes related to inflammatory response and macrophage polarization regulated by electroacupuncture intervention.RESULTS:BPVC injection induced the infiltration of local macrophages at the L4-L5 segment of lumbar multifidus.Comparison of mean IOD values with 2 d and 5 d post injury revealed the highest expression of CD68+ macrophages on day 3 post injury by immunohistochemistry.(P < 0.001,P < 0.001,respectively).Compared with the model group,the cell counts of iNOs+ CD68+ M1-macrophages were lower in the electroacupuncture group,while the positive percent of CD163+ CD206+ M2-macrophages was higher in the electroacupuncture group,on day 3 after BPVC injection(P < 0.001,P < 0.001,respectively).Moreover,the results of sequencing and bioinformatic analysis suggested that exosomal miRNAs were involved in the EA regulating macrophage polarization.CONCLUSIONS:Electroacupuncture can promote macrophage polarization to reduce inflammation following lumbar multifidus muscular injury. 展开更多
关键词 ELECTRO-ACUPUNCTURE muscle repair macrophage polarization INFLAMMATION
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Effect of acupuncture on brain activity in patients with decreasing ovarian reserve:a resting-state functional magnetic resonance imaging study
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作者 BAI Tianyu YANG Jiaen +6 位作者 YIN Liang LI Jinling LIU Jianxian LI Zongchang SUN Zeming JIA Ning XU Chengchao 《Journal of Traditional Chinese Medicine》 2025年第2期450-457,共8页
OBJECTIVE:To examine the variations in brain regions among individuals with decreasing ovarian reserve(DOR) compared to healthy controls using resting-state functional magnetic resonance imaging(rs-fMRI),and to assess... OBJECTIVE:To examine the variations in brain regions among individuals with decreasing ovarian reserve(DOR) compared to healthy controls using resting-state functional magnetic resonance imaging(rs-fMRI),and to assess the immediate effects of acupuncture stimulation on these brain regions in DOR patients.METHODS:Twenty patients diagnosed with DOR(DOR group) and twenty healthy controls(HC group) who underwent rs-fMRI scans were included.The DOR group received acupuncture and underwent a subsequent rsfMRI scan.Amplitude of low-frequency fluctuations(ALFF) analysis was utilized to identify disparities in brain regions between DOR and HC groups,and to evaluate the immediate effects of acupuncture on DOR patients' brain regions.Common brain regions were identified as seed points for functional connectivity(FC) analysis.RESULTS:In this study,a total of 20 HCs and 20 patients with DOR were initially enrolled.However,due to incomplete personal information,three participants were removed from the HC group.Additionally,two DOR patients experienced symptoms such as physical discomfort and shortness of breath during the MRI scan,leading to their exclusion due to excessive head movement parameters.Consequently,17 HCs and 16 DOR patients completed the entire study protocol.Comparative analysis revealed that DOR patients exhibited increased ALFF values in the left inferior temporal gyrus(ITG) and middle temporal gyrus(MTG),while ALFF values in the bilateral superior frontal gyrus(SFG),middle frontal gyrus(MFG),and left inferior frontal gyrus(IFG) were decreased compared to HCs.Following acupuncture intervention,ALFF values in the left SFG,MFG,and supplementary motor area(SMA) of DOR patients increased.Furthermore,functional connectivity(FC) analysis demonstrated increased connectivity of the left SFG with the bilateral calcarine sulcus and lingual gyrus post-acupuncture.CONCLUSION:This study highlights abnormal neural activity in the SFG,MFG,IFG,and ACC in DOR patients compared to HCs.Acupuncture was found to regulate the activity of the SFG,bringing it closer to normal levels,and enhancing its functional connectivity with the bilateral calcarine sulcus and lingual gyrus. 展开更多
关键词 ACUPUNCTURE brain activity ovarian reserve magnetic resonance imaging
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Effectivenss of electroacupuncture for skeletal muscle pain in Parkinson's disease:a Clinical randomized controlled trial 被引量:3
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作者 WANG Shaosong SUN Jingqing +4 位作者 FENG Qingyin LI Bin WANG Xin YUAN Fan CUI Yingxue 《Journal of Traditional Chinese Medicine》 SCIE CSCD 2024年第2期388-395,共8页
