The purpose of this study was to systematically review the scientific literature about the effects of supplementation with Ashwagandha () on maximum oxygen consumption (VO), as well as to provide directions for clinical practice. A systematic search was conducted in three electronic databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA). The inclusion criteria were: (a) VOdata, with means± standard deviation before and after the supplement intervention, (b) the study was randomized controlled trial (RCT), (c) the article was written in English. The quality of evidence was evaluated according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.A meta-analysis was performed to determine effect sizes. Five studies were selected in the systematic review (162 participants) and four were included in the meta-analysis (142 participants). Results showed a significant enhancement in VOin healthy adults and athletes (= 0.04). The mean difference was 3.00 (95% CI from 0.18 to 5.82) with high heterogeneity. In conclusion, Ashwagandha supplementation might improve the VOin athlete and non-athlete people. However, further research is need to confirm this hypothesis since the number of studies is limited and the heterogeneity was high.

Objective. To assess the evidence of efficacy and safety of acupuncture for amblyopia and analyze the current situation of its clinical setting. Methods. We systemically searched Wanfang, Chongqing Weipu Database for Chinese Technical Periodicals (VIP), China National Knowledge Infrastructure (CNKI), and PubMed. Published randomized controlled trials (RCT) and controlled clinical trials (CCT) that evaluated the effect of acupuncture for amblyopia compared with conventional treatment were identified. The methodological quality of the included trials was assessed based on the Jadad scale. Data synthesis was facilitated using RevMan 5.1. Results. Fourteen trials involving 2662 participants satisfied the minimum criteria for meta-analysis. The evidence showed that the total effective rate of treatment within the group receiving acupuncture was higher than that in conventional group; there were statistically significant differences between groups (polled random effects model (RR) = 1.17, 95% confidence interval (1.11, 1.24), Z = 5.56, P<0.00001). Conclusion. The total effective rate of acupuncture for amblyopia was significantly superior to conventional treatment, indicating that acupuncture was a promising treatment for amblyopia. However, due to the limited number of CCTs and RCTs, especially those of large sample size and multicenter randomized controlled studies that were quantitatively insufficient, we could not reach a completely affirmative conclusion until further studies of high quality are available.

OBJECTIVE:To evaluate the efficacy and safety of acupuncture in the treatment of epilepsy.

METHODS:We first collected research data about randomized control trials (RCTs) of acupuncture treatment of epilepsy from databases CNKI, CBM, VIP and Wanfang using key words"(acupuncture)","(epilepsy)"or"(epilepsy)"or"(epilepsy)", and from PubMed, Google Scholar, and Cochrane Library using key words"acupuncture""needling""prod""epilepsy""epilepsies"or"seizure disorder"or"simple seizure"from the date of database construction to May 5, 2017. Then, two researchers extracted the study outcomes and evaluated the evidence qualification of the research data independently using GRADE profile 3.6 software and analyzed the primary outcome indexes using RevMan 5.3 and STATA 14.0.

RESULTS:Eleven articles containing 827 cases were included in the Meta-analysis. We found that acupuncture or acupuncture in combination with other conventional drugs had a significantly better efficacy than conventional drugs in the treatment of epilepsy [=3.94, 95%CI (2.49, 6.24),=5.85,<0.000 01]. There was a statistical heterogeneity (=0.04, l=60%), and the Meta-analysis was not feasible for the studies of acupuncture vs medication. Combination of acupuncture and Chinese traditional drugs was significantly better than simple Chinese traditional drugs [= 4.61, 95%CI (2.18, 9.74),=4.01,<0.000 1], and combination of acupuncture and wes-tern medicines was obviously better than simple western medicines [=3.07, 95%CI(1.24, 7.65),=2.41,=0.02] in the treatment of epilepsy.

CONCLUSION:Acupuncture therapy may have a positive effect in the treatment of epilepsy but the conclusion needs further verification due to very fewer high-quality and well-designed RCTs found at the present.

