Acupuncture is an ancient treatment method used in traditional Chinese medicine and has been popularized worldwide. Over the past decade, there has been an increase in the amount of acupuncture research, mostly comprised of randomized controlled trials (RCTs) that aimed to answer the question on the efficacy of acupuncture. However, poor methodology and low replicability in these acupuncture RCTs have resulted in uncertainty about the efficacy of acupuncture. In this review, current advancements and challenges in acupuncture RCTs, regarding the methodological aspects of randomization, blinding, sham acupuncture and quality of reporting, were discussed. While there have been advancements in various aspects, current acupuncture RCTs still face pressing issues such as inadequate randomization and blinding, unviable sham acupuncture controls, and poor reporting quality. Given these limitations, this review seeks to identify the methodological problems that are responsible for these problems and to suggest solutions that could help to overcome them so as to improve the quality of future studies evaluating the efficacy of acupuncture. Please cite this article as: Seetoh WS, Lim RQR, Xu RB, Sun MX, Zhang P, Wang MN. Advancements and challenges of acupuncture randomized controlled trials. J Integr Med. 2025; 23(4): 333-343.
Acupuncture Therapy ; Humans ; Randomized Controlled Trials as Topic/methods* ; Research Design

Objective:To compare the effects of intermittent oro-esophageal tube feeding (IOE) and nasogastric tube feeding (NGT) on nutritional status, complications, swallowing function and airway protection in persons with post-stroke dysphagia (PSD).Methods:Sixty PSD patients were randomized into an observation group ( n=30) and a control group ( n=30). In addition to conventional medication and swallowing rehabilitation, the observation group received supplemental IOE nutrition, while the control group was given NGT. Before and after one month, both groups were evaluated using the Functional Oral Intake Scale (FOIS), and such nutritional indicators as body mass index (BMI), hemoglobin (Hb) levels, albumin (ALB), prealbumin (PAB), skinfold at the triceps (TSF) and arm muscle circumference (AMC) were measured. The morphology of each subject′s epiglottis, any edema of the arytenoid mucosa and vocal cord mobility were assessed using fiberoptic endoscopic evaluation of swallowing (FEES). Murray Secretion Scale ratings were documented, along with laryngeal sensation during swallowing, swallowing reflex, the Yale Pharyngeal Residue Severity Rating Scale, and the Rosenbek Penetration-aspiration Scale. Results:Both groups showed significant improvement in their average FOIS scores and all of the nutritional descriptors, but with significantly greater improvement in the observation group. Abnormalities in the shape of the epiglottis, arytenoid edema and vocal cord mobility had decreased significantly in both groups. This was also true of larynx sensation, swallowing reflex, pharyngeal secretions, residue and penetration/aspiration. On average the improvements were significantly greater in the observation group.Conclusion:Compared with NGT, IOE more effectively improves swallowing, enhances airway functioning and reduces NGT syndrome among PSD patients. These observations support its clinical adoption.

Objective:To explore the effects of early vitamin D supplementation on the immune function of premature infants.Methods:A total of 150 premature infants admitted to Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to March 2023 were enrolled perspectively, they were divided into the intervention group (75 cases) and the control group (75 cases) by the random number table method. The control group received formula milk intervention, and the intervention group received early vitamin D supplementation treatment on the basis of the control group. The course of treatment was 14 d. The levels of serum 25-hydroxyvitamin D [25- (OH) D], immunoglobulin (Ig), T cell subsets, complement C3, C4, and serum interleukin (IL)-1β and IL-10 were compared between the two groups before and after intervention.Results:The level of serum 25- (OH) D in the intervention group at 14 d after intervention was higher than that in the control group, the level of IL-1β was lower than that in the control group: (30.13 ± 6.00) nmol/L vs. (26.84 ± 5.79) nmol/L, (0.54 ± 0.20) ng/L vs. (0.65 ± 0.23) ng/L, there were statistical differences ( P<0.05). The levels of CD 3+, CD 4+, complement C3, C4, and IL-10 in the intervention group were higher than those in the control group at 14 d after intervention: 0.692 ± 0.043 vs. 0.632 ± 0.038, 0.400 ± 0.027 vs. 0.369 ± 0.026, (0.98 ± 0.26) g/L vs. (0.84 ± 0.24) g/L, (0.20 ± 0.05) g/L vs. (0.16 ± 0.04) g/L, (13.82 ± 3.64) ng/L vs. (11.36 ± 2.93) ng/L, there were statistical differences ( P<0.05). There were no statistically significant differences in the levels of IgA, IgM and IgG between the two groups before and after intervention ( P>0.05). Conclusions:Early vitamin D supplementation can significantly improve T cell subsets and regulate IL-1β/IL-10 levels in premature infants.