OBJECTIVE:To explore the effect of electroacupuncture on skeletal muscle pain in Parkinson's disease(PD).METHODS:A single-center randomized controlled trial was conducted with sixty patients with Parkinson's d... OBJECTIVE:To explore the effect of electroacupuncture on skeletal muscle pain in Parkinson's disease(PD).METHODS:A single-center randomized controlled trial was conducted with sixty patients with Parkinson's disease with skeletal muscle pain were randomly divided into electroacupuncture group and sham acupuncture control group with 30 patients each.The electric acupuncture group was treated with electric acupuncture,while the control group was treated with Park needle pseudoacupuncture.Both groups were treated 5 times a week for a total of 4 weeks,and both groups completed 20 treatments.King's Parkinson's Pain Scale(KPPS)and visual analog scale(VAS)were used before and after treatment to evaluate the pain degree of patients.Realtime shear wave elastography(SWE)and modified Ashworth score(MAS)were used to evaluate the changes of muscle tone.Parkinson's comprehensive Score Scale(MDS-UPDRS,including UPDRS Ⅱ and UPDRS Ⅲ)was used to evaluate exercise ability.Hamilton Depression Scale(HAMD)score was used to evaluate the emotional changes of patients.Spearman correlation analysis was used to explore the correlation between pain degree and muscle tone,exercise ability and emotion.RESULTS:During the study,one case fell off in the control group,and 30 cases were eventually included in the analysis and treatment group and 29 cases in the control group.After treatment,Young's modulus of biceps and quadriceps and shear wave velocity of biceps were decreased in electroacupuncture group compared with before treatment,while KPPS score,VAS score,UPDRS Ⅱ,UPDRS Ⅲ and modified Ashworth score were decreased,with statistical significance(P<0.05).There was no statistical significance in control group(P>0.05).After treatment,KPPS score,VAS score,UPDRS Ⅱ and UPDRS Ⅲ,MAS,HAMD score,Young's modulus of biceps and shear wave velocity in electroacupuncture group were significantly lower than those in control group(P<0.05).Spearman correlation analysis showed that KPPS score was positively correlated with UPDRS Ⅲ(r=0.414,P<0.05).KPPS score was positively correlated with HAMD score(r=0.576,P<0.01).CONCLUSION:Electroacupuncture therapy can effectively improve skeletal muscle pain in patients with Parkinson's disease,reduce the muscle hardness of patients,improve patients'daily life ability,and improve patients'emotional disorders.The degree of skeletal muscle pain in PD patients is correlated with motor ability and emotional disorders,but there is no significant correlation between the degree of skeletal muscle pain and the muscle tone of PD patients. 展开更多
关键词 Parkinson disease MUSCLE SKELETAL PAIN ELECTROACUPUNCTURE muscle tention mood disorders randomized controlled trial
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World Federation of Acupuncture-Moxibustion Societies Clinical Practice Guideline on Acupuncture-Moxibustion:Non-Specific Low Back Pain recommendation summaries 被引量:4
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作者 Xiao-xu LIU Ying-ying GUO +9 位作者 Yu-tong FEI Man HUANG Yong-ming YE Jin-na YU Hui-ze LIN Wen-xi YAN Lan-ping LIU Ke-xin ZHU Jun LIANG Tao YANG 《World Journal of Acupuncture-Moxibustion》 CAS CSCD 2024年第3期213-221,共9页
Clinical Practice Guideline on Acupuncture and Moxibustion:Nonspecific low back pain was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October... Clinical Practice Guideline on Acupuncture and Moxibustion:Nonspecific low back pain was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for nonspecific low back pain approved by an international academic organization,which provides the evidence-based recommendations and practical therapeutic protocols for international acupuncture practitioners.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the Principles of the World Health Organization Handbook for Guideline Development.The guideline development group(GDG)from different countries,with different professions,played a critical role in the formulation of clinical questions,recommendations,and therapeutic protocols.Recommendations are the key content of a CPG and the direct answers to clinical questions.Hence,this article focuses on the recommendations of this CPG.The recommendations were formulated using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of seven recommendations for ten clinical questions were formulated in this CPG,including one conditional recommendation for either the intervention or the comparison based on very low quality of evidence,and six conditional recommendations for the intervention based on very low quality of evidence. 展开更多
关键词 Nonspecific lowbackpain Acupuncture MOXIBUSTION Clinical practice guideline RECOMMENDATIONS
