Transcutaneous electrical acupoint stimulation for children with attention-deficit/hyperactivity disorder: a randomized clinical trial

Vitamin D insufficiency and sleep disturbances in children with ADHD: a case-control study

Introduction

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorders often co-occurring with sleep problems and other physical disorders. Vitamin D regulates sleep and supports normal brain function. Regrettably, no studies have looked at whether vitamin D insufficiency exacerbates sleep problems in ADHD children and further affects ADHD symptoms.

Objective

This study aimed to examine whether vitamin D insufficiency exacerbates sleep problems and ADHD symptoms in children aged 6-14 years.

Methods

This is a case-control study, 260 ADHD children (aged 6-14 years) were enrolled in, of whom 95 had vitamin D insufficiency and 165 had sufficiency. Collected all ADHD symptom severity and functional impairment scales, including Swanson, Nolan and Pelham (SNAP) scale, Integrated Visual and Auditory Continuous Performance Test (IVA-CPT), Conners parents symptom questionnaire (PSQ) and Weiss Functional Impairment Rating Scale-Parent Form (WFIRS-P). All guardians of children with ADHD complete the Children's Sleep Habits Questionnaire (CSHQ).

Results

The CSHQ total scores of the ADHD children in both groups were significantly higher than 41, which means that ADHD children overall have sleep problems. Compared to ADHD children with vitamin D sufficiency group, we observed significantly higher sleep duration and sleep disordered breathing scores in ADHD children with vitamin D insufficiency group (all p< 0.05). However, there was no direct effect of vitamin D insufficiency on the type of ADHD, symptoms or functional impairment (all p> 0.05). Further analyses showed a correlation between the CSHQ and symptoms, functional impairment scores in children with ADHD.

Conclusion

Sleep problems are highly prevalent in children with ADHD. Vitamin D insufficiency has a significant impact on both sleep duration and sleep disordered breathing, but no notable direct effects on ADHD symptoms or functional impairment. Our findings underscore the importance of screening for vitamin D insufficiency in children with ADHD, particularly given its association with sleep disturbances, which may indirectly affect symptom severity.

Effect of Different Frequencies of Transcutaneous Electrical Acupoint Stimulation (TEAS) on EEG Source Localization in Healthy Volunteers: A Semi-Randomized, Placebo-Controlled, Crossover Study

Background/Objectives: Transcutaneous electrical acupoint stimulation (TEAS), also known as transcutaneous electroacupuncture stimulation, delivers electrical pulses to the skin over acupuncture points ("acupoints") via surface electrodes. Electroencephalography (EEG) is an important tool for assessing the changes in the central nervous system (CNS) that may result from applying different TEAS frequencies peripherally-i.e., acting via the peripheral nervous system (PNS)-and determining how these influence cerebral activity and neural plasticity. Methods: A total of 48 healthy volunteers were allocated in a semi-randomized crossover study to receive four different TEAS frequencies: 2.5 pulses per second (pps); 10 pps; 80 pps; and sham (160 pps at a low, clinically ineffective amplitude). TEAS was applied for 20 min to each hand at the acupuncture point Hegu (LI4). The EEG was recorded during an initial 5 min baseline recording, then during TEAS application, and after stimulation for a further 15 min, separated into three periods of 5 min (initial, intermediate, and final) in order to assess post-stimulation changes. Source localization analysis was conducted for the traditional five EEG frequency bands: delta (0.1-3.9 Hz), theta (4-7.9 Hz), alpha (8-13 Hz), beta (14-30 Hz), and gamma (30.1-45 Hz). Results: Within-group source localization analyses of EEG data showed that during the initial 5 min post-stimulation, theta oscillations in the 2.5 pps TEAS group increased over the parahippocampal gyrus (t = 4.42, p < 0.01). The 10 pps TEAS group exhibited decreased alpha rhythms over the inferior parietal gyrus (t = -4.20, p < 0.05), whereas the sham (160 pps) TEAS group showed decreased delta rhythms over the postcentral gyrus (t = -3.97, p < 0.05). During the intermediate 5 min post-stimulation, the increased theta activity over the left parahippocampal gyrus (BA27) remained in the 2.5 pps TEAS group (t = 3.97, p < 0.05). However, diminished alpha rhythms were observed in the 10 pps TEAS group over the postcentral gyrus (t = -4.20, p < 0.01), as well as in the delta rhythms in the sham (160 pps) TEAS group in the same area (t = -4.35, p < 0.01). In the final 5 min post-stimulation, reduced alpha rhythms were exhibited over the insula in the 10 pps TEAS group (t = -4.07, p < 0.05). Interaction effects of condition by group demonstrate decreased alpha rhythms in the 10 pps TEAS group over the supramarginal gyrus during the initial 5 min post-stimulation (t = -4.31, p < 0.05), and decreased delta rhythms over the insula in the sham TEAS group during the final 5 min post-stimulation (t = -4.42, p < 0.01). Conclusions: This study revealed that low TEAS frequencies of 2.5 pps and 10 pps modulate theta and alpha oscillations over the brain areas related to emotional and attentional processes driven by external stimuli, as well as neural synchronization of delta rhythms in the sham group in brain areas related to stimulus expectation at baseline. It is hoped that these findings will stimulate further research in order to evaluate such TEAS modulation effects in clinical patients.

