Seung-Hun Cho

Acupuncture for vasomotor menopausal symptoms: a systematic review

Objective: The aim of this study was to critically assess whether acupuncture therapy reduces vasomotor menopausal symptoms and to evaluate the adverse effects of acupuncture therapy on the basis of the results of randomized controlled trials (RCTs). Methods: Nineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs in which acupuncture was used to reduce vasomotor menopausal symptoms before July 2008. There were no language restrictions. The methodological quality of the eligible studies was assessed using the categories provided by the Menstrual Disorders and Subfertility Review Group. Results: Eleven studies, which included a total of 764 individual cases, were systematically reviewed. The methodological quality of the trials varied substantially. Six trials compared acupuncture treatment to sham or placebo acupuncture. Only one study using a nonpenetrating placebo needle found a significant difference in the severity outcomes of hot flashes between groups (mean difference, 0.48; 95% CI, 0.05-0.91). Five studies reported a reduced frequency of hot flashes within groups; however, none found a significant difference between groups. An analysis of the outcomes of the trials that compared acupuncture with hormone therapy or oryzanol for reducing vasomotor symptoms showed that acupuncture was superior. Three RCTs reported minimal acupuncture-related adverse events. Conclusions: There is no evidence from RCTs that acupuncture is an effective treatment in comparison to sham acupuncture for reducing menopausal hot flashes. Some studies have shown that acupuncture therapies are better than hormone therapy for reducing vasomotor symptoms. However, the number of RCTs compared with a nonpenetrating placebo control needle or hormone therapy was too small, and the methodological quality of some of the RCTs was poor. Further evaluation of the effects of acupuncture on vasomotor menopausal symptoms based on a well-controlled placebo trial is therefore warranted.

Acupressure for primary dysmenorrhoea: a systematic review.

OBJECTIVESnTo assess the effectiveness of acupressure for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs).nnnSTUDY DESIGNnElectronic databases including English, Korean, Japanese and Chinese databases were systematically searched for RCTs investigating acupressure for primary dysmenorrhoea up to July 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Assessing risk of bias of the Cochrane Handbook edited by Higgins and Altman.nnnRESULTSnFour RCTs comprising a total of 458 participants were systematically reviewed. Only one of the included trials described adequate methods of randomisation. All trials did not have clear descriptions of their method of allocation concealment. Two studies reported significant improvements in the severity of pain for acupressure compared with sham acupressure on non-acupoints. Acupressure reduced the pain and anxiety typical of dysmenorrhoea in a Taiwan study. The U.S. study using an acupressure device reported that the reduction of menstrual pain was significantly better in worst menstrual pain, menstrual pain symptom intensity and the consumption of pain medication, compared with conventional treatment. One study investigated adverse events and reported that there was no adverse event in acupressure treatment.nnnCONCLUSIONSnThe available data from RCTs suggest that acupressure alleviates menstrual pain. These results were limited by the small number of trials. Well-designed RCTs with rigorous methods of randomisation, and adequately concealed allocation, are needed.

Does the effect of acupuncture depend on needling sensation and manipulation

BACKGROUNDnAcupuncture sensation and manipulation have been considered to be an important component of acupuncture in traditional Asian medicine. However, there has been limited research as to whether acupuncture sensation is associated with therapeutic benefit. This study investigated the relationship between acupuncture sensation and analgesic effect according to acupuncture manipulation.nnnMETHODnFifty-three healthy volunteers received three different forms of acupuncture in a single-blinded crossover design: superficial needling (0.3 cm), deep needling (2 cm) and needling with bi-directional rotation. The effects of acupuncture were evaluated by using the pressure pain threshold. Acupuncture sensation measurement was done in two ways.nnnRESULTSnBoth total acupuncture sensation and increase of the pressure pain threshold were maximum in needling with rotation, followed by deep needling and superficial needling. Repeated-measure analysis of variance (ANOVA) analysis was carried out to assess whether there was a significant difference; both showed significant difference (p = 0.000, 0.003). A paired sample t-test was carried out, which revealed that needling with rotation showed significant difference from both superficial needling and deep needling. Further, the correlation between the total acupuncture sensation and changes in pressure pain threshold were calculated using Pearson correlation; there was a significant correlation (p = 0.002, p = 0.013).nnnCONCLUSIONnAcupuncture sensation and pressure pain threshold increase according to the depth and rotation of acupuncture. Especially, both display significant increase with needle rotation. Further, there is a significant correlation between acupuncture needling sensation and increase in pressure pain threshold. It seems that needle rotation and acupuncture sensation play an important role in verifying the effect of acupuncture.

Protective effects of Chunghyuldan against ROS-mediated neuronal cell death in models of Parkinson's disease.

