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Zhang XH, Cui H, Zheng SM, Lu Y, Yuan HW, Zhang L, Wang HH, Du RS. Electroacupuncture regulates microglial polarization via inhibiting NF-κB/COX2 pathway following traumatic brain injury. Brain Res 2023; 1818:148516. [PMID: 37562566 DOI: 10.1016/j.brainres.2023.148516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Neuroinflammation and oxidative stress are important pathological mechanisms following traumatic brain injury (TBI). The NF-κB/COX2 pathway regulates neuroinflammation and oxidative damage, while microglia also play an important role in neuroinflammation. Since NF-κB is involved in microglial polarization, targeting this pathway and microglial polarization is a critical component of TBI treatment. Currently, electroacupuncture (EA) is widely used to treat various symptoms after TBI, but the mechanisms of EA remain poorly understood. Additionally, the optimal frequency of EA remains unclear, which affects its efficacy. This study focuses on exploring the optimal frequency parameters of EA on TBI and investigating the underlying mechanisms of EA through NF-κB/COX2 pathway and microglial polarization. METHODS The study was divided into two parts. In Experiment 1, 42 Sprague Dawley (SD) rats were induced and randomly divided into seven groups (n = 6). Except for the sham group, all rats underwent controlled cortical impact (CCI) to establish TBI model. Four EA groups (with different frequencies) and manual acupuncture (without current stimulation) received stimulation on the acupoints of Shuigou (GV26), Fengchi (GB20) and Neiguan (PC6) once a day for 7 days. The neurological function was assessed by modified Neurological Severity Scores (mNSS), and the rats' memory and learning were examined by the Morris water maze (MWM). SOD, MDA, and GSH-Px were detected to evaluate the levels of oxidative stress. The levels of IL-1β, IL-6, and TNF-α were evaluated by Enzyme Linked Immunosorbent Assay (ELISA). Detection of the above indicators indicated a treatment group that exerted the strongest neuroprotection against TBI, we then conducted Experiment 2 using this screened acupuncture treatment to investigate the mechanism of acupuncture. 48 rats were randomly divided into four groups (n = 12): sham, TBI model, acupuncture and PDTC (NF-κB inhibitor). Evaluations of mNSS, MWM test, SOD, MDA, GSH-Px, IL-1β, IL-6, TNF-α, and IL-10 were the same as in Experiment 1. Western blot was applied for detecting the expression levels of NF-κB, p-NF-κB, COX2, and Arg-1. TUNEL was used to examine neuronal apoptosis. Brain structure was observed by H&E. Iba-1, COX2, and Arg-1 were investigated by immunofluorescence staining. RESULTS EA with frequency of 2/100 Hz markedly improved neuronal and cognitive function as compared to the other treatment groups. Moreover, it downregulated the expression of MDA, IL-6, IL-1β, and TNF-α and upregulated the levels of SOD and GSH-Px. In addition, Both EA with 2/100 Hz and PDTC reduced the levels of p-NF-κB, COX2 and M1 markers (COX2, IL-6, IL-1β, TNF-α) and increased the levels of M2 markers (Arg-1, IL-10). Moreover, they had similar effects on reducing inflammation, oxidative stress and apoptosis, and improving neuronal and cognitive function. CONCLUSIONS The collective findings strongly suggest that EA with 2/100 Hz can improve neurologic function by suppressing neuroinflammation, oxidative stress and apoptosis. Additionally, we confirm that EA promotes microglial polarization towards the M2 phenotype through the suppression of NF-κB/COX2 pathway, thus exerting neuroprotective effects after TBI.
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Affiliation(s)
- Xiao-Hui Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Hai Cui
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Shu-Mei Zheng
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Yun Lu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Hong-Wen Yuan
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Lu Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Hong-Hong Wang
- Faculty of Chinese Medicine Science Guangxi University of Chinese Medicine, China
| | - Ruo-Sang Du
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China.