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Effects of anterior sciatic nerve acupuncture on lower limb paralysis after cerebral infarction:study protocol for a randomized controlled trial 被引量:4
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作者 LI Menghan WANG Yu +4 位作者 RAN Dawei YANG Xinming DENG Shizhe SHI Lei MENG Zhihong 《Journal of Traditional Chinese Medicine》 SCIE CSCD 2024年第1期205-211,共7页
Stroke is the main cause of disability in the middle and old age.Hemiplegia,especially lower limb paralysis,often leads to the loss of self-care ability and a series of secondary injuries.The main method to improve he... Stroke is the main cause of disability in the middle and old age.Hemiplegia,especially lower limb paralysis,often leads to the loss of self-care ability and a series of secondary injuries.The main method to improve hemiplegic limb movement is exercise therapy,but there are still many patients with disabilities after rehabilitation treatment.As one of the non-pharmacological therapies for stroke,acupuncture has been recognized to improve motor function in patients.Here,we propose a new method,anterior sciatic nerve acupuncture,which can stimulate both the femoral nerve and the sciatic nerve.We designed this study to determine the effect of this method on lower limb motor function.Sixty participants recruited with hemiplegia after cerebral infarction will be randomly assigned to the test group or control group in a 1:1 ratio.The control group will receive Xingnao Kaiqiao acupuncture,and the test group will receive anterior sciatic nerve acupuncture on this basis.All participants will get acupuncture treatment once a day,6 times a week for 2 weeks.The primary outcome is Fugl-Meyer Assessment of Lower Extremity and the secondary outcomes are Modified Ashworth Scale and Modified Barthel Index.Data will be collected before treatment,1week after treatment,and 2 weeks after treatment,and then statistical analysis will be performed.This study can preliminarily verify the effect of anterior sciatic nerve acupuncture on improving lower limb motor function in patients with cerebral infarction,which may provide an alternative approach for clinical treatment of hemiplegia. 展开更多
关键词 anterior sciatic nerve ACUPUNCTURE PARALYSIS cerebral infarction Xingnao Kaiqiao clinical protocols
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World Federation of Acupuncture-Moxibustion Societies(WFAS)Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis recommendation summaries 被引量:2
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作者 Shi-hao DU Jing LIU +8 位作者 Sheng CHEN Shan-ze WANG Guan-qun WANG Shuo DU Xiao-long XIE Bi-hui PENG Wei GUO Chao YANG Ji-ping ZHAO 《World Journal of Acupuncture-Moxibustion》 CAS CSCD 2024年第3期179-188,共10页
Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.... Clinical Practice Guideline on Acupuncture and Moxibustion:Allergic Rhinitis was revised and released by the Standards Working Committee of World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023.This is the first clinical practice guideline(CPG)on acupuncture and moxibustion for allergic rhinitis approved by an international academic organization,which provides evidence-based recommendations and the practical therapeutic protocols for acupuncture practitioners globally.This CPG was developed by following Grades of Recommendation,Assessment,Development,and Evaluation(GRADE)methodology,and the principles of the World Health Organization Handbook for Guideline Development.The members in the guideline development group(GDG)were from different countries,with different professions,and they played a critical role in the development of clinical questions,recommendations,and therapeutic protocols.Recommendations are the core of a CPG and the direct answers to clinical questions,due to which this article focuses on the recommendations of this CPG.The recommendations were developed by using the modified Delphi method and the GRADE grid rules,based on the updated systematic reviews of clinical evidence.A total of 15 recommendations for 15 clinical questions were developed in this CPG,including one strong recommendation for intervention based on high-quality evidence,three conditional recommendations for either the intervention or the comparison based on very low quality of evidence,and 11 conditional recommendations for the intervention based on very low quality of evidence. 展开更多
关键词 Allergic rhinitis Acupuncture MOXIBUSTION Clinical practice guideline(CPG) Clinical questions
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