The aim of this study was to examine the effects of manual/electrical acupuncture treatment on tinnitus in a randomised, single-blinded, placebo-controlled design. Fifty patients (46 males, 4 females) suffering from tinnitus were investigated. The patients were randomly assigned to three groups: a manual acupuncture group (MA), an electrical acupuncture group (EA), and a placebo group (PL). The frequency of tinnitus occurrence, tinnitus intensity, and reduction of life quality were recorded before treatment (Baseline), after 6 treatments (After-Treatment), and 1 month after the completion of treatment (1-Month-After). Standard audiometric tests were conducted on each patient at Baseline and After-Treatment. The patients also provided an overall subjective evaluation of treatment effectiveness at each stage. Eight to ten acupoints were selected at each treatment by an experienced acupuncturist. Six treatments were performed, each separated by an interval of 1 week. Analysis of variance and t-tests were used to statistically compare the data. The frequency of tinnitus occurrence and the tinnitus loudness were significantly decreased After-Treatment compared with Baseline in the EA group (P<0.009). Life quality was improved After-Treatment and at 1-Month-After compared with Baseline in both MA and EA groups (P<0.038). However, no significant differences were detected among the three groups (P>0.079). The audiogram did not show any significant changes after treatment in either group (P>0.091). The overall subjective evaluation indicated significant improvements After-Treatment compared with Baseline in both MA and EA groups (P<0.011). Furthermore, After-Treatment subjective evaluation was significantly better in the EA group compared with either the MA or PL group (P<0.011). These results indicate that there is no statistically significant differential effect of manual or electrical acupuncture on tinnitus treatment efficacy, however, electrical acupuncture does confer some relative advantages.

Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

BACKGROUND:Qigong and Tai Chi are the two most popular traditional Chinese exercises, known as mind-body movement therapies. Previous studies suggest that Qigong and Tai Chi may be beneficial in reducing depressive symptoms. This was the first study to systematically review and compare the effects of Qigong and Tai Chi on depressive symptoms.

METHODS:A systematic search of six electronic databases was undertaken through to February 2014, for randomized controlled trials (RCTs) which reported depressive symptoms measured by a depressive symptom rating scale. The standardized mean difference in depressive symptoms score between Qigong or Tai Chi and a control group (at the end of follow-up) was extracted as a primary outcome. The secondary outcome was the standardized mean gain in symptom score (SMG) relative to the baseline from individual arms of the RCTs for various forms of care including Qigong, Tai Chi, usual care, other exercise, education and miscellaneous interventions.

RESULTS:Thirty studies with a total of 2328 participants (823 males and 1505 females) were included. A significant effect was found for the Qigong interventions (Cohen's d -0.48 95% CI -0.48 to -0.12; SMG -0.52, 95% CI -0.79 to -0.26). There was no significant effect seen for Tai Chi for the primary endpoint. No mean change in symptom scores were seen for Tai Chi, usual care, other exercises, education and the 'miscellaneous' group in pre-post assessment in single arms. The Qigong results were found to be robust in sensitivity analyses.

CONCLUSIONS:Qigong appears to be beneficial for reducing depressive symptom severity. However, given the low quality of the included studies and the documented evidence of publication bias, these results should be viewed cautiously.

PURPOSE: We reviewed studies from 1999 to 2009 on anxiolytic effects of different essential oils toward rodents in anxiety-related behavioral models. METHOD: Journal papers that evaluated the anxiolytic effects of essential oils for rodents were extracted from available electronic data bases. RESULTS: The results based on 14 studies showed that different rodent species were recruited including ICR mice and Swiss mice. Most of studies applied the Elevated Plus Maze (EPM) as the animal behavioral model. Lavender oil was the most popular within the 14 studies. Lavender and rose oils were found to be effective in some of the studies. Only one study reported the underlying neurophysiological mechanism in terms of concentrations of emotionally related neuro-transmitters such as dopamine, serotonin, and their derivatives, in various brain regions. CONCLUSION: Some essential oils are found to be effective to induce anxiolytic effect in rodents under different animal anxiety models. However, more standardized experimental procedures and outcome measures are needed in future studies. Translational research to human subjects is also recommended.

BACKGROUND:Active commuting is associated with greater physical activity, but there is no consensus on the actual beneficial effects of this type of physical activity on health outcomes.

OBJECTIVE:To examine the association between active commuting and risk of all-cause mortality, incidence and mortality from cardiovascular diseases, cancer and diabetes through meta-analysis.

METHODS:A comprehensive search of MEDLINE, Embase, Google Scholar, Web of Science, The Cochrane Library, Transport Research International Documentation database, and reference lists of included articles was conducted. Only prospective cohort studies were included.

RESULTS:Twenty-three prospective studies including 531,333 participants were included. Participants who engaged in active commuting had a significantly lower risk of all-cause mortality [relative risk (RR) 0.92, 95% CI 0.85-0.98] and cardiovascular disease incidence (RR 0.91; 95% CI 0.83-0.99). There was no association between active commuting and cardiovascular disease mortality and cancer. Participants who engaged in active commuting had a 30% reduced risk of diabetes (RR 0.70; 95% CI 0.61-0.80) in three studies after removal of an outlying study that affected the heterogeneity of the results. Subgroup analyses suggested a significant risk reduction (- 24%) of all-cause mortality (RR 0.76; 95% CI 0.63-0.94) and cancer mortality (- 25%; RR 0.75; 95% CI 0.59-0.895) among cycling commuters.