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Liu Z, Wang X, Wu Z, Yin G, Chu H, Zhao P. HBOT has a better cognitive outcome than NBH for patients with mild traumatic brain injury: A randomized controlled clinical trial. Medicine (Baltimore) 2023; 102:e35215. [PMID: 37713814 PMCID: PMC10508512 DOI: 10.1097/md.0000000000035215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Normobaric hyperoxia (NBH) and hyperbaric oxygen therapy (HBOT) are effective treatment plan for traumatic brain injury (TBI). The aim of this study was to compare cognitive outcome after mild TBI between NBH and HBOT so as to provide a more suitable treatment strategy for patients with mild TBI. METHODS A prospective research was conducted between October 2017 and March 2023, enrolling patients with mild TBI (Glasgow coma scale score: 13-15 points) within 24 hours of injury in Cangzhou Central Hospital. Patients were randomized into 3 groups: group control (C), group NBH and group HBOT. The patients in HBOT group received hyperbaric oxygen therapy in high pressure oxygen chamber and patients in NBH group received hyperbaric oxygen therapy. at 0 minute before NBH or HBOT (T1), 0 minute after NBH or HBOT (T2) and 30 days after NBH or HBOT (T3), level of S100β, NSE, GFAP, HIF-1α, and MDA were determined by ELISA. At the same time, the detection was performed for MoCA and MMSE scores, along with rSO2. RESULTS The results showed both NBH and HBOT could improve the score of MoCA and MMSE, as well as the decrease the level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2 compared with group C. Furthermore, the patients in group HBOT have higher score of MoCA and MMSE and lower level of S100β, NSE, GFAP, HIF-1α, MDA, and rSO2. CONCLUSION Both NBH and HBOT can effectively improve cognitive outcome for patients with mild TBI by improving cerebral hypoxia and alleviating brain injury, while HBOT exert better effect than NBH.
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Affiliation(s)
- Zhiguo Liu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Xirui Wang
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Zhiyou Wu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Gangfeng Yin
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Haibin Chu
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
| | - Pengyue Zhao
- The Third Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, China
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Jia H, Chen Y, Wang Y, Jia L, Tian Y, Jiang H. The neuroprotective effect of electro-acupuncture on cognitive recovery for patients with mild traumatic brain injury: A randomized controlled clinical trial. Medicine (Baltimore) 2023; 102:e32885. [PMID: 36820591 PMCID: PMC9907991 DOI: 10.1097/md.0000000000032885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a major health and socioeconomic problem that affects all societies. Consciousness disorder is a common complication after TBI while there is still no effective treatment currently. The aim of this study was to investigate the protective effect of electro-acupuncture (EA) on cognitive recovery for patients with mild TBI. METHODS A total of 83 patients with initial Glasgow coma scale score higher than 12 points were assigned into this study. Then patients were randomly divided into 2 groups: EA group and control group (group C). Patients in group EA received EA treatment at Neiguan and Shuigou for 2 weeks. At 0 minute before EA treatment (T1), 0 minute after EA treatment (T2), and 8 weeks after EA treatment (T3), level of neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), hypoxia inducible factor-1α (HIF-1α), and malondialdehyde were tested by enzyme-linked immunosorbent assay. The score of Montreal Cognitive Function Assessment (MoCA) and mini-mental state examination (MMSE) as well as cerebral oxygen saturation (rSO2) were detected at the same time. RESULTS Compared with the baseline at T1, the level of NSE, GFAP, HIF-1α, MDA, and rSO2 decreased, and the score of MoCA and MMSE increased in the 2 groups were significantly increased at T2-3 (P < .05). Compared with group C, the level of NSE, GFAP, HIF-1α, MDA, and rSO2 decreased, and the score of MoCA and MMSE increased were significantly increased at T2-3 in group EA; the difference were statistically significant (P < .05). CONCLUSIONS EA treatment could improve the cognitive recovery for patients with mild TBI and the potential mechanism may be related to improving cerebral hypoxia and alleviating brain injury.