Objective:To investigate the clinical effectiveness of vitamin D combined with conventional anti-infective therapy and formula feeding in the treatment of preterm infants with infectious diseases.Methods:A total of 150 premature infants with infectious diseases treated in Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January to December 2022 were prospectively selected as the study objects, and divided into the control group and the study group according to the admission sequence number, with 75 cases in each group. The control group was treated with routine anti-infection regimen and formula feeding, and the study group was combined with early vitamin D supplementation on the basis of the control group. Both groups were treated continuously for 4 weeks. Serum prealbumin (pre-Alb), 25-hydroxyvitamin D[25-(OH)D], immune indexes and inflammatory response indexes were compared between the two groups before and after treatment, and neonatal complications and adverse reactions were compared between the two groups.Results:After treatment, the levels of serum 25-(OH)D and pre-Alb in the study group were higher than those in the control group: (37.58 ± 4.02) nmol/L vs. (27.20 ± 3.75) nmol/L, (141.27 ± 16.79) mg/L vs. (132.83 ± 16.36) mg/L, there were statistical differences ( P<0.05). After treatment, the levels of serum complement C3, C4, immunoglobulin (Ig) M and IgG in the study group were higher than those in the control group : (0.92 ± 0.15) g/L vs. (0.77 ± 0.19) g/L, (0.18 ± 0.05) g/L vs. (0.15 ± 0.04) g/L, (0.24 ± 0.04) g/L vs. (0.22 ± 0.05) g/L, (8.07 ± 1.05) g/L vs. (7.68 ± 1.13) g/L, there were statistical differences ( P<0.05). After treatment, the serum levels of interleukin-2 (IL) in the study group was higher than that in the control group, while the levels of IL-4, amyloid A (SAA), soluble human tumor necrosis factor receptor 1 (sTNFR-1) and Toll-like receptor 4 (TLR4) in the study group were lower than those in the control group: (4.61 ± 1.14) pg/L vs. (3.81 ± 0.91) pg/L, (20.53 ± 2.61) pg/L vs. (23.97 ± 3.12) pg/L, (5.56 ± 1.78) mg/L vs. (7.24 ± 1.93) mg/L, (4.16 ± 1.27) mg/L vs. (6.08 ± 1.54) mg/L, (75.21 ± 7.39) mg/L vs. (81.42 ± 8.17) mg/L, there were statistical differences ( P<0.05). The incidence rates of neonatal pneumonia, necrotizing enterocolitis (NEC) and metabolic bone disease in the study group were lower than those in the control group: 1.33%(1/75) vs. 10.67%(8/75), 1.33%(1/75) vs. 10.67%(8/75), 0 vs. 9.33%(7/75), there were statistical differences ( P<0.05). Conclusions:Vitamin D supplementation can effectively maintain the nutritional status of premature infants with infectious diseases and improve the immune system function, regulate inflammation and reduce complications.

Objective To analyze epidemiological characteristics and influencing factors of atrial fibrillation (AF) in Suqian in 2019-2023. Methods A total of 1 869 patients with AF admitted to medical institutions in Suqian from January 2019 to December 2023 were selected as the survey subjects. The diagnosis and treatment data of the AF patients were retrospectively analyzed to explore epidemiological characteristics. A total of 2 000 healthy controls during the same period were selected as the control group. The influencing factors of AF were analyzed by univariate and multivariate logistic regression models. Results The incidence of AF in Suqian increased with the increase of year, age and labor intensity. The incidence rate was higher (>50%) in patients with male gender, old age, education level of junior high school and below, city living, heavy physical labor, smoking history, drinking history and underlying diseases (coronary heart disease, stroke, heart failure, hyperuricemia, hyperthyroidism, hypertension, diabetes mellitus, and hyperlipidemia). Multivariate logistic regression analysis showed that hyperuricemia, hyperthyroidism, cognitive dysfunction and anxiety/depression were influencing factors of AF in Suqian (P<0.05). Conclusion From 2019 to 2023, AF risk is relatively high in patients in Suqian, which is closely related to hyperuricemia, hyperthyroidism, cognitive dysfunction and anxiety/depression.