Previous reports have suggested that the herbal medicine Chunghyuldan (CHD, Qingxue-dan in Chinese and Daio-Orengedokuto in Japanese) has wide-ranging biological effects, including anti-hyperlipidaemic, anti-ischaemic, anti-inflammatory and antioxidant activities. Reactive oxygen species (ROS)-mediated mitochondrial dysfunction is thought to be one of the major pathological mechanisms responsible for Parkinsons disease (PD) and may underlie the selective loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) that is a hallmark of this disease. In this study, we examined the neuroprotective effects of CHD in PD models produced by treatment with neurotoxins that act via ROS-mediated mitochondrial dysfunction. In an in vitro PD model using 6-hydroxydopamine, CHD applied at concentrations of 10 and 100 μg/ml exhibited significant protective effects in PC12 cells by inhibiting intracellular ROS generation. CHD applied at 10 and 100 μg/ml also prevented 6-hydroxydopamine-induced mitochondrial depolarization and elevation of caspase-3 activity. At the same doses, CHD showed regulatory effects on the haem oxygenase-1 and gp91 phagocytic oxidase which have critical roles in generating ROS. In addition, CHD protected dopaminergic neurons in a primary mesencephalic culture against MPP+ neurotoxicity. In an in vivo PD model produced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine treatment (20 mg/kg, 4 times, i.p.), co-administration of CHD (50 mg/kg, 5 days, p.o.) ameliorated PD-like behavioural symptoms (bradykinesia) and reduced dopaminergic neuronal damage in the SNpc and striatum as measured by immunocytochemistry. These results demonstrate the neuroprotective effects of CHD in PD models that are mediated through inhibition of ROS generation and associated mitochondrial dysfunction.

Acupuncture for Alcohol Dependence: A Systematic Review

BACKGROUNDnAcupuncture has been used in the treatment of substance-related disorders for the past 30 years. However, a systematic review to assess the effect of various types of acupuncture for alcohol dependence has not yet been performed. The present systematic review assessed the results of randomized controlled trials (RCTs).nnnMETHODSnNineteen electronic databases, including English, Korean, Japanese, and Chinese databases, were systematically searched for RCTs of acupuncture for alcohol dependence up to June 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Cochrane Handbook.nnnRESULTSnEleven studies, which comprised a total of 1,110 individual cases, were systematically reviewed. Only 2 of 11 trials reported satisfactorily all quality criteria. Four trials comparing acupuncture treatment and sham treatments reported data for alcohol craving. Three studies reported that there were no significant differences. Among 4 trials comparing acupuncture and no acupuncture with conventional therapies, 3 reported significant reductions. No differences between acupuncture and sham treatments were found for completion rates (Risk Ratio = 1.07, 95% confidence interval, CI = 0.91 to 1.25) or acupuncture and no acupuncture (Risk Ratio = 1.15, 95% CI = 0.79 to 1.67). Only 3 RCTs reported acupuncture-related adverse events, which were mostly minimal.nnnCONCLUSIONSnThe results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.

Protective effects of standardized Thuja orientalis leaves against 6-hydroxydopamine-induced neurotoxicity in SH-SY5Y cells.

Although the etiology of Parkinsons disease (PD) remains unknown, recent studies have suggested that oxidative stress (OS) and apoptosis, as a result of mitochondrial defects, may play important roles in its pathogenesis. 6-Hydroxydopamine (6-OHDA), a neurotoxin commonly used in models of PD, induces selective catecholaminergic cell death, mediated by reactive oxygen species (ROS) and mitochondrial defects. This study investigated the protective effect of Thuja orientalis leaves (TOFE), a well-known oriental traditional medicine, on 6-OHDA-induced neurotoxicity in SH-SY5Y cells. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and Hoechst staining showed that TOFE attenuated the cell damage caused by 6-OHDA stress. TOFE showed strong radical scavenging effects in 2,2-diphenyl-2-picrylhydrazyl and 2,2-azinobis-(3-ethyl-benzthiazoline-6-sulphonic acid) assays, and it reduced the intracellular ROS and extracellular nitric oxide production induced by 6-OHDA. Additionally, TOFE blocked the reduction in the mitochondrial membrane potential, the release of cytochrome c, and the activation of caspase-3. Moreover, TOFE decreased the phosphorylation of extracellular signal-regulated kinase (pERK), which has pro-apoptotic functions. Taken together, TOFE might protect SH-SY5Y cells from 6-OHDA through the downregulation of OS and mitochondrial-mediated apoptosis, and regulation of pERK.

Efficacy of acupuncture in management of premenstrual syndrome: A systematic review

BACKGROUNDnThe effectiveness of acupuncture in the case of premenstrual syndrome (PMS) is not fully understood.nnnOBJECTIVESnTo assess the effectiveness and adverse effects of acupuncture for the symptomatic treatment of PMS from randomised controlled trials (RCTs).nnnSEARCH STRATEGYnElectronic databases, including English, Korean, Japanese and Chinese, were systematically searched up to January 2009 with no language restrictions.nnnSELECTION CRITERIAnRCTs comparing acupuncture with control investigating acupuncture for PMS were considered.nnnDATA COLLECTION AND ANALYSISnStudy collection and quality assessment were performed by two reviewers using the criteria described in the Cochrane Handbook.nnnMAIN RESULTSnNine studies were systematically reviewed. Only two of the nine trials reported details regarding sequence generation and allocation concealment. Four studies reported a significant difference in reduction of PMS symptoms for acupuncture treatment compared with pharmacological treatment. Two studies reported the improvements in primary symptoms within the acupuncture and herbal medications groups compared with baseline. Only two RCTs reported information regarding acupuncture-related adverse events, which included one case of a small subcutaneous haematoma.nnnCONCLUSIONSnAlthough the included trials showed that acupuncture may be beneficial to patients with PMS, there is insufficient evidence to support this conclusion due to methodological flaws in the studies, including unknowns in sequence generation, concealment of allocation, blinding and outcome measures.