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Affiliation(s)
- Haokun Jia
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
- * Correspondence: Haokun Jia, Department of Neurosurgery, Cangzhou Central Hospital, No. 50, Xinhua West Road, Yunhe District, Cangzhou, Hebei Province, 061017, China (e-mail: )
| | - Yonghan Chen
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
| | - Yi Wang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
| | - Linwei Jia
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
| | - Yaohui Tian
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
| | - Hao Jiang
- Department of Neurosurgery, Cangzhou Central Hospital, Cangzhou City, Hebei, China
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Huo BB, Zheng MX, Hua XY, Wu JJ, Xing XX, Ma J, Fang M, Xu JG. Effect of aging on the cerebral metabolic mechanism of electroacupuncture treatment in rats with traumatic brain injury. Front Neurosci 2023; 17:1081515. [PMID: 37113153 PMCID: PMC10128857 DOI: 10.3389/fnins.2023.1081515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Objective Aging has great influence on the clinical treatment effect of cerebrovascular diseases, and evidence suggests that the effect may be associated with age-related brain plasticity. Electroacupuncture is an effective alternative treatment for traumatic brain injury (TBI). In the present study, we aimed to explore the effect of aging on the cerebral metabolic mechanism of electroacupuncture to provide new evidence for developing age-specific rehabilitation strategies. Methods Both aged (18 months) and young (8 weeks) rats with TBI were analyzed. Thirty-two aged rats were randomly divided into four groups: aged model, aged electroacupuncture, aged sham electroacupuncture, and aged control group. Similarly, 32 young rats were also divided into four groups: young model, young electroacupuncture, young sham electroacupuncture, and young control group. Electroacupuncture was applied to "Bai hui" (GV20) and "Qu chi" (LI11) for 8 weeks. CatWalk gait analysis was then performed at 3 days pre- and post-TBI, and at 1, 2, 4, and 8 weeks after intervention to observe motor function recovery. Positron emission computed tomography (PET/CT) was performed at 3 days pre- and post-TBI, and at 2, 4, and 8 weeks after intervention to detect cerebral metabolism. Results Gait analysis showed that electroacupuncture improved the forepaw mean intensity in aged rats after 8 weeks of intervention, but after 4 weeks of intervention in young rats. PET/CT revealed increased metabolism in the left (the injured ipsilateral hemisphere) sensorimotor brain areas of aged rats during the electroacupuncture intervention, and increased metabolism in the right (contralateral to injury hemisphere) sensorimotor brain areas of young rats. Results This study demonstrated that aged rats required a longer electroacupuncture intervention duration to improve motor function than that of young rats. The influence of aging on the cerebral metabolism of electroacupuncture treatment was mainly focused on a particular hemisphere.
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Affiliation(s)
- Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- *Correspondence: Jian-Guang Xu,
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Yang Y, Zhang D, Wu L, Zhang J, Wu D, Li X, Zhi F, Yang G, Kong X, Hong J, Zhao Y, Liu J, Shi Z, Ma X. Electroacupuncture inhibits the corneal ROS/TXNIP/NLRP3 signaling pathway in a rat model of dry eye syndrome. Acupunct Med 2021; 40:78-88. [PMID: 34553633 DOI: 10.1177/09645284211039235] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Electroacupuncture (EA) treatment has been found to ameliorate clinical symptoms in patients with dry eye, but its mechanisms are still not entirely clear. OBJECTIVE To study the regulation of EA on ocular surface function and the corneal reactive oxygen species (ROS)/thioredoxin-interacting protein (TXNIP)/Nod-like receptor protein 3 (NLRP3) inflammatory signaling pathway in dry eye syndrome (DES) model rats. METHODS Male Sprague-Dawley (SD) rats were randomly divided into five groups: Normal, Model, Model + EA, Model + NAC (N-actetylcysteine) and Model + NS (normal saline). The DES model was developed by subcutaneous injection of scopolamine hydrobromide with exposure to an air draft in the latter four groups. After intervention, the Schirmer I test (SIT), tear film break-up time (BUT) and ROS content were measured, the histopathological changes of corneal tissues were observed, and the mRNA and protein expression levels of TXNIP, NLRP3, apoptosis-associated Speck-like protein containing CARD (ASC), caspase-1, interleukin (IL)-1β and IL-18 were detected. RESULTS Compared with the Model group, the SIT and BUT increased significantly in the Model + EA group after intervention (p < 0.05), and the corneal injury was improved. Corneal ROS content declined in both Model + EA and Model + NAC groups (p < 0.05), and mRNA expression of TXNIP, NLRP3, ASC and caspase-1 also decreased (p < 0.01). Corneal protein expression of TXNIP, NLRP3, IL-1β and IL-18 decreased significantly in the Model + EA group (p < 0.01). CONCLUSION Inhibiting the ROS/TXNIP/NLRP3 signaling pathway may be the mechanism underlying the role of EA in improving corneal injury in DES model rats.
