Objective: To explore the mechanism of An-Pressing manipulation in relieving energy crisis in chronic myofascial trigger points (MTrPs) by observing the effects of An-Pressing manipulation on adenosine triphosphate (ATP), adenosine 5'-monophosphate (AMP)-activated protein kinase (AMPK)/peroxisome proliferator-activated receptor γ coactivator 1α (PGC-1α) pathway and mitochondrial ultrastructure of skeletal muscle cells in MTrPs rats. Methods: Forty-eight male Sprague-Dawley rats were randomly divided into a blank group, a model group, a lidocaine group, and an An-Pressing manipulation group, with 12 rats in each group. The model group, lidocaine group and An-Pressing manipulation group were used to replicate the MTrPs rat model by blunt shock and centrifugal motion method. After modeling, the An-Pressing manipulation group was subjected to 7 times An-Pressing manipulation, once every other day; the lidocaine group was treated with 3 times of injection of lidocaine at the MTrPs, once every 6 d. The blank group and the model group were fed normally without intervention. After the intervention, local muscle tissue was taken to detect the content of ATP and the expression of AMPK, phosphorylated AMPK (phospho-AMPK), PGC-1α, and glucose transporter 4 (GluT4), and the ultrastructure of mitochondria was observed under an electron microscope. Results: Compared with the blank group, the ATP content in the model group was decreased (P<0.05), the protein expression levels of phospho-AMPK, PGC-1α, and GluT4 and the ratio of phospho-AMPK to AMPK were decreased (P<0.05); under the electron microscope, the number of mitochondria decreased, and they were deformed, small in volume, and had deformed cristae. Compared with the model group, the ATP contents in the An-Pressing manipulation group and the lidocaine group were increased (P<0.05), and the protein expression levels of phospho-AMPK, PGC-1α, and GluT4 and the ratio of phospho-AMPK to AMPK were increased (P<0.05); under the electron microscope, the number of mitochondria increased, the shape and size of the mitochondria were basically normal, and the cristae could be seen. Compared with the lidocaine group, phospho-AMPK and the ratio of phospho-AMPK to AMPK in the An-Pressing manipulation group were increased (P<0.05); under the electron microscope, the numbers of mitochondria were similar, and the shape and size of the mitochondria were basically normal without swelling, and the cristae could be observed. Conclusion: An-Pressing manipulation can increase the ATP content in MTrPs tissue, improve the expression levels of PGC-1α and GluT4 proteins and the ratio of phospho-AMPK to AMPK; its mechanism may relate to the activation of AMPK/PGC-1α signaling pathway to promote the repair of mitochondrial damages.

BACKGROUND:Pressing massage applied to myofascial trigger points(MTrPs)has shown clear effect in relieving pain.However,further research is needed to investigate the effects of different levels of pressure applied during the massage. OBJECTIVE:To investigate the different strength of pressing on MTrPs in rats with chronic pain. METHODS:Sixty SPF-rated male Sprague-Dawley rats were randomly divided into a blank group of 10 rats not involved in MTrPs modeling and 50 rats involved in modeling.The MTrPs model was established in the left medial thigh muscle of rats by blunt strikes combined with centrifugal exercise and 40 rats that met the evaluation criteria after modeling were randomly divided into model group,light press group,medium press group and heavy press group,with 10 rats in each group.The rats in the blank group and the model group were not intervened,while the rats in the light press group,the medium press group and the heavy press group were intervened with a homemade press stimulator with light force(0.3 kg),medium force(0.5 kg)and heavy force(0.7 kg)to MTrPs.The intervention time was 7.5 minutes per session,with one session every other day,totaling seven sessions.Electromyogram,soft tissue tension and mechanical pain threshold were detected by electrophysiological instruments,soft tissue tension tester,and pressure painmeter,respectively.After the intervention,in the blank group,muscle tissue was taken from the inside of the left thigh,while in the other groups,MTrPs tissue was taken.The pathological morphology was observed by hematoxylin-eosin staining,while enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of cyclooxygenase-2,prostaglandin E2 and bradykinin. RESULTS AND CONCLUSION:Compared with the blank group,the model group had lower mechanical pain thresholds,higher soft tissue tone,higher amplitude frequency of spontaneous electrical activity,significant pathomorphological changes,and increased levels of cyclooxygenase-2,prostaglandin E2 and bradykinin(P<0.05).Compared with the model group,the medium press group and the heavy press group showed increased mechanical pain thresholds,decreased soft tissue tension,decreased spontaneous potential frequency amplitude,and decreased levels of cyclooxygenase-2,prostaglandin E2 and bradykinin(P<0.05),and significant recovery on pathomorphological changes.No significant changes in the above indicators were observed in the light press group(P>0.05).Compared with the medium press group,the heavy press group showed better improvement in the above indicators(P<0.05).To conclude,moderate to heavy pressing is often required to alleviate MTrPs pain.

OBJECTIVEThe clinical research literature regarding acupuncture treatment for vascular dementia was reviewed and analyzed to provide the references for clinical selection and compatibility of acupoints.

METHODSWith computer and manual retrieval method, the clinical literature regarding acupuncture treatment for vascular dementia in recent 10 years was collected. The acupoint type, meridian and use frequency were analyzed.

RESULTSTotally 38 articles of acupuncture treatment for vascular dementia were screened; the most selected meridians were the governor vessel, gallbladder meridian, stomach meridian and spleen meridian; the main acupoints with frequency of more than 5 times were Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), Fengchi (SP 40) and Shuigou (GV 26); the matching acupoints with frequency of more than 5 times were Fenglong (ST 40), Zusanli (ST 36), Taichong (LR 3), Taixi (KI 3), Sanyinjiao (SP 6), Xuehai (SP 10), Zhongwan (CV 12), Neiguan (PC 6), Fengchi (GB 20).

CONCLUSIONSThe rules and characteristics of acupoint selection for vascular dementia were featured with taking the local acupoints at head as main points, combining disease differentiation and syndrome differentiation as clinical principle, valuing local acupoints and distal acupoints, applying various techniques of acupuncture and moxibustion and combing traditional acupuncture manipulation and modern electroacupuncture stimulation.

OBJECTIVETo systematically evaluate the efficacy and safety of acupuncture on diarrhea-predominant irritable bowel syndrome (IBS) in the past five years.

METHODSOnline databases, including CNKI, VIP, WANFANG, PubMed, CBM, ScienceDirect OnSite, Cochrane Library, etc. were searched for randomized controlled trials (RCTs) of acupuncture for diarrhea-predominant IBS. Retrieval time was from January of 2011 to January of 2016. According to modified Jadad standard, the bias risk and quality assessment of each RCT included were evaluated by two researchers. RevMan 5.3 software was adopted for the meta-analysis.

RESULTSTotally 17 RCTs were included with 1 333 patients. The result of meta-analysis indicated the total effective rate of clinical symptoms improvement in the acupuncture group or acupuncture combined with western medicine group was superior to that in the western medicine group (=3.92, 95%:2.83~5.43,<0.01), and the funnel plot was basically symmetry. The result of meta-analysis showed 3-month recurrence rate:=0.22, 95%:0.12~0.41 (<0.01), indicating the recurrence rate in the acupuncture group was lower than that in the western medicine group in three month.

CONCLUSIONSAcupuncture for diarrhea-predominant irritable bowel syndrome is superior to conventional treatment of western medication, which can improve the clinical symptoms and reduce the recurrence rate of patients.