Pharmacopuncture for Cancer Care: A Systematic Review

Background. Pharmacopuncture, injection to acupoints with pharmacological medication or herbal medicine, is a new acupuncture therapy widely available in Korea and China for cancer-related symptoms. However, the evidence is yet to be clear. Objective. To determine pharmacopunctures effectiveness on cancer-related symptoms. Methods. Eleven databases were searched for randomized controlled trials of pharmacopuncture in cancer patients. The Cochrane risk of bias (ROB) assessment tool was used for quality assessment. Results. Twenty-two studies involving 2,459 patients were included. Five trials of chemotherapy-induced nausea and vomiting (CINV) underwent meta-analysis. Pharmacopuncture significantly relieved severity of CINV compared with control group (3 trials, risk ratio (RR) 1.28, 95% confidence interval (CI) = 1.14–1.44). The frequency of CINV was also significantly reduced with pharmacopuncture (2 trials, RR 2.47, 95% CI = 2.12–2.89). Seventeen trials studied various symptoms, and in most studies, pharmacopuncture significantly relieved pain, ileus, hiccup, fever, and gastrointestinal symptoms and improved quality of life in various cancer patients. ROB was generally high. Conclusion. It may be suggested with caution that pharmacopuncture may help various symptom relief in cancer patients, but it is hard to draw a firm conclusion due to clinical heterogeneity and high ROB of the included studies, hence warranting further investigation.

Efficacy of acupuncture treatment for functional dyspepsia: A systematic review and meta-analysis.

OBJECTIVESnThe use of acupuncture treatment (AT) for functional dyspepsia is increasing, particularly in Asia. However, the efficacy of AT and its side effects have not been assessed. We performed a systematic review and meta-analysis of studies related to the effectiveness of AT for functional dyspepsia.nnnDESIGNnThis study is a systemic review and meta-analysis. Seven electronic databases, including those in the English and Chinese languages, were systematically searched for randomized controlled trials of AT for functional dyspepsia through November 2012. There were no language restrictions.nnnSETTINGnRandomized controlled trials (RCT) AT compared with placebo control or a comparative intervention were considered. The methodological qualities of the studies were evaluated using the risk of bias (ROB). Subgroups were analyzed according to the kinds of controls.nnnMAIN OUTCOME MEASURESnThe primary outcomes were symptom scores. These included visual analogue scale (VAS) and Nepean Dyspepsia Index (NDI). Secondary outcomes were the total effective rate and adverse effects.nnnRESULTSnTwenty studies, including 1423 individual cases, were systematically reviewed. The risk of bias was high. Compared to sham AT, AT was associated with a significant positive effect in patients with functional dyspepsia (2.66, 95% CI 1.85-3.82). AT also improved symptoms for functional dyspepsia (1.18, 95% CI 1.01-2.60) compared to GI tract regulators on total effective rate. In addition, two articles produced a scale in favor of AT compared to medication (0.54, 95% CI 0.18-0.90). Two RCTs reported minimal AT-related adverse events.nnnCONCLUSIONSnThe evidence suggests that AT is effective for functional dyspepsia. However, well-planned, long-term studies are necessary to evaluate the efficacy of AT for functional dyspepsia.

Efficacy of Acupuncture in Reducing Preoperative Anxiety: A Meta-Analysis

Background. Acupuncture has been shown to reduce preoperative anxiety in several previous randomized controlled trials (RCTs). In order to assess the preoperative anxiolytic efficacy of acupuncture therapy, this study conducted a meta-analysis of an array of appropriate studies. Methods. Four electronic databases (MEDLINE, EMBASE, CENTRAL, and CINAHL) were searched up to February 2014. In the meta-analysis data were included from RCT studies in which groups receiving preoperative acupuncture treatment were compared with control groups receiving a placebo for anxiety. Results. Fourteen publications (N = 1,034) were included. Six publications, using the State-Trait Anxiety Inventory-State (STAI-S), reported that acupuncture interventions led to greater reductions in preoperative anxiety relative to sham acupuncture (mean difference = 5.63, P < .00001, 95% CI [4.14, 7.11]). Further eight publications, employing visual analogue scales (VAS), also indicated significant differences in preoperative anxiety amelioration between acupuncture and sham acupuncture (mean difference = 19.23, P < .00001, 95% CI [16.34, 22.12]). Conclusions. Acupuncture therapy aiming at reducing preoperative anxiety has a statistically significant effect relative to placebo or nontreatment conditions. Well-designed and rigorous studies that employ large sample sizes are necessary to corroborate this finding.