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Affiliation(s)
- Yanting Yang
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dan Zhang
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Lijie Wu
- Acupuncture-Moxibustion Department, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
| | - Ji Zhang
- Department of Traditional Chinese Medicine, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, China
| | - Danyan Wu
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiying Li
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangyuan Zhi
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guang Yang
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Xiehe Kong
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Jue Hong
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yue Zhao
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Jie Liu
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Zheng Shi
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Xiaopeng Ma
- Laboratory of Acupuncture-Moxibustion and Immunology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Kiselev NI, Lim VG, Novikov AV, Bordina OV, Ternovoy KS. [Complex rehabilitation of a patient with marked motor and cognitive impairments after a brain injury]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:88-92. [PMID: 32621473 DOI: 10.17116/jnevro202012005188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the presented case report, the complex approach of rehabilitation in the remote period of traumatic brain injury (TBI) allowed the achievement of the significant clinical effect. The authors analyzed the experience of reflex therapy in the treatment of TBI. The effectiveness and potential of acupuncture, objectification of the results are topical issues that require further research.
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Affiliation(s)
- N I Kiselev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V G Lim
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Novikov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O V Bordina
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K S Ternovoy
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Liu T, Lu Y, Yu J, Kuang W, Wang X, Jiang Y, Qiu X, Wen X, Zeng Y, Zhang G, Liu Y. Effect of auricular electroacupuncture combined with body acupuncture in improving the consciousness of patients after traumatic brain injury: Study protocol for a randomized controlled trial. Medicine (Baltimore) 2019; 98:e16587. [PMID: 31348298 PMCID: PMC6709251 DOI: 10.1097/md.0000000000016587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) has become a major cause of morbidity and mortality both in China and abroad. Disorders of consciousness following severe TBI is a common refractory complication, resulting in difficult rehabilitation and poor life quality. However, effective therapeutic approaches remain limited. Although acupuncture has been widely applied in the treatment of neurological disorders in China, its efficacy and safety for consciousness recovery remain to be elucidated. METHODS Here, we conduct a study design and protocol of a randomized, blinded, controlled study to evaluate the efficacy and safety of electroacupuncture at auricular acupoints "heart" and "brainstem" combined with body acupuncture in the consciousness recovery of patients with TBI. A total of 80 patients with initial Glasgow coma scale score between 3 and 8 points will be recruited in the trial and randomized into intervention (combined application of auricular electroacupuncture and body acupuncture) group or control (conventional treatment) group. Patients in the intervention group will receive electroacupuncture at bilateral auricular acupoints "heart" and "brainstem" (4 points in total) combined with body acupuncture in addition to conventional treatment while patients in the control group will receive conventional treatment alone for 8 weeks. The primary outcomes are changes of Glasgow coma scale score and mismatch negativity of event-related brain potentials at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The secondary outcome measures will be changes of Barthel and FuglMeyer scores at baseline after 4 weeks after the final treatment and 4 weeks after the final treatment. The safety will also be assessed by monitoring the incidence of adverse events and changes in vital signs during the study. DISCUSSION Results from this trial will significantly support the application of auricular acupuncture and body acupuncture in the consciousness recovery of patients with severe TBI. If found to be effective and safe, auricular acupuncture combined with body acupuncture will be a valuable complementary option for comatose patients with TBI. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR1800020245. Registered on 21 December 2018.
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Affiliation(s)
- Tong Liu
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Yanqing Lu
- Department of Acupuncture and Rehabilitation, Guangzhou University of Chinese Medicine
| | - Jiani Yu
- Department of Rehabilitation Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China
| | - Weichuan Kuang
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Xiaoyin Wang
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Ye Jiang
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Xiaojia Qiu
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Xi Wen
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Yao Zeng
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Guitao Zhang
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
| | - Yue Liu
- Department of Acupuncture and Rehabilitation, GuangDong Second Hospital of Traditional Chinese Medicine
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