Aberrant amplitude of low-frequency fluctuation and functional connectivity in children with different subtypes of ADHD: a resting-state fNIRS study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with different subtypes of pathogenesis. Insufficient research on the subtypes of ADHD has limited the effectiveness of therapeutic methods.

METHODS

This study used resting-state functional near-infrared spectroscopy (fNIRS) to record hemodynamic signals in 34 children with ADHD-combined subtype (ADHD-C), 52 children with ADHD-inattentive subtype (ADHD-I), and 24 healthy controls (HCs). The amplitude of low-frequency fluctuation (ALFF) and the functional connectivity (FC) analysis were conducted for all subjects.

RESULTS

Compared with HCs, the ADHD group exhibited significantly increased ALFF and decreased FC. The ADHD-C group showed significantly higher ALFF in partial brain regions and significantly lower FC between multiple brain regions than participants with ADHD-I. The male group displayed a significant increase in ALFF in some brain regions, while no significant difference was found in FC when compared to the female group.

CONCLUSIONS

This study provides evidence to support the subtype classification of ADHD-I and ADHD-C, and the combined analysis of ALFF and FC has the potential to be a promising biomarker for the diagnosis of ADHD.

Effect of transcutaneous electrical acupoint stimulation at different frequencies on mild hypertension: A randomized controlled trial

BACKGROUND

Transcutaneous electrical acupoint stimulation (TEAS) may contribute to blood pressure (BP) control, but the evidence remains insufficient. Our objectives were to evaluate the impact of TEAS on hypertension and determine the optimal frequency.

METHODS

A total of 120 hypertensive patients were randomly allocated to the TEAS-2Hz group, TEAS-10Hz group, or usual care control group in a 1:1:1 ratio. All patients were advised to continue their usual antihypertensive regimen. Additionally, patients in the TEAS groups received TEAS therapy 3 times per week for 4 weeks, with a 4-week follow-up.

RESULTS

The primary outcome was the change in systolic BP (SBP) from baseline to week 4. Secondary outcomes included changes in diastolic BP (DBP), mean arterial pressure (MAP), heart rate (HR), heart rate variability (HRV), and 12-item health survey (SF-12) at different time points. Both TEAS groups showed reductions in SBP relative to control (TEAS-2Hz group vs. control, -4.70 mmHg [95 % CI, -7.00 to -2.40 mmHg]; P < 0.001; TEAS-10Hz group vs. control, -8.66 mmHg [95 % CI, -10.97 to -6.36 mmHg]; P < 0.001). TEAS-10Hz provided a significant decrease in SBP than TEAS-2Hz (-3.96 mmHg [95 % CI, -1.66 to -6.26 mmHg]; P< 0.001). TEAS groups also exhibited reductions in DBP, MAP, HR, LF/HF ratio（LF/HF）, very low frequency (VLF), and normalized low frequency (LF norm), and an increase in normalized high frequency (HF norm) than control. No differences were observed among groups in low frequency (LF), high frequency (HF), total power (TP), very low frequency (VLF), and SF-12.

CONCLUSION

TEAS might be a promising adjunctive therapy for hypertension, and the recommended frequency is 10 Hz, which should be confirmed in larger trials.

Applications of functional near-infrared spectroscopy in non-drug therapy of traditional Chinese medicine: a review

Non-drug therapies of traditional Chinese medicine (TCM), including acupuncture, massage, tai chi chuan, and Baduanjin, have emerged as widespread interventions for the treatment of various diseases in clinical practice. In recent years, preliminary studies on the mechanisms of non-drug therapies of TCM have been mostly based on functional near-infrared spectroscopy (fNIRS) technology. FNIRS is an innovative, non-invasive tool to monitor hemodynamic changes in the cerebral cortex. Our review included clinical research conducted over the last 10 years, establishing fNIRS as a reliable and stable neuroimaging technique. This review explores new applications of this technology in the field of neuroscience. First, we summarize the working principles of fNIRS. We then present preventive research on the use of fNIRS in healthy individuals and therapeutic research on patients undergoing non-drug therapies of TCM. Finally, we emphasize the potential for encouraging future advancements in fNIRS studies to establish a theoretical framework for research in related fields.

A bibliometric analysis of acupuncture for neurodevelopmental disorders: A Call for increased output and future research priorities

Objective

To perform a bibliometric analysis of published research on acupuncture for neurodevelopmental disorders and to provide new insights for future studies.

Methods

Web of Science Core Collection was used to search for articles on acupuncture for neurodevelopmental disorders in children, from inception to Dec 4, 2022. VOSviewer and CiteSpace software were used for bibliometric analyses. VOSviewer was used to analyze and visualize the knowledge maps of the articles' countries, authors, and institutions of origin, the journals and keywords. CiteSpace was used to visualize the dual-map overlay of the journals in which the articles were published and those publishing the articles they cited.

Results

A total of 119 papers were retrieved. The highest number of publications came from China, followed by the United States and South Korea. The most frequently cited article was from the United States, followed by China. The most publications were from KyungHee University, followed by Sichuan University. Author Cho, Seung-hun from KyungHee University published the most articles. The Journal of Alternative and Complementary Medicine and Medicine published the most articles. The top three most frequently used keywords were "acupuncture", "children", and "complementary".

Conclusion

Research intensity and recognition, as well as collaboration within the field of acupuncture for treating neurodevelopmental disorders in children has increased. Research is generally diverse and comprehensive, and the neuro-endocrine-immune mechanism should be a new direction for further development. More basic research is also needed, to elucidate the therapeutic mechanisms, to standardize and validate the use of acupuncture for neurodevelopmental disorders.

Research trends of acupuncture therapy on postoperative nausea and vomiting from 2011 to 2023: A bibliometric analysis

BACKGROUND

The utilization of acupuncture as a therapeutic intervention for the management of postoperative nausea and vomiting has experienced a notable increase in its popularity, and the purpose of this analysis is to provide a comprehensive understanding of the level of concern within the academic discipline and the main contributors and their partnership, as well as to identify research focal points and trends.

METHODS

A comprehensive search was carried out to identify relevant articles on the topic of acupuncture therapy for PONV in the Web of Science and China National Knowledge Internet. The search spanned from January 1, 2011, to June 6, 2023. The annual publications were count to see the degree of scholarly attention devoted to the discipline and how it has changed over time. A statistical analysis of article distribution across various journals was conducted to serve a rough indicator for assessing the quality of articles. And a bibliometric analysis was conducted using the software CiteSpace to visually analyze various aspects of the literature. Analyze authors, institutions and countries to identify the main contributors and their collaborative relationship; and analyze keywords and references to explore research hotspots and trends.

