Standards for reporting interventions in clinical trials of cupping (STRICTOC): extending the CONSORT statement

Reporting guidelines for traditional Chinese medicine could be improved: a cross-sectional study

OBJECTIVES

The aim of this study is to identify available reporting guidelines for traditional Chinese medicine (TCM), delineate their fundamental characteristics, assess the scientific rigor of their development process, and evaluate their dissemination.

STUDY DESIGN AND SETTING

A search was conducted in Medline (via PubMed), China National Knowledge Infrastructure (CNKI), SinoMed, WANFANG DATA, and the EQUATOR Network to identify TCM reporting guidelines. A preprepared Excel database was used to extract information on the basic characteristics, development process, and dissemination information. The development process quality of TCM reporting guidelines was assessed by evaluating their compliance with the Guidance for Developers of Health Research Reporting Guidelines (GDHRRG). The extent of dissemination of these guidelines was analyzed by examining the number of citations received.

RESULTS

A total of 26 reporting guidelines for TCM were obtained from 20 academic journals, with 61.5% of them published in English journals. Among the guidelines, 14 (53.8%) were registered in the EQUATOR Network. On average, the compliance rate of GDHRRG guidelines was reported to be 63.3% ranging from 22.2% to 94.4%. Three steps showed poor compliance, namely guideline endorsement (23.1%), translated guidelines (19.2%), and developing a publication strategy (19.2%). Furthermore, the compliance rate of GDHRRG guidelines published in English journals was higher than that in Chinese journals. In terms of the dissemination, 15.4% of the guidelines had been cited over 100 times, while 73.1% had been cited less than 50 times.

CONCLUSION

The development of TCM reporting guidelines still has limitations in terms of regarding scientific rigor and follow-up dissemination. Therefore, it is important to ensure adherence to the scientific process in the development of TCM reporting guidelines and to strengthen their promotion, dissemination, and implementation.

Laser auriculotherapy associated with cupping therapy in chronic spinal pain: Randomized controlled clinical trial

BACKGROUND

Musculoskeletal spine disorders are common causes of chronic pain and impair functionality. Laser auriculotherapy and cupping has played a significant role in the treatment of chronic pain.

OBJECTIVE

to evaluate the effect of laser auriculotherapy associated with cupping at systemic acupuncture points on chronic spinal pain.

METHODS

Randomized controlled clinical trial. Volunteers underwent three evaluations: an initial evaluation, a final evaluation immediately after the last intervention session, and a 15-day follow-up. The pain was identified using the numeric pain scale. The pain threshold was also evaluated against mechanical stimulation using a Digital Dynamometer at specific points in the cervical, thoracic and lumbar regions. Fifty individuals with chronic spinal pain, randomized into groups: experimental (n = 25), submitted to 10 sessions of auriculotherapy with laser and cupping therapy and control (n = 25).

RESULTS

The experimental group achieved pain intensity reduction between pre and post and follow-up moments (p < 0.0001), of greatest pain in the last seven days among all moments (p < 0.0001), of least pain in the pre with post moment (p = 0.006) and follow-up (p = 0.002), and an increased pain threshold between pre and post (p = 0.023). The control group achieved a reduction in the nociceptive threshold between pre and post (p = 0.001) and follow-up (p < 0.0001). The experimental group showed reduced pain intensity (p = 0.027) and greater pain (p = 0.005) after intervention and in pain intensity (p = 0.018), greater (p < 0.0001) and less pain (p = 0.025) at follow-up, compared to the control group.

CONCLUSION

Auriculotherapy with laser associated with cupping therapy may effectively reduce pain intensity and increase the nociceptive threshold.

STandards for Reporting Interventions in Clinical Trials Of Tuina/Massage (STRICTOTM): Extending the CONSORT statement

OBJECTIVES

Massage is a common therapy of nonpharmacological treatments, particularly in Tuina (Chinese massage) as its most common style, detailed guidance in reporting the intervention is warranted for its evaluation and replication. Based on the CONSORT (Consolidated Standards of Reporting Trials), we aimed to develop an Extension for Tuina/Massage, namely "The STandards for Reporting Interventions in Clinical Trials Of Tuina/Massage (STRICTOTM)."

METHODS

A group of professional clinicians, trialists, methodologists, developers of reporting guidelines, epidemiologists, statisticians, and editors has developed this STRICTOTM checklist through a standard methodology process recommended by the EQUATOR (Enhancing the QUAlity and Transparency of Health Research) Network, including prospective registration, literature review, draft of the initial items, three rounds of the Delphi survey, consensus meeting, pilot test, and finalization of the guideline.