Objective:To explore the effects of early vitamin D supplementation on the immune function of premature infants.Methods:A total of 150 premature infants admitted to Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to March 2023 were enrolled perspectively, they were divided into the intervention group (75 cases) and the control group (75 cases) by the random number table method. The control group received formula milk intervention, and the intervention group received early vitamin D supplementation treatment on the basis of the control group. The course of treatment was 14 d. The levels of serum 25-hydroxyvitamin D [25- (OH) D], immunoglobulin (Ig), T cell subsets, complement C3, C4, and serum interleukin (IL)-1β and IL-10 were compared between the two groups before and after intervention.Results:The level of serum 25- (OH) D in the intervention group at 14 d after intervention was higher than that in the control group, the level of IL-1β was lower than that in the control group: (30.13 ± 6.00) nmol/L vs. (26.84 ± 5.79) nmol/L, (0.54 ± 0.20) ng/L vs. (0.65 ± 0.23) ng/L, there were statistical differences ( P<0.05). The levels of CD 3+, CD 4+, complement C3, C4, and IL-10 in the intervention group were higher than those in the control group at 14 d after intervention: 0.692 ± 0.043 vs. 0.632 ± 0.038, 0.400 ± 0.027 vs. 0.369 ± 0.026, (0.98 ± 0.26) g/L vs. (0.84 ± 0.24) g/L, (0.20 ± 0.05) g/L vs. (0.16 ± 0.04) g/L, (13.82 ± 3.64) ng/L vs. (11.36 ± 2.93) ng/L, there were statistical differences ( P<0.05). There were no statistically significant differences in the levels of IgA, IgM and IgG between the two groups before and after intervention ( P>0.05). Conclusions:Early vitamin D supplementation can significantly improve T cell subsets and regulate IL-1β/IL-10 levels in premature infants.

Objective:To investigate the clinical effectiveness of vitamin D combined with conventional anti-infective therapy and formula feeding in the treatment of preterm infants with infectious diseases.Methods:A total of 150 premature infants with infectious diseases treated in Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January to December 2022 were prospectively selected as the study objects, and divided into the control group and the study group according to the admission sequence number, with 75 cases in each group. The control group was treated with routine anti-infection regimen and formula feeding, and the study group was combined with early vitamin D supplementation on the basis of the control group. Both groups were treated continuously for 4 weeks. Serum prealbumin (pre-Alb), 25-hydroxyvitamin D[25-(OH)D], immune indexes and inflammatory response indexes were compared between the two groups before and after treatment, and neonatal complications and adverse reactions were compared between the two groups.Results:After treatment, the levels of serum 25-(OH)D and pre-Alb in the study group were higher than those in the control group: (37.58 ± 4.02) nmol/L vs. (27.20 ± 3.75) nmol/L, (141.27 ± 16.79) mg/L vs. (132.83 ± 16.36) mg/L, there were statistical differences ( P<0.05). After treatment, the levels of serum complement C3, C4, immunoglobulin (Ig) M and IgG in the study group were higher than those in the control group : (0.92 ± 0.15) g/L vs. (0.77 ± 0.19) g/L, (0.18 ± 0.05) g/L vs. (0.15 ± 0.04) g/L, (0.24 ± 0.04) g/L vs. (0.22 ± 0.05) g/L, (8.07 ± 1.05) g/L vs. (7.68 ± 1.13) g/L, there were statistical differences ( P<0.05). After treatment, the serum levels of interleukin-2 (IL) in the study group was higher than that in the control group, while the levels of IL-4, amyloid A (SAA), soluble human tumor necrosis factor receptor 1 (sTNFR-1) and Toll-like receptor 4 (TLR4) in the study group were lower than those in the control group: (4.61 ± 1.14) pg/L vs. (3.81 ± 0.91) pg/L, (20.53 ± 2.61) pg/L vs. (23.97 ± 3.12) pg/L, (5.56 ± 1.78) mg/L vs. (7.24 ± 1.93) mg/L, (4.16 ± 1.27) mg/L vs. (6.08 ± 1.54) mg/L, (75.21 ± 7.39) mg/L vs. (81.42 ± 8.17) mg/L, there were statistical differences ( P<0.05). The incidence rates of neonatal pneumonia, necrotizing enterocolitis (NEC) and metabolic bone disease in the study group were lower than those in the control group: 1.33%(1/75) vs. 10.67%(8/75), 1.33%(1/75) vs. 10.67%(8/75), 0 vs. 9.33%(7/75), there were statistical differences ( P<0.05). Conclusions:Vitamin D supplementation can effectively maintain the nutritional status of premature infants with infectious diseases and improve the immune system function, regulate inflammation and reduce complications.

Objective:To compare the effects of intermittent oro-esophageal tube feeding (IOE) and nasogastric tube feeding (NGT) on nutritional status, complications, swallowing function and airway protection in persons with post-stroke dysphagia (PSD).Methods:Sixty PSD patients were randomized into an observation group ( n=30) and a control group ( n=30). In addition to conventional medication and swallowing rehabilitation, the observation group received supplemental IOE nutrition, while the control group was given NGT. Before and after one month, both groups were evaluated using the Functional Oral Intake Scale (FOIS), and such nutritional indicators as body mass index (BMI), hemoglobin (Hb) levels, albumin (ALB), prealbumin (PAB), skinfold at the triceps (TSF) and arm muscle circumference (AMC) were measured. The morphology of each subject′s epiglottis, any edema of the arytenoid mucosa and vocal cord mobility were assessed using fiberoptic endoscopic evaluation of swallowing (FEES). Murray Secretion Scale ratings were documented, along with laryngeal sensation during swallowing, swallowing reflex, the Yale Pharyngeal Residue Severity Rating Scale, and the Rosenbek Penetration-aspiration Scale. Results:Both groups showed significant improvement in their average FOIS scores and all of the nutritional descriptors, but with significantly greater improvement in the observation group. Abnormalities in the shape of the epiglottis, arytenoid edema and vocal cord mobility had decreased significantly in both groups. This was also true of larynx sensation, swallowing reflex, pharyngeal secretions, residue and penetration/aspiration. On average the improvements were significantly greater in the observation group.Conclusion:Compared with NGT, IOE more effectively improves swallowing, enhances airway functioning and reduces NGT syndrome among PSD patients. These observations support its clinical adoption.

Objective To investigate the incidence rate,clinical characteristics,and prognosis of neonatal stroke in Shenzhen,China.Methods Led by Shenzhen Children's Hospital,the Shenzhen Neonatal Data Collaboration Network organized 21 institutions to collect 36 cases of neonatal stroke from January 2020 to December 2022.The incidence,clinical characteristics,treatment,and prognosis of neonatal stroke in Shenzhen were analyzed.Results The incidence rate of neonatal stroke in 21 hospitals from 2020 to 2022 was 1/15 137,1/6 060,and 1/7 704,respectively.Ischemic stroke accounted for 75％(27/36);boys accounted for 64％(23/36).Among the 36 neonates,31(86％)had disease onset within 3 days after birth,and 19(53％)had convulsion as the initial presentation.Cerebral MRI showed that 22 neonates(61％)had left cerebral infarction and 13(36％)had basal ganglia infarction.Magnetic resonance angiography was performed for 12 neonates,among whom 9(75％)had involvement of the middle cerebral artery.Electroencephalography was performed for 29 neonates,with sharp waves in 21 neonates(72％)and seizures in 10 neonates(34％).Symptomatic/supportive treatment varied across different hospitals.Neonatal Behavioral Neurological Assessment was performed for 12 neonates(33％,12/36),with a mean score of(32±4)points.The prognosis of 27 neonates was followed up to around 12 months of age,with 44％(12/27)of the neonates having a good prognosis.Conclusions Ischemic stroke is the main type of neonatal stroke,often with convulsions as the initial presentation,involvement of the middle cerebral artery,sharp waves on electroencephalography,and a relatively low neurodevelopment score.Symptomatic/supportive treatment is the main treatment method,and some neonates tend to have a poor prognosis.

Objective Tissue uptake and distribution of nano-/microplastics was studied at a single high dose by gavage in vivo.Methods Fluorescent microspheres (100 nm, 3 μm, and 10 μm) were given once at a dose of 200 mg/(kg·body weight). The fluorescence intensity (FI) in observed organs was measured using the IVIS Spectrum at 0.5, 1, 2, and 4 h after administration. Histopathology was performed to corroborate these findings.Results In the 100 nm group, the FI of the stomach and small intestine were highest at 0.5 h, and the FI of the large intestine, excrement, lung, kidney, liver, and skeletal muscles were highest at 4 h compared with the control group (P < 0.05). In the 3 μm group, the FI only increased in the lung at 2 h (P < 0.05). In the 10 μm group, the FI increased in the large intestine and excrement at 2 h, and in the kidney at 4 h (P < 0.05). The presence of nano-/microplastics in tissues was further verified by histopathology. The peak time of nanoplastic absorption in blood was confirmed.Conclusion Nanoplastics translocated rapidly to observed organs/tissues through blood circulation;however, only small amounts of MPs could penetrate the organs.