RESULTS

This study examined a comprehensive collection of 819 articles focused on acupuncture therapy for PONV, demonstrating a varying upward trend in the quantity of publications. Notably, the most productive author and institution were identified as Zheng Man and Guangzhou University of Traditional Chinese Medicine, respectively. While China had the highest number of publications, the United States held a greater prominence in this specific field. Collaboration among contributors was found to be weak. High-frequency keywords in the publications included "transcutaneous electrical acupoint stimulation," "electroacupuncture," "pain," and so forth. The literature with the highest citation count pertained to "Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting," while the article with the highest centrality was "Consensus Guidelines for the Management of Postoperative Nausea and Vomiting." Several large clusters obtained from the references are also included "postoperative pain," "transcutaneous electrical acupoint stimulation". Nothing pertaining to mechanism study was found in the analysis results.

CONCLUSION

The utilization of acupuncture for the treatment of postoperative nausea and vomiting has been gaining increasing recognition, although there remains room for improvement in the quality of research conducted in this area. Chinese authors and institutions have emerged as significant contributors to this field, while the United States has demonstrated greater proficiency in fostering collaborative efforts. It is imperative to enhance collaboration among these contributors. The current focal points of acupuncture for PONV encompass pain management, electroacupuncture, auricular acupuncture, and transcutaneous electrical acupoint stimulation. Additionally, TEA and enhanced recovery after surgery have been identified as the forefronts of research in this particular domain. In addition, there is still much room for research in the aspect of mechanism and insurance coverage. This study provides an in-depth perspective on acupuncture for PONV, which offers reference material for clinicians with rational choice of therapeutic scheme, educators with hot topics, and researchers with valuable research directions.

Efficacy and safety of transcutaneous electrical acupoints stimulation for preoperative anxiety in thoracoscopic surgery: study protocol for a randomised controlled trial

INTRODUCTION

Preoperative anxiety occurs at a very high rate in patients undergoing video-assisted thoracoscopic surgery (VATS). Moreover, it will result in poor mental state, more analgesic consumptions, rehabilitation delay and extra hospitalisation costs. Transcutaneous electrical acupoints stimulation (TEAS) is a convenient intervention for pain control and anxiety reduction. Nevertheless, TEAS efficacy of preoperative anxiety in VATS is unknown.

METHODS AND ANALYSIS

This single-centre randomised sham-controlled trial will be conducted in cardiothoracic surgery department of the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine in China. A total of 92 eligible participants with pulmonary nodules (size ≥8 mm) who are arranged for VATS will be randomly assigned to a TEAS group and a sham TEAS (STEAS) group in a 1:1 ratio. Daily TEAS/STEAS intervention will be administered starting on 3 days before the VATS and continued once per day for three consecutive days. The primary outcome will be the generalised anxiety disorder scale score change between the day before surgery with the baseline. The secondary outcomes will include serum concentrations of 5-hydroxytryptamine, norepinephrine and gamma-aminobutyric acid, intraoperative anaesthetic consumption, time to postoperative chest tube removal, postoperative pain, and length of postoperative hospital stay. The adverse events will be recorded for safety evaluation. All data in this trial will be analysed by the SPSS V.21.0 statistical software package.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine (approval number: 2021-023). The results of this study will be distributed through peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04895852.

Effect of transcutaneous electrical acupoint stimulation on pregnancy outcomes in women with in vitro fertilization-embryo transfer: A systematic review and meta-analysis

Objective: The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) on pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer (IVF-ET), in order to provide evidence-based medical support. Methods: We searched the Cochrane Library, Embase, PubMed, Web of Science, SinoMed, and CNKI for relevant randomized controlled trials (RCTs) from inception to 31 May 2022, using the search terms "transcutaneous electrical acupoint stimulation," "TEAS," "in vitro fertilization-embryo transfer," "IVF-ET," "randomized controlled trial," and "clinical trials." The experimental group was treated with TEAS or combined with ovulation-inducing medication, and the control group was treated with mock TEAS (mTEAS), ovulation-inducing medication, or no intervention. The main outcome was the clinical pregnancy rate. Secondary outcomes were the embryo implantation rate, live birth rate, biochemical pregnancy rate, and number of oocytes retrieved. Stata15.1 software was used for data summary and analysis. Results: This review involved 15 RCTs and 4,281 participants. TEAS were superior to the control group for improving the clinical pregnancy rate [RR: 1.29, 95% CI: 1.19 to 1.40; p < 0.001; I² = 23.0%], embryo implantation rate [RR: 1.43, 95% CI: 1.22 to 1.69; p < 0.001; I² = 35.9%], live birth rate [RR: 1.33, 95% CI: 1.14 to 1.54; p < 0.001; I² = 47.3%], and biochemical pregnancy rate [RR: 1.15, 95% CI: 1.05 to 1.26; p = 0.003; I² = 49.1%], without significant heterogeneity. TEAS had no statistically significant effect on the number of oocytes retrieved as compared with the control group, and the heterogeneity was high [SMD: 0.34, 95% CI: -0.04 to 0.72; p = 0.081; I² = 77.6%]. We performed subgroup analysis based on the sample size, interventions and intervention time-point. The results showed that the sample size had no effect on the results. There was no significant difference between TEAS and ovulation-inducing medication in the clinical pregnancy rate or the embryo implantation rate. In addition, TEAS did not significantly increase the embryo implantation rate or the live birth rate, compared with no intervention. In terms of safety, mild allergic symptoms were found in both the experimental group and the control group. Conclusion: In general, existing evidence supports the potential value of TEAS as an adjunctive treatment for improving pregnancy outcomes. High-quality, large-sample RCTs are needed to further support this conclusion. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=334892, identifier PROSPERO CRD42022334892.

Multitarget high-definition transcranial direct current stimulation improves response inhibition more than single-target high-definition transcranial direct current stimulation in healthy participants

Prior studies have focused on single-target anodal transcranial direct current stimulation (tDCS) over the right inferior frontal gyrus (rIFG) or pre-supplementary motor area (pre-SMA) to improve response inhibition in healthy individuals. However, the results are contradictory and the effect of multitarget anodal stimulation over both brain regions has never been investigated. The present study aimed to investigate the behavioral and neurophysiological effects of different forms of anodal high-definition tDCS (HD-tDCS) on improving response inhibition, including HD-tDCS over the rIFG or pre-SMA and multitarget HD-tDCS over both areas. Ninety-two healthy participants were randomly assigned to receive single-session (20 min) anodal HD-tDCS over rIFG + pre-SMA, rIFG, pre-SMA, or sham stimulation. Before and immediately after tDCS intervention, participants completed a stop-signal task (SST) and a go/nogo task (GNG). Their cortical activity was recorded using functional near-infrared spectroscopy (fNIRS) during the go/nogo task. The results showed multitarget stimulation produced a significant reduction in stop-signal reaction time (SSRT) relative to baseline. The pre-to-post SSRT change was not significant for rIFG, pre-SMA, or sham stimulation. Further analyses revealed multitarget HD-tDCS significantly decreased SSRT in both the high-performance and low-performance subgroups compared with the rIFG condition which decreased SSRT only in the low-performance subgroup. Only the multitarget condition significantly improved neural efficiency as indexed by lower △oxy-Hb after stimulation. In conclusion, the present study provides important preliminary evidence that multitarget HD-tDCS is a promising avenue to improve stimulation efficacy, establishing a more effective montage to enhance response inhibition relative to the commonly used single-target stimulation.