RESULTS

A checklist of seven items (namely Tuina/Massage rationale, details of Tuina/Massage, intervention regimen, other components of the intervention, Tuina/Massage provider background, control or comparator interventions, and precaution measures), and 16 subitems were developed. Explanations and examples (E&E) for each item are also provided.

CONCLUSIONS

The working group hopes that the STRICTOTM, in conjunction with both the CONSORT statement and extension for nonpharmacologic treatment, can improve the reporting quality and transparency of Tuina/Massage clinical research.

The efficacy and safety of dry cupping in cervical spondylosis with optimization of cup application time - a randomized clinical trial

OBJECTIVES

Dry cupping therapy (DCT) is considered beneficial in the amelioration of cervical spondylosis (CS) symptoms in Unani medicine. Therefore, the focus of this study was to ascertain the efficacy of DCT and optimal cup application time duration for CS.

METHODS

It was a randomized clinical trial involving 45 participants with clinically diagnosed CS. The eligible subjects were randomly categorized into three groups, each having 15 participants. Each of the three groups, i.e., A, B, and C, received DCT daily for 15 days for 8 min, 10 min, and 12 min, respectively. All the participants were evaluated at the baseline, 7th, and 15th days of the trial using the neck disability index (NDI) as well as the visual analogue scale (VAS).

RESULTS

The baseline mean ± SD of NDI and VAS scores were significantly reduced in all the three groups at the end of the trial. Although all three groups were statistically equal in terms of NDI, group-C demonstrated greater efficacy in terms of VAS.

CONCLUSIONS

The per-protocol analysis showed that dry cupping effectively alleviated neck pain across all treatment groups. Although, this effect on neck disability index was statistically equal in all three groups, the 12-min protocol was more successful in reducing pain.

7T Small Animal MRI Research for Hepatic Alveolar Echinococcosis

OBJECTIVES

7T small animal magnetic resonance imaging (MRI) was used to analyze the growth characteristics of hepatic alveolar echinococcosis (HAE).

METHODS

A mouse model of HAE was established by intraperitoneal injection of alveolar Echinococcus tissue suspension. Ten mouse models successfully inoculated by ultrasound screening were selected. The mouse model was scanned with T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI) sequence by 7T small animal MRI. Size, morphology, boundary, signal, and relationship with surrounding tissues of the lesions were recorded as characteristic alterations. Mice were killed at the end of the experiment, and the pathological specimens were taken for routine hematoxylin and eosin staining.

RESULTS

Lesions were mainly located in the right lobe of the liver. The multivesicular structure is the characteristic manifestation of this disease. In the liver, lesions invaded the portal vein and were mainly distributed at the hepatic hilum. The left branch of the portal vein was mainly invaded. The mean diameter of the lesions in the left lobe of the liver was larger than in other parts of the liver. The mean diameter of the cystic solid lesions was greater than the multilocular cystic lesions. HAE showed hypointense on T1WI, hyperintense on T2WI, and hypointense on DWI; the marginal zone of the lesion showed hyperintensity on DWI and grew toward the hilum. The MRI features of intraperitoneal lesions were similar to those of intrahepatic lesions. Intraperitoneal lesions increased faster than intrahepatic lesions in the same period.

CONCLUSION

Polyvesicular structure is a characteristic manifestation of hepatic alveolar echinococcosis in mice. The noninvasive monitoring of liver HAE in mice by 7T small animal MRI provides a visual basis for the diagnosis and treatment integration of HAE.

Wet Cupping (al-hijama) for Mental Health: A Systematic Review

This systematic review aimed to evaluate the effects of wet cupping on the treatment of mental illness. A total of 2,670 studies were retrieved using PubMed, Cochrane Library, Web of Science, Google Scholar, and Science Direct databases, and of these, 2,661 were excluded due to not meeting the inclusion criteria. There were 9 articles included in this review including 1,124 individuals who received wet cupping. Mental health was explored in, those who had migraines, metabolic syndrome, smoking addiction, post-traumatic stress, chronic medical disease, and depression. As an intervention procedure, the triple S technique was used in all studies. Only 3 studies reported that none of the participants complained of adverse events during or after the cupping therapy. In all studies, wet cupping was reported to be effective in reducing psychological symptoms. However, there are few randomized controlled trials testing the e?ectiveness of wet cupping in the treatment of mental health, and most are of poor quality. Therefore, more rigorous studies are required before the effectiveness of wet cupping for the treatment of mental illness can be determined.