CONCLUSION:People who engaged in active commuting had a significantly reduced risk of all-cause mortality, cardiovascular disease incidence and diabetes.

PURPOSE/OBJECTIVES:To compare differences in the chemotherapy-induced nausea and vomiting (CINV) among three groups of women (acupressure, placebo acupressure, and usual care) undergoing chemo-therapy for breast cancer.

DESIGN:A multicenter, longitudinal, randomized clinical trial throughout one cycle of chemotherapy.

SETTING:Ten community clinical oncology programs associated with the M.D. Anderson Cancer Center and nine independent sites located throughout the United States.

SAMPLE:160 women who were beginning their second or third cycle of chemotherapy for breast cancer treatment and had moderate nausea intensity scores with their previous cycles.

METHODS:Subjects were randomized to one of three groups: acupressure to P6 point (active), acupressure to SI3 point (placebo), or usual care only. Subjects in the acupressure group were taught to apply an acupressure wrist device by research assistants who were unaware of the active acupressure point. All subjects completed a daily log for 21 days containing measures of nausea and vomiting and recording methods (including antiemetics and acupressure) used to control these symptoms.

MAIN RESEARCH VARIABLES:Acute and delayed nausea and vomiting.

RESULTS:No significant differences existed in the demographic, disease, or treatment variables among the treatment groups. No significant differences were found in acute nausea or emesis by treatment group. With delayed nausea and vomiting, the acupressure group had a statistically significant reduction in the amount of vomiting and the intensity of nausea over time when compared with the placebo and usual-care groups. No significant differences were found between the placebo and usual-care groups in delayed nausea or vomiting.

CONCLUSIONS:Acupressure at the P6 point is a value-added technique in addition to pharmaceutical management for women undergoing treatment for breast cancer to reduce the amount and intensity of delayed CINV.

IMPLICATIONS FOR NURSING:Acupressure is a safe and effective tool for managing delayed CINV and should be offered to women undergoing chemotherapy for breast cancer.

BACKGROUND:Acupuncture has a history of traditional use in China for women's health conditions including premenstrual syndrome (PMS), but its effectiveness for this condition remains unclear. This review examined the available evidence supporting the use of acupuncture or acupressure to treat PMS.

OBJECTIVES:To evaluate the effectiveness and safety of acupuncture or acupressure for women with PMS or premenstrual dysphoric disorder (PMDD).

SEARCH METHODS:We searched the Cochrane Gynaecology and Fertility Specialised Register, Cochrane Central Register of Studies Online (CENTRAL CRSO), MEDLINE, Embase, AMED, PsycINFO, CINAHL (from inception to 21 September 2017), two clinical trial databases (from their inception to 21 September 2017), and four electronic databases in China (from their inception to 15 October 2017): Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), VIP information/ Chinese Scientific Journals database and WANFANG. Reference lists from included articles were handsearched.

SELECTION CRITERIA:We included studies if they randomised women with PMS and associated disorders (PMDD and late luteal phase dysphoric disorder/LPDD) to receive acupuncture or acupressure versus sham, usual care/waiting-list control or pharmaceutical interventions mentioned by the International Society for Premenstrual Disorders (ISPMD). If acupuncture or acupressure were combined with another therapy, these studies were also included where the additional therapy was the same in both groups. Cross-over studies were eligible for inclusion, but only data from the first phase could be used.

DATA COLLECTION AND ANALYSIS:Two review authors independently selected the studies, assessed eligible studies for risk of bias, and extracted data from each study. Study authors were contacted for missing information. The quality of the evidence was assessed using GRADE. Our primary outcomes were overall premenstrual symptoms and adverse events. Secondary outcomes included specific PMS symptoms, response rate and quality of life.

MAIN RESULTS:Five trials (277 women) were included in this review. No trials compared acupuncture or acupressure versus other active treatments. The number of treatment sessions ranged from seven to 28. The quality of the evidence ranged from low to very low quality, the main limitations being imprecision due to small sample sizes and risk of bias related to detection bias and selective reporting.Acupuncture versus sham acupunctureAcupuncture may provide a greater reduction in mood-related PMS symptoms (mean difference (MD) -9.03, 95% confidence interval (CI) -10.71 to -7.35, one randomised controlled trial (RCT), n = 67, low-quality evidence) and in physical PMS symptoms (MD -9.11, 95% CI -10.82 to -7.40, one RCT, n = 67, low-quality evidence) than sham acupuncture, as measured by the Daily Record of Severity of Problems scale (DRSP). The evidence suggests that if women have a mood score of 51.91 points with sham acupuncture, their score with acupuncture would be between 10.71 and 7.35 points lower and if women have a physical score of 46.11 points, their score with acupuncture would be between 10.82 and 7.4 points lower.There was insufficient evidence to determine whether there was any difference between the groups in the rate of adverse events (risk ratio (RR) 1.74, 95% CI 0.39 to 7.76, three RCTs, n = 167, I= 0%, very low-quality evidence).Specific PMS symptoms were not reportedThere may be little or no difference between the groups in response rates. Use of a fixed-effect model suggested a higher response rate in the acupuncture group than in the sham group (RR 2.59, 95% CI 1.71 to 3.92; participants = 100; studies = 2; I= 82%), but owing to the high heterogeneity we tested the effect of using a random-effects model, which provided no clear evidence of benefit for acupuncture (RR 4.22, 95% CI 0.45 to 39.88, two RCTs, n = 100, I= 82%, very low-quality evidence).Acupuncture may improve quality of life (measured by the WHOQOL-BREF) compared to sham (MD 2.85, 95% CI 1.47 to 4.23, one RCT, n = 67, low-quality evidence).Acupuncture versus no treatmentDue to the very low quality of the evidence, we are uncertain whether acupuncture reduces PMS symptoms compared to a no treatment control (MD -13.60, 95% CI -15.70 to -11.50, one RCT, n = 14).No adverse events were reported in either group.No data were available on specific PMS symptoms, response rate or quality of life outcomes.Acupressure versus sham acupressureWe found low-quality evidence that acupressure may reduce the number of women with moderate to severe PMS symptoms at the end of the trial compared to sham acupressure (RR 0.64 95% CI 0.52 to 0.79, one RCT, n = 90, low-quality evidence). The evidence suggests that if 97 women out of 100 in the sham acupressure group had moderate to severe PMS symptoms, the number of women in the acupressure group with moderate to severe symptoms would be 50 to 76 women.Acupressure may improve both physical (MD 24.3, 95% CI 17.18 to 31.42, one RCT, n = 90, low-quality evidence) and mental (MD 17.17, 95% CI 13.08 to 21.26, one RCT, n = 90, low-quality evidence) quality of life.No data were available on adverse events, specific symptoms or response rates.

AUTHORS' CONCLUSIONS:The limited evidence available suggests that acupuncture and acupressure may improve both physical and psychological symptoms of PMS when compared to a sham control. There was insufficient evidence to determine whether there was a difference between the groups in rates of adverse events.There is no evidence comparing acupuncture or acupressure versus current ISPMD recommended treatments for PMS such as selective serotonin reuptake inhibitors (SSRIs). Further research is required, using validated outcome measures for PMS, adequate blinding and suitable comparator groups reflecting current best practice.

PURPOSE:This systematic review and meta-analysis aims to assess the therapeutic and adverse effects of acupuncture for benign prostatic hyperplasia (BPH) in randomized controlled trials (RCTs).

METHODS:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Database, the China National Knowledge Infrastructure, the VIP Database and the Wanfang Database. Parallel-group RCTs of acupuncture for men with symptomatic BPH were included. Data from the included trials were extracted by two independent reviewers and were analyzed with The Cochrane Collaboration Review Manager software (RevMan 5.3.5) after risk of bias judgments. The primary outcome measure of this review was a change in urological symptoms.

RESULTS:Eight RCTs, which involved 661 men with BPH, were included. Follow-up varied from 4 weeks to 18 months. Pooling of the data from three trials that compared acupuncture with sham-acupuncture revealed that in the short term (4-6 weeks), acupuncture can significantly improve IPSS (MD -1.90, 95% CI -3.58 to -0.21). A sensitivity analysis of the short-term endpoint showed the same result (MD -3.01, 95% CI -5.19 to -0.84) with a borderline minimal clinical important difference (MCID). Qmax of the short-term endpoint indicated statistically positive beneficial effects of acupuncture (MD -1.78, 95%CI -3.43, -0.14). A meta-analysis after medium-term follow-up (12-18 weeks) indicated no significant effect on IPSS when the data from two trials were combined (MD -2.04, 95% CI -4.19, 0.10).

CONCLUSION:Statistically significant changes were observed in favor of acupuncture in moderate to severe BPH with respect to short-term follow-up endpoints. The clinical significance of these changes needs to be tested by further studies with rigorous designs and longer follow-up times.

TRIAL REGISTRATION NUMBER:PROSPERO CRD42014013645.

Background:The objective of this study was to compare the efficacy and side effects of acupuncture, sham acupuncture, and drugs in the treatment of diarrhoea-predominant irritable bowel syndrome.

Methods:Randomized controlled trials (RCTs) assessing the effects of acupuncture and drugs were comprehensively retrieved from electronic databases (such as PubMed, Cochrane Library, Embase, CNKI, Wanfang Database, VIP Database, and CBM) up to December 2017. Additional references were obtained from review articles. With document quality evaluations and data extraction, Network Meta-Analysis was performed using a random-effects model under a frequentist framework.

Results:A total of 29 studies (n = 9369) were included; 19 were high-quality studies, and 10 were low-quality studies. NMA showed the following: (1) the ranking of treatments in terms of efficacy in diarrhoea-predominant irritable bowel syndrome is acupuncture, sham acupuncture, pinaverium bromide, alosetron = eluxadoline, ramosetron, and rifaximin; (2) the ranking of treatments in terms of severity of side effects in diarrhoea-predominant irritable bowel syndrome is rifaximin, alosetron, ramosetron = pinaverium bromide, sham acupuncture, and acupuncture; and (3) the treatment of diarrhoea-predominant irritable bowel syndrome includes common acupoints such as ST25, ST36, ST37, SP6, GV20, and EX-HN3.

Conclusion:Acupuncture may improve diarrhoea-predominant irritable bowel syndrome better than drugs and has the fewest side effects. Sham acupuncture may have curative effect except for placebo effect. In the future, it is necessary to perform highly qualified research to prove this result. Pinaverium bromide also has good curative effects with fewer side effects than other drugs.

BACKGROUND:Insomnia is the common complaint among patients with stroke. Acupuncture has increasingly been used for insomnia relief after stroke. The aim of the present study was to summarize and evaluate evidence on the effectiveness of acupuncture in relieving insomnia after stroke.

METHODS:Seven databases were searched from inception through October 2014 without language restrictions. Randomized controlled trials (RCTs) were included if acupuncture was compared to placebo or other conventional therapy for treatment of insomnia after stroke. Assessments were performed using the Pittsburgh sleep quality index (PSQI), the insomnia severity index (ISI), the Athens insomnia scale (AIS), and the efficacy standards of Chinese medicine.

RESULTS:A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI (weighted mean difference, 4.31; 95 % confidence interval [CI], 1.67-6.95; P = 0.001) and by the efficacy standards of Chinese medicine (risk ratio, 1.25; 95 % CI, 1.12-1.40; P < 0.001). Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI (weighted mean difference, 4.44; 95 % CI, 2.75-6.13; P < 0.001) and the AIS (weighted mean difference, 3.64; 95 % CI, 2.28-5.00; P < 0.001).

CONCLUSIONS:Our results suggest that acupuncture could be effective for treating insomnia after stroke. However, further studies are needed to confirm the role of acupuncture in the treatment of this disorder.

Context:Traumatic brain injury (TBI) is an injury to the brain that occurs as a result of a direct impact, and affected persons are usually in a long-term coma. The evidence of the safety and effectiveness of acupuncture to treat coma is still not convincing.

Objective:The study intended to assess the effectiveness and safety of acupuncture for arousing a patient in a coma following TBI.

Design:Medline, Embase, CENTRAL, and 4 Chinese medical databases were searched from their inception to March 1, 2018, without language restrictions. The dataset included randomized controlled trials (RCTs) that examined acupuncture as a therapy for arousing patients in a coma after TBI. The literature was screened ;the data were extracted ;and the methodological quality of the included studies was assessed. Meta-analyses were performed on the included data.

Setting:This study was conducted at Tianjin University of Traditional Chinese Medicine (Tianjin City, China).

Participants:Participants in the selected RCTs were people of any age and either gender who were in a coma caused by TBI.

Interventions:The intervention group in the selected RCTs had received acupuncture for TBI, either as a sole therapy or combined with other treatments, and the control group had received placebo acupuncture, sham acupuncture, conventional treatments, or other treatments. The interventions included traditional acupuncture, electroacupuncture, ear acupuncture, and scalp acