Traditional Chinese veterinary medicine: the mechanism and management of acupuncture for chronic pain

Postoperative neurocognitive disorders in the elderly: how can we stop the harm? A literature review

Postoperative neurocognitive disorders (PND) represent a significant challenge affecting patients undergoing surgical procedures, particularly in the elderly population. These disorders can lead to profound impairments in cognitive function, impacting memory, attention, and overall quality of life. Despite ongoing research efforts to identify risk factors and improve management strategies, PND remains underdiagnosed and poorly understood, complicating postoperative recovery and rehabilitation. This review aims to explore the recent advancement in the literature about PND, focusing on the underlying mechanisms, risk factors, and potential therapeutic approaches. We highlight recent advancements in the understanding of neuroinflammation, and it is implications for novel therapies to prevent PND. By synthesizing the latest research, we hope to provide insights that could lead to improved outcomes for patients at risk for PND and foster a shift towards more effective preventive measures in such population.

Acupuncture in Zoological Companion Animals

Over the past years, the concept of pain management in veterinary medicine has evolved and led to the establishment of a new concept of multimodal approach to pain management, as the current standard of care. The use of multimodal analgesia combining pharmacologic and nonpharmacologic techniques not only helps optimize the quality and efficacy of analgesia but also may prevent the development of chronic or persistent pain. During the past decade, acupuncture has become more popular and evolved into one of the most used forms of integrative medicine interventions and nonpharmacologic therapeutic options for pain management in humans and animals in North America and Europe. There is ample evidence from basic and clinical research for acupuncture is effective in the treatment of acute and chronic pain by influencing neural networks of the nervous system. While in the modern days' veterinary acupuncture has been predominantly used in horses and dogs, its popularity in zoologic companion animals (ZCA) has increased in recent years as an adjunct therapy for treating musculoskeletal, neurologic, and gastrointestinal disorders due to its minimal invasiveness and low risk of adverse events. The integrative use of acupuncture has become even more important with the increasingly limited use of opiates in veterinary medicine due to the opiate crisis. The purpose of this article aims to provide guidance for using acupuncture for pain management in ZCA in clinical practice, based on available information and recommendations from experienced veterinary acupuncturists.

Evidence-Based Application of Acupuncture for Pain Management in Companion Animal Medicine

The use of veterinary acupuncture for pain relief is expanding among small animal practitioners. Although acupuncture was developed as part of the medical system in Ancient China, research into the scientific basis of its effects is expanding rapidly. Acupuncture is very effective for analgesia on a local, segmental, and suprasegmental level. Many forms of acupuncture can be used independently or as part of a balanced multi-modal approach for the control of acute and chronic pain. In the hands of a skilled practitioner, acupuncture can be a safe and effective modality for treating pain in companion animals. This article outlines the mechanisms of action of acupuncture, its related neurophysiology and provides examples from the literature demonstrating its effectiveness.

Application of veterinary naturopathy and complementary medicine in small animal medicine—A survey among German veterinary practitioners

Background

The international use of and interest in veterinary naturopathy and complementary medicine are increasing. There are diverse modes of treatment, and owners seem to be well informed. However, there is a lack of data that describes the state of naturopathic or complementary veterinary medicine in Germany. This study aims to address the issue by mapping the currently used treatment modalities, indications, existing qualifications, and information pathways. In order to map the ongoing controversy, this study records the advantages and disadvantages of these medicines as experienced by veterinarians. Demographic influences are investigated to describe distributional impacts on using veterinary naturopathy and complementary medicine.

Methods

A standardised questionnaire was used for the cross-sectional survey. It was distributed throughout Germany in a written and digital format from September 2016 to January 2018. Because of the open nature of data collection, the return rate of questionnaires could not be calculated. To establish a feasible timeframe, active data collection stopped when the previously calculated limit of 1061 questionnaires was reached. With the included incoming questionnaires of that day a total of 1087 questionnaires were collected. Completely blank questionnaires and those where participants did not meet the inclusion criteria (were not included, leaving 870 out of 1087 questionnaires to be evaluated. A literature review and the first test run of the questionnaire identified the following treatment modalities: homoeopathy, phytotherapy, traditional Chinese medicine (TCM), biophysical treatments, manual treatments, Bach Flower Remedies, neural therapy, homotoxicology, organotherapy, and hirudotherapy which were included in the questionnaire. Categorical items were processed using descriptive statistics in absolute and relative numbers based on the population of completed answers provided for each item. Multiple choices were possible. Metric data were not normally distributed (Shapiro Wilk Test); hence the median, minimum, and maximum were used for description. The impact of demographic data on the implementation of veterinary naturopathy and complementary techniques was calculated using the Mann-Whitney-U-Test for metric data and the exact Fisher-Test for categorical data.

Results

Overall 85.4% (n = 679 of total 795 non-blank data sets) of all the questionnaire participants used naturopathy and complementary medicine. The treatments most commonly used were complex homoeopathy (70.4%, n = 478), phytotherapy (60.2%, n = 409), classic homoeopathy (44.3%, n = 301) and biophysical treatments (40.1%, n = 272). The most common indications were orthopedic (n = 1798), geriatric (n = 1428) and metabolic diseases (n = 1124). Over the last five years, owner demand for naturopathy and complementary treatments was rated as growing by 57.9% of respondents (n = 457 of total 789). Veterinarians most commonly used scientific journals and publications as sources for information about naturopathic and complementary contents (60.8%, n = 479 of total 788). These were followed by advanced training acknowledged by the ATF (Academy for Veterinary Continuing Education, an organisation that certifies independent veterinary continuing education in Germany) (48.6%, n = 383). The current information about naturopathy and complementary medicine was rated as adequate or nearly adequate by a plurality (39.5%, n = 308) of the respondents of this question. Further, 27.7% (n = 216) of participants chose the option that they were not confident to answer this question and 91 answers were left blank. The most commonly named advantages in using veterinary naturopathy and complementary medicine were the expansion of treatment modalities (73.5%, n = 566 of total 770), customer satisfaction (70.8%, n = 545) and lower side effects (63.2%, n = 487). The ambiguity of studies, as well as the unclear evidence of mode of action and effectiveness (62.1%, n = 483) and high expectations of owners (50.5%, n = 393) were the disadvantages mentioned most frequently. Classic homoeopathy, in particular, has been named in this context (78.4%, n = 333 of total 425). Age, gender, and type of employment showed a statistically significant impact on the use of naturopathy and complementary medicine by veterinarians (p < 0.001). The university of final graduation showed a weaker but still statistically significant impact (p = 0.027). Users of veterinary naturopathy and complementary medicine tended to be older, female, self-employed and a higher percentage of them completed their studies at the University of Berlin. The working environment (rural or urban space) showed no statistical impact on the veterinary naturopathy or complementary medicine profession.

Conclusion

This is the first study to provide German data on the actual use of naturopathy and complementary medicine in small animal science. Despite a potential bias due to voluntary participation, it shows a large number of applications for various indications. Homoeopathy was mentioned most frequently as the treatment option with the most potential disadvantages. However, it is also the most frequently used treatment option in this study. The presented study, despite its restrictions, supports the need for a discussion about evidence, official regulations, and the need for acknowledged qualifications because of the widespread application of veterinary naturopathy and complementary medicine. More data regarding the effectiveness and the mode of action is needed to enable veterinarians to provide evidence-based advice to pet owners.

Acupuncture and Traditional Chinese Veterinary Medicine in Zoological and Exotic Animal Medicine: A Review and Introduction of Methods

Acupuncture has been used extensively in domestic animal medicine to treat a variety of medical conditions and diseases as an adjunct or primary therapy. Exotic animals are becoming increasingly common as pets. Owners are expecting therapies for these non-domestic animals to be similar to those available to their other domestic pets. Additionally, zoological and aquatic facilities provide medical care for the entire lives of the animals that are housed in their facilities. Many conditions similar to those observed in domestic animals can develop in zoological species and can benefit from treatment with acupuncture. Through operant conditioning or routine medical examinations, the use of acupuncture as an adjunct therapy is becoming more common. The following paper presents a summary of the types of non-domestic animals treated, for which conditions, and how these methods are commonly used.

Evaluation of Toxicity, Bacteriostatic, Analgesic, Anti-Inflammatory, and Antipyretic Activities of Huangqin-Honghua-Pugongying-Jinyinhua Extract

The extensive use of antibiotics has caused the global spread of multidrug-resistant bacteria and genes, seriously reducing antibiotic efficacy and threatening animal and human health. As an alternative, traditional Chinese veterinary medicine (TCVM) was used in this study for its lack of drug resistance and low toxicity. Huangqin-honghua-pugongying-jinyinhua extract (HHPJE), a novel TCVM, consists of the extracts of Huangqin (Scutellaria baicalensis), Honghua (Carthami Flos), Pugongying (Taraxacum) and Jinyinhua (Lonicerae Japonicae Flos), and was developed to treat bovine mastitis. In this study, we evaluated the toxicity, bacteriostatic, analgesic, anti-inflammatory, and antipyretic activities of HHPJE. Our results show that HHPJE did not show any acute oral toxicity and can be considered safe for oral administration. Additionally, HHPJE possessed a dose-dependent antibacterial effect on Staphylococcus aureus, Escherichia coli, Streptococcus agalactiae and Streptococcus dysgalactiae. HHPJE (60, 30 and 15 g/kg) can reduce the abdominal pain by 44.83 ± 7.69%, 43.15 ± 9.50% and 26.14 ± 4.17%, respectively. The percentages of anti-inflammation inhibition (60, 30 and 15 g/kg) were 35.34 ± 2.17%, 22.29 ± 2.74% and 12.06 ± 3.61%, respectively. The inhibition rates (60, 30 and 15 g/kg) of antipyretic activity were 82.05%, 65.71% and 52.80%, respectively. The evaluation of pharmacodynamics and toxicity indicate that HHPJE possesses significant bacteriostatic, analgesic, anti-inflammatory and antipyretic potential, and also that it is safe for acute oral toxicity, which means it has potential value for treating bovine mastitis in future and alleviating clinical symptoms with no drug resistance or side effects.

Electroacupuncture for Temporomandibular Disorders: A Systematic Review of Randomized Controlled Trials

Although electroacupuncture (EA) is an effective treatment for pain relief, there has been no systematic review of EA treatment for temporomandibular disorder TMD. This systematic review aimed to evaluate the efficacy and safety of EA in TMD management. We searched 14 databases until April 2021 for randomized controlled trials (RCTs) evaluating the effects of EA on TMDs. Eleven RCTs with 667 patients that used three acupuncture points (ST6, ST7, and LI4) were included. Two RCTs reported significant effects of EA plus microwave treatment compared with EA treatment alone on the total effectiveness rate (TER) for TMD. Further, two studies reported that compared with ultrashort wave alone, EA plus ultrashort wave had a significant effect on the TER for TMD and visual analog scale. All RCTs did not report adverse events. Our findings demonstrated the positive potential of EA in TMD management. However, there was weak evidence regarding EA use for TMD management given the poor quality and small sample sizes of the included studies. In the future, well-designed RCTs are required. It is necessary to investigate clinical trials and systematic reviews to compare the effectiveness and safety of EA and acupuncture for TMD.

Determination of the Minimum Infusion Rate of Alfaxalone Combined with Electroacupuncture in Goats

Simple Summary

Goats have been used as animal models in research and are increasingly kept as pets like dogs and cats. Total intravenous anesthesia (TIVA) is increasingly used in companion animals. Electroacupuncture (EA) has been proven to produce analgesia, therefore, the objective of this study was to investigate the effect of EA on alfaxalone-based TIVA in goats. In this current study, the minimum infusion rate (MIR) of alfaxalone was determined in a combination with EA. The findings found that EA reduces the alfaxalone MIR required to prevent purposeful movement of the extremities in response to standardized noxious. In conclusion, EA provided analgesia, reduced the MIR of alfaxalone-based IV anesthesia, and thereby alleviated the adverse cardiorespiratory effects associated with alfaxalone anesthesia in goats.

Abstract

Total intravenous anesthesia (TIVA) is increasingly used in companion animals. The effect of electroacupuncture (EA) on alfaxalone-based TIVA has not been previously reported in goats. Therefore, the objective of this study was to determine the minimum infusion rate (MIR) of alfaxalone required to prevent purposeful movement of the extremities in response to standardized noxious stimulation during its combination with EA in goats. Twelve clinically healthy goats weighing 18.5 ± 2 kg were randomly assigned to two groups (six goats/group). Alfaxalone alone (ALF group) and alfaxalone combined with EA (EA-ALF group). In the EA-ALF, alfaxalone was administered 30 min after EA stimulation. For induction of anesthesia, a bolus of alfaxalone was given at 3 mg/kg IV, and an infusion dose of 9.6 mg/kg/h was initially set for maintenance. The MIR of alfaxalone in both groups was determined by testing for responses to stimulation (clamping on a digit with Vulsellum forceps) at 10-min intervals after induction of anesthesia till the entire period of the experiment. Cardiopulmonary parameters and nociceptive threshold were measured throughout anesthesia. The median alfaxalone MIR was significantly lower in the EA-ALF group than the ALF group [9 (4.8–9.6) and 12 (11.4–18)], respectively; p = 0.0035). In the ALF group, goats anesthetized with MIR showed a significant increase in heart rate and cardiac output (p < 0.0001 and 0.0312, respectively), and decrease in respiratory rate (p < 0.0001), hemoglobin oxygen saturation (p = 0.0081), and rectal temperature (p = 0.0046) compared with those in the EA-ALF. Additionally, goats in the EA-ALF showed a higher nociceptive threshold than those in the ALF group (p < 0.0001). EA provided analgesia, reduced the MIR of alfaxalone-based IV anesthesia and thereby alleviated the adverse cardiorespiratory effects associated with alfaxalone anesthesia in goats.

[Naturopathy and complementary medicine in small animal science - definitions and contents]

Naturopathic and complementary procedures attain increasing popularity in veterinary medicine. A common understanding of definitions and contents of these fields is crucial for communication between pet owners and veterinarians. This paper reviews the existing definitions and the various contents of naturopathy and complementary veterinary medicine as well as their assigned treatment options. Naturopathy includes phytotherapy, hydro-therapy, thermotherapy, electrotherapy, manual therapy/chiropractic/osteopathy, and dietetic treatment. Homeopathy, homotoxicology, Traditional Chinese Medicine including acu-puncture and Chinese herbal medicine, neural therapy, organotherapy and Bach flower remedies are known as complementary treatments. The level of evidence based on scientific literature and the opportunity for certification procedures differ between treatment modalities. In the area of small animal medicine, the most extensive body of literature is available on the subject of acupuncture, in part comprising high evidence levels.

Acupuncture Combined with Chinese Medicine Iontophoresis Treatment for Chronic Progressive Cervical Intervertebral Disk Disease in a Dog

CASE REPORT

A 12-year-old castrated male dog with nonambulatory tetraplegia was diagnosed with spinal stenosis at C3-C4 through X-ray examination and with ventral extradural spinal compression at C3-C4 through myelography and computed tomography. The diagnosis of traditional Chinese veterinary medicine was local Qi and blood stagnation, spleen Qideficiency, blood deficiency, and kidney Yang deficiency. We initiated treatment using a combination of acupuncture and Chinese medicine iontophoresis with laser therapy. After 12 treatment days, there was a significant improvement in the dog's ambulation function, which was indicated by proper walking and flexible head-turning.

CONCLUSION

This indicates that combining acupuncture and Chinese medicine iontophoresis could be a potential treatment for chronic progressive cervical intervertebral disk disease in dogs.

Antiviral mechanisms of candidate chemical medicines and traditional Chinese medicines for SARS-CoV-2 infection

The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become a global pandemic. Up to now, numerous medicines have been applied or approved for the prevention and control of the virus infection. However, the efficiency of each medicine or combination is completely different or still unknown. In this review, we discuss the types, characteristics, antiviral mechanisms, and shortcomings of recommended candidate medicines for SARS-CoV-2 infection, as well as perspectives of the drugs for the disease treatment, which may provide a theoretical basis for drug screening and application.

Veterinary acutherapy in management of musculoskeletal disorders: An eye-opener to the developing countries' veterinarians

Traditional Chinese medicine practitioners believed that the maintenance of the health status of any individual or animal is by the harmonious flow of Chi (life force) along a pathway known as the meridian. Interruption or blockage of Chi brings about disorders, pain, and diseases. Acutherapy, therefore, aims at correcting the interruption or blockage of the harmonious flow of Chi along the meridian to restore the healthy condition of the body system. This correction could be accomplished by either acupuncture or acupressure, and are both collectively referred to as acutherapy. This form of therapy has been used in both humans and animals for several decades. It is, however, just gaining popularity in the treatment of humans and is still not yet in practice among veterinarians for animal patients in most developing countries like Nigeria. This review, therefore, is aimed at exposing veterinarians from the developing countries to the general application of acutherapy with emphasis on the musculoskeletal system and associated pain where it is most applied. It is highly recommended that the universities, where Veterinary Medicine is studied in developing countries, should endeavor to train their veterinary surgeons in this area and see to how acutherapy can be included in the curriculum.

The effects of acupressure on the symptoms severity and function status and electrodiagnostic findings in patients with carpal tunnel syndrome

OBJECTIVE

This study aimed to evaluate the effects of acupressure on the symptoms severity, function status and electrodiagnostic findings in patients with Carpal tunnel syndrome (CTS).

DESIGN

This double blind, randomized, controlled clinical trial study was conducted on 57 patients with CTS that selected through convenience sampling. The patients were randomly assigned to three groups, including (1) acupressure; (2) placebo acupressure; and (3) control.

SETTING

The study was conducted in the medical centers affiliated to Semnan University of Medical Sciences, Iran.

INTERVENTION

The intervention groups received acupressure or placebo for one month. The control group received only routine cares (splints and analgesics) with no additional intervention.

PRIMARY OUTCOMES

The severity of symptoms and hand function were evaluated by the Boston Carpal Tunnel Syndrome Questionnaire, and electrodiagnostic findings, including Nerve Conduction Velocity (NCV), Distal Sensory Latency (DSL), and Distal Motor Latency (DML) were measured by Electromyography device before and after the intervention.

RESULTS

The results showed significant differences in the mean severity of symptoms, hand function, NCV, DSL, and DML before and after the intervention in the acupressure group (P < 0.05). Significant differences were also observed between the means difference in severity of symptoms, hand function, and NCV, DSL, and DML before and after the intervention in the three groups (P < 0.05).

CONCLUSION

According to the results, acupressure was effective in reducing the severity of clinical symptoms, improving the hand function, and improving the electrodiagnostic findings. Therefore, the application of acupressure can be recommended for improving clinical symptoms of patients with CTS.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two-Year Retrospective Analysis

Acupuncture and the administration of herbal supplements are increasingly used in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively) and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7 ± 3.7 vs. 9.5 ± 4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections in acupuncture points (pharmacopuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

The Emperor's New Clothes-An Epistemological Critique of Traditional Chinese Veterinary Acupuncture

Simple Summary

Complementary and alternative medicines have gained increased popularity in the veterinary field. Among them, Traditional Chinese Veterinary Medicine, including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. This paper relies upon an epistemological approach to investigate conceptual, historical and scientific assertions about veterinary acupuncture made by their advocates. Argument by analogy is used to demonstrate that Traditional Chinese Veterinary Medicine is based on pre-scientific principles, similar to those of humoral medicine and bloodletting, and that acupuncture is, in effect, a placebo. The paper concludes with recommendations for veterinary regulators and colleagues.

Abstract

Within the last few decades, complementary and alternative medicines have gained increased popularity in the veterinary field. Although many authors have exposed the scientific fallacies and historical misconceptions used to justify such therapies, those efforts have not succeeded in detracting veterinary practitioners from embracing them. Notably, Traditional Chinese Veterinary Medicine (TCVM), including acupuncture, has emerged as one of the main alternatives to conventional veterinary medicine. In this paper, analogical reasoning is used to investigate conceptual, historical and scientific assertions made by the advocates of TCVM. The paper is divided into two parts: The first aims to appraise conceptual and historical claims made by veterinary acupuncturists. I defend that TCVM is a pre-scientific construct, similar to humoral doctrine, and that acupuncture is analogous to bloodletting. The second part is focused on scientific evidence of clinical application of acupuncture in the dog, showing how science is yet to validate veterinary acupuncture and defending that claims of efficacy are due to placebo effect. It is suggested that veterinary acupuncture needs to abandon Traditional Chinese Medicine and embrace science-based medicine tout court. On the other hand, high quality scientific studies, including randomized controlled trials, need to be presented. Veterinary regulators must bring the issue of non-conventional therapies into their agendas.

AVALIAÇÃO DO EFEITO DA ACUPUNTURA E TÉCNICAS AFINS E PERFIL CLÍNICO E EPIDEMIOLÓGICO DE CÃES COM DOENÇAS NEUROLÓGICAS E OSTEOMUSCULARES ATENDIDOS EM SERVIÇO DE REABILITAÇÃO VETERINÁRIA

Resumo Este estudo retrospectivo avaliou 181 cães com doenças neurológicas e osteomusculares atendidos em um serviço de reabilitação e dor crônica, durante o período de 2013 a 2015. Objetivou-se caracterizar o perfil epidemiológico e clínico dos animais e analisar a eficácia da acupuntura (AP) e terapias afins e respectiva evolução clínica. O diagnóstico baseou-se no exame físico, neurológico, ortopédico e de imagem. As afecções mais prevalentes foram as do sistema nervoso central, sobretudo doença do disco toracolombar e traumas vertebromedulares agudos. Nas enfermidades neurológicas, o tratamento foi considerado eficaz quando os pacientes foram capazes de recuperar a deambulação e para as lesões medulares, quando houve melhora clínica do quadro neurológico avaliado por meio de escores. O sucesso obtido nos quatro segmentos medulares foi de 69,5%. Nas enfermidades osteomusculares, 47% dos cães apresentavam lesões no joelho e 44% displasia coxofemoral (DCF). Adotou-se a escala analógica visual (EAV) de locomoção para definir o sucesso do tratamento nestas doenças, que foi de 52,8%. As técnicas que mais se associaram à AP manual foram, por ordem decrescente, a eletroacupuntura, a ozonioterapia e o LASER. O número de sessões de AP foi em média de 7,6±3,5. Conclui-se que a AP e técnicas afins melhoraram o escore de déficit neurológico nas doenças neurológicas avaliadas quando usadas de forma isolada e quando associadas à medicina convencional.

Tranquilizing and Allaying Excitement Needling Method Affects BDNF and SYP Expression in Hippocampus

Sleep disorder is a state of sleep loss caused by various reasons, which leads to a series of changes, such as emotion, learning and memory, and immune function. “Tranquilizing and allaying excitement” was widely used in clinical treatment of insomnia; however, the mechanism was still not very clear. We randomly divided rats into three groups: control group, sleep deprivation group, and acupuncture treatment group. We observed BDNF and SYP expression in hippocampus in these three groups. Both protein contents and mRNA contents of BDNF and SYP were measured by western blot, immunohistochemistry, and RT-PCR analysis. The sleep deprivation model was established using modified multiple platform sleep deprivation method (MMPM). Our study explored the BDNF and SYP abnormality in hippocampus caused by sleep deprivation and “tranquilizing and allaying excitement” intervention regulated the abnormal expression of BDNF and SYP caused by sleep deprivation on the short run and the long run. Our study provided a molecular evidence that “tranquilizing and allaying excitement” treatment in rats with sleep disorder affects learning and memory ability.

The Effects of Transcutaneous Electrical Acupoint Stimulation (TEAS) on Fatigue in Haemodialysis Patients

INTRODUCTION

Fatigue is one of the most common symptom in End-stage renal disease (ESRD) patients receiving haemodialysis treatment. In recent years, researchers investigated the role of alternative medicine methods such as acupuncture in treatment of the chronic disease; however, there is a paucity of information regarding the fatigue of haemodialysis patients.

AIM

To evaluate the effects of Trans Cutaneous Electrical Acupoint Stimulation (TEAS) on fatigue among ESRD patients receiving haemodialysis treatment.

MATERIALS AND METHODS

This randomized clinical trial was conducted over a five month, in Kermanshah-Iran haemodialysis centers in 2009. Fifty six patients who had undergone haemodialysis and meeting the inclusion criteria, were divided into two groups by simple random sampling; TEAS (28 cases) and TEAS-Sham group (28 cases). The data was gathered through the Brief Fatigue Inventory (BFI), entered into SPSS-16 software and analysed by descriptive and inferential statistics.

RESULTS

Out of 56, 38 patients (67.9%) were male and 45 (80.4%) were married. The mean and standard deviation of age were 52.29±15.26 years. The inferential tests showed no differences in the clinical and the demographic characteristics of patients among two groups (p > 0.05). The mean rank of fatigue score in TEAS and TEAS-Sham groups was 30.68 and 26.32 respectively (p=0.317) at the first of study. The results of the Mann-Whitney U-test indicated that there were significant differences between the TEAS and Sham groups after intervention (p = 0.002).

CONCLUSION

Findings of the present study revealed that application of the TEAS on these acupoints had produced a better recovery rate of fatigue in TEAS group than Sham group after a course of ten session intervention. So, it is suggested that this plan be provided to the haemodialysis patients.

Integrative veterinary medical education and consensus guidelines for an integrative veterinary medicine curriculum within veterinary colleges

Integrative veterinary medicine (IVM) describes the combination of complementary and alternative therapies with conventional care and is guided by the best available evidence. Veterinarians frequently encounter questions about complementary and alternative veterinary medicine (CAVM) in practice, and the general public has demonstrated increased interest in these areas for both human and animal health. Consequently, veterinary students should receive adequate exposure to the principles, theories, and current knowledge supporting or refuting such techniques. A proposed curriculum guideline would broadly introduce students to the objective evaluation of new veterinary treatments while increasing their preparation for responding to questions about IVM in clinical practice. Such a course should be evidence-based, unbiased, and unaffiliated with any particular CAVM advocacy or training group. All IVM courses require routine updating as new information becomes available. Controversies regarding IVM and CAVM must be addressed within the course and throughout the entire curriculum. Instructional honesty regarding the uncertainties in this emerging field is critical. Increased training of future veterinary professionals in IVM may produce an openness to new ideas that characterizes the scientific method and a willingness to pursue and incorporate evidence-based medicine in clinical practice with all therapies, including those presently regarded as integrative, complementary, or alternative.

Efficacy and safety of Myofascial-meridian Release Acupuncture (MMRA) for chronic neck pain: a study protocol for randomized, patient- and assessor-blinded, sham controlled trial

Background

The purpose of this study is to evaluate the efficacy and safety of myofascial-meridian release acupuncture (MMRA) in the treatment of chronic neck pain compared with sham acupuncture.

Methods/design

A protocol for a randomized, patient- and assessor-blinded, sham controlled parallel trial is presented. Seventy-four participants with a ≥3 month history of neck pain and a score of ≥4 on the 11-point pain intensity numerical rating scale (PI-NRS) will be randomly assigned to the MMRA group (n = 37) or sham acupuncture group (n = 37). The participants will receive the MMRA treatment or sham acupuncture treatment twice per week for 4 weeks. The primary outcome is the mean change in the PI-NRS (0 = no pain and 10 = worst possible pain, 11-point Likert scale) from baseline to 4 weeks. The secondary outcomes are the mean change from baseline on the clinical relevance of the pain (ratio of changes greater than 1.5 or with percentiles greater than 30 % and 50 % in the PI-NRS), function (Neck Disability Index and Cervical Range of Motion), autonomic and psychometric measurements (Heart Rate Variability and Perceived Stress Scale), quality of life (EuroQol), global assessment (Patient Global Impression of Change), semi-objective outcomes (pressure pain threshold, consumption of rescue medicine and days of restricted activity) and immunologic/stress biomarkers. Adverse events will be evaluated at every visit.

Discussion

The results of this trial will provide evidence to confirm the efficacy and safety of acupuncture for chronic neck pain.

Trial registration

The trial is registered with the Clinical Research Information Service (CRiS), Republic of Korea: KCT0001573. 

A Retrospective Analysis of 5,195 Patient Treatment Sessions in an Integrative Veterinary Medicine Service: Patient Characteristics, Presenting Complaints, and Therapeutic Interventions

Integrative veterinary medicine, the combination of complementary and alternative therapies with conventional care, is increasingly prevalent in veterinary practice and a focus of clinical instruction in many academic teaching institutions. However, the presenting complaints, therapeutic modalities, and patient population in an integrative medicine service have not been described. A retrospective analysis of 5,195 integrative patient treatment sessions in a veterinary academic teaching hospital demonstrated that patients most commonly received a combination of therapeutic modalities (39% of all treatment sessions). The 274 patients receiving multiple modalities were most frequently treated for neurologic and orthopedic disease (50.7% versus 49.6% of all presenting complaints, resp.). Older neutered or spayed dogs (mean age = 9.0 years) and Dachshunds were treated more often than expected based on general population statistics. Acupuncture, laser therapy, electroacupuncture, and hydrotherapy were frequently administered (>50% patients). Neurologic patients were more likely to receive acupuncture, electroacupuncture, and therapeutic exercises but less likely than orthopedic patients to receive laser, hydrotherapy, or therapeutic ultrasound treatments (P < 0.05). The results suggest that the application of these specific modalities to orthopedic and neurologic diseases should be subjected to increased evidence-based investigations. A review of current knowledge in core areas is presented.

The holistic effects of acupuncture treatment

Traditional Chinese Medicine (TCM), as a complex medical science which reflects philosophical principles and embodies large dialectical thought, is used to place the human body into a large system for observation. Acupuncture as a vital part of TCM, has been practiced to treat various diseases and symptoms. However, acupuncture is also facing severe challenges resulted from insufficient modern scientific research. Nowadays, the holistic effects of acupuncture can be researched by some modern approaches, such as the systems biology and fMRI technique. It is believed that having a better understand will greatly promote acupuncture research and be beneficial to scientization and modernization of acupuncture.

Systems biology of meridians, acupoints, and chinese herbs in disease

Meridians, acupoints, and Chinese herbs are important components of traditional Chinese medicine (TCM). They have been used for disease treatment and prevention and as alternative and complementary therapies. Systems biology integrates omics data, such as transcriptional, proteomic, and metabolomics data, in order to obtain a more global and complete picture of biological activity. To further understand the existence and functions of the three components above, we reviewed relevant research in the systems biology literature and found many recent studies that indicate the value of acupuncture and Chinese herbs. Acupuncture is useful in pain moderation and relieves various symptoms arising from acute spinal cord injury and acute ischemic stroke. Moreover, Chinese herbal extracts have been linked to wound repair, the alleviation of postmenopausal osteoporosis severity, and anti-tumor effects, among others. Different acupoints, variations in treatment duration, and herbal extracts can be used to alleviate various symptoms and conditions and to regulate biological pathways by altering gene and protein expression. Our paper demonstrates how systems biology has helped to establish a platform for investigating the efficacy of TCM in treating different diseases and improving treatment strategies.

Proteomic response to acupuncture treatment in spontaneously hypertensive rats

Previous animal and clinical studies have shown that acupuncture is an effective alternative treatment in the management of hypertension, but the mechanism is unclear. This study investigated the proteomic response in the nervous system to treatment at the Taichong (LR3) acupoint in spontaneously hypertensive rats (SHRs). Unanesthetized rats were subject to 5-min daily acupuncture treatment for 7 days. Blood pressure was monitored over 7 days. After euthanasia on the 7^th day, rat medullas were dissected, homogenized, and subject to 2D gel electrophoresis and MALDI-TOF analysis. The results indicate that blood pressure stabilized after the 5th day of acupuncture, and compared with non-acupoint treatment, Taichong-acupunctured rat’s systolic pressure was reduced significantly (P<0.01), though not enough to bring blood pressure down to normal levels. The different treatment groups also showed differential protein expression: the 2D images revealed 571±15 proteins in normal SD rats’ medulla, 576±31 proteins in SHR’s medulla, 597±44 proteins in medulla of SHR after acupuncturing Taichong, and 616±18 proteins in medulla of SHR after acupuncturing non-acupoint. In the medulla of Taichong group, compared with non-acupoint group, seven proteins were down-regulated: heat shock protein-90, synapsin-1, pyruvate kinase isozyme, NAD-dependent deacetylase sirtuin-2, protein kinase C inhibitor protein 1, ubiquitin hydrolase isozyme L1, and myelin basic protein. Six proteins were up-regulated: glutamate dehydrogenase 1, aldehyde dehydrogenase 2, glutathione S-transferase M5, Rho GDP dissociation inhibitor 1, DJ-1 protein and superoxide dismutase. The altered expression of several proteins by acupuncture has been confirmed by ELISA, Western blot and qRT-PCR assays. The results indicate an increase in antioxidant enzymes in the medulla of the SHRs subject to acupuncture, which may provide partial explanation for the antihypertensive effect of acupuncture. Further studies are warranted to investigate the role of oxidative stress modulation by acupuncture in the treatment of hypertension.