Traditional and new applications of the HCR in biosensing and biomedicine

The hybridization chain reaction is a very popular isothermal nucleic acid amplification technology. A single-stranded DNA initiator triggers an alternate hybridization event between two hairpins forming a double helix polymer. Due to isothermal, enzyme-free and high amplification efficiency characteristics, the HCR is often used as a signal amplification technology for various biosensing and biomedicine fields. However, as an enzyme-free self-assembly reaction, it has some inevitable shortcomings of relatively slow kinetics, low cell internalization efficiency, weak biostability of DNA probes and uncontrollable reaction in these applications. More and more researchers use this reaction system to synthesize new materials. New materials can avoid these problems skillfully by virtue of their inherent biological characteristics, molecular recognition ability, sequence programmability and biocompatibility. Here, we summarized the traditional application of the HCR in biosensing and biomedicine in recent years, and also introduced its new application in the synthesis of new materials for biosensing and biomedicine. Finally, we summarized the development and challenges of the HCR in biosensing and biomedicine in recent years. We hope to give readers some enlightenment and help.

The Effect of Wet Cupping on Baroreceptor Sensitivity in Hypertensive Patients in Sidenreng Rappang Regency, South Sulawesi

Wet cupping therapy  removes toxins  thereby increasing blood flow and  stimulating baroreceptors sensitivity which provides a stimulus to the autonomic nerves. This stimulus reduces the sympathetic nerves’ work and inhibits  the vasomotor center, leading to vasodilation, therefore decreasing blood pressure and pulse frequency. This research aims to determine the effect of wet cupping therapy on baroreceptors sensitivity with blood pressure and pulse frequency indicators. It was conducted in Sidenreng Rappang Regency, South Sulawesi, eastern Indonesia from February to May 2021. Randomized Controlled Trial (RCT) method was used including two groups of 31 respondents each. The intervention group used wet cupping therapy to regulate anti-hypertensive drugs and the control group used anti-hypertensive drugs with blood pressure and pulse frequency measurements until 6 weeks after the therapy. Wet cupping affects baroreceptor sensitivity by reducing the indicators. The result showed a significant difference in blood pressure measurement (systolic; diastolic) before and after the 2-week follow-up period (P = 0.000; P = 0.001), and between 2 and 4 weeks (P = 0.000; P = 0.000), but between 4 and 6 weeks there was no significant difference in the intervention group (P = 0.248; P = 0.583). There was a significant difference in pulse frequency at 2 and 4 weeks after the intervention (P = 0.016). In conclusion, wet cupping therapy effectively increases baroreceptor sensitivity by reducing blood pressure and pulse frequency indicators in hypertensive patients up to 4 weeks limit after the therapy, without any serious side effects experienced by respondents.

Assessment of the reporting quality of randomised controlled trials of massage

Objective

To assess the reporting quality of randomised controlled trials (RCTs) of massage, particularly whether necessary elements related to massage interventions were adequately reported.

Methods

A total of 8 electronic databases were systematically searched for massage RCTs published in English and Chinese from the date of their inception to June 22, 2020. Quality assessment was performed using three instruments, namely the CONSORT (Consolidated Standards of Reporting Trials) 2010 Checklist (37 items), the CONSORT Extension for NPT (Nonpharmacologic Treatments) 2017 checklist (18 items), and a self-designed massage-specific checklist (16 items) which included massage rationale, intervention and control group details. Descriptive statistics were additionally used to analyse the baseline characteristics of included trials.

Results

A total of 2,447 massage RCTs were identified, of which most (96.8%) were distributed in China. For the completeness of CONSORT, NPT Extension, and massage-specific checklists, the average reporting percentages were 50%, 10% and 45%, respectively. Of 68 assessed items in total (exclusion of 3 repeated items on intervention), 42 were poorly presented, including 18 CONSORT items, 15 NPT items, and 9 massage-specific items. Although the overall quality of reporting showed slightly improvement in articles published after 2010, the international (English) journals presented a higher score of the CONSORT and NPT items, while the Chinese journals were associated with the increased score of massage-specific items.

Conclusion

The quality of reporting of published massage RCTs is variable and in need of improvement. Reporting guideline “CONSORT extension for massage” should be developed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13020-021-00475-6.

Effects of ear acupuncture combined with cupping therapy on severity and threshold of chronic back pain and physical disability: A randomized clinical trial

Background and aim

Chronic back pain causes physical, functional, and emotional disabilities. Traditional Chinese Medicine therapies have been shown as interventions to treat chronic back pain. The present study aimed to clinically evaluate the effects of ear acupuncture combined with cupping therapy on people with chronic back pain.

Experimental procedure

We conducted an open-label, randomized, parallel-group controlled clinical trial. Following the CONSORT statement recommendations, 198 participants were randomized into ‘ear acupuncture’ and ‘ear acupuncture and cupping therapy’ groups. Data were collected in three different points; before the first session (initial) with the patient, after the last session (final), and seven days after the end of the treatment (follow-up). The Brief Pain Inventory, a digital algometer, and the Rolland Morris Disability Questionnaire were used for data collection. Generalized Estimation Equation model was used to examine the association between the interventions and the primary outcome pain severity.

Results

Pain severity, pressure pain threshold, and physical disability improved over time in both groups. However, for the patients being treated with both ear acupuncture and cupping therapy, significant changes were seen in pain severity, pain relief, and physical disabilities between the initial and final sessions. For the ‘ear acupuncture and cupping therapy’ group, significant changes were also seen for pain relief and physical disability in the follow-up session.

Conclusion

Ear acupuncture combined with cupping therapy was shown to be more effective in the treatment of chronic back pain when compared to treatment using only ear acupuncture.

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Ear acupuncture plus cupping therapy is effective to treat chronic back pain.

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Patients treated with both interventions achieved positive changes in all variables.

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These are interventions that can be implemented in clinical practice.

Effects of dry cupping on pain, function and quality of life in women with knee osteoarthritis: a protocol for a sham-controlled randomised trial

INTRODUCTION

Knee osteoarthritis (KOA) is the most common cause of pain and disability worldwide. Dry cupping has been used as non-pharmacological approach to control pain and improve physical function. However, there is a lack of high-quality scientific evidence regarding its effects on this condition. This protocol describes a sham-controlled, randomised and simple blind study that aims to evaluate the effect of dry cupping on pain, function and quality of life in women with KOA.

METHODS AND ANALYSIS

Sixty-two women diagnosed with KOA, based on American College of Rheumatology clinical criteria, and aged from 50 to 75 years, will be randomly distributed into two groups (31 per group): real and sham dry cupping. Both applications will occur with acrylic cups around the knee. The intervention will last 15 min, two times a week over six consecutive weeks, for a total of 12 sessions. Both groups will be assessed at four different times: before the intervention (T0), after 3 weeks intervention (T3), at the end of the protocol (T6) and 4 weeks after the interventions (follow-up: T10). The primary outcome will be pain intensity (Numerical Pain Rating Scale), and secondary outcomes will be knee-related health status (Western Ontario and McMaster Universities Osteoarthritis Index), functional capacity (8-step stair climb test, 40-metre fast-paced walk test and 30-second chair stand test), quality of life (Short-Form 36) and global perceived effect.

ETHICS AND DISSEMINATION

This protocol was approved by the UFRN/FACISA Ethics Committee (number 3.737.688). The study results will be disseminated to the participants and submitted to a peer-reviewed journal and scientific meetings.

TRIAL REGISTRATION NUMBER

NCT04331158.

The therapeutic effect of splenectomy plus selective pericardial devascularization versus conventional pericardial devascularization on portal hypertension in China: a meta-analysis

Background

To systematically review perioperative outcomes and postoperative complications between splenectomy plus s-EGDV and n-sEGDV for portal hypertension complicated with thoracic esophageal varices and bleeding by a meta-analysis.

Method

We searched the databases of PubMed, the Cochrane Library, Web of Science, EMBASE, TCGA, Chinese Biomedicine Database from January 2000 to June 2017, and included studies that compared perioperative outcomes and postoperative complications between s-EGDV and n-sEGDV. These included studies were assessed by two independent investigators.

Results

Seven randomized controlled trials (RCTs) and seven non-randomized observational clinical studies (OCS) were included. The s-EGDV was more beneficial than n-sEGDV in reducing the PVF (OR = 4.26; 95% CI, 2.81–5.71; P < 0.00001; I² = 97% for heterogeneity), portal vein flow (OR = −111.75; 95% CI, −197.13–26.38; P = 0.01; I² = 90% for heterogeneity), portal hypertensive gastropathy(OR = 0.38; 95% CI, 0.28–0.51; P < 0.00001; I² = 0% for heterogeneity), hepatic encephalopathy (OR = 0.40; 95% CI, 0.23–0.71; P = 0.002; I² = 22% for heterogeneity), postoperative re-bleeding (OR = 0.43; 95% CI, 0.29–0.63; P < 0.0001; I² = 9% for heterogeneity), postoperative mortality (OR = 0.52; 95% CI, 0.32–0.85; P = 0.009; I² = 0% for heterogeneity) and in increasing hepatic artery flow (OR = 92.53; 95% CI, 9.60–175.46; P = 0.03; I² = 95% for heterogeneity).

Conclusion

sEGDV offers a more effective surgical approach with fewer complications to treat portal hypertension than n-sEGDV. Upon further detailed analysis of the surgical indications and hemodynamic and postoperative major complications of selective devascularization, sEGDV likely will provide us with a new direction in the choice of surgical approach for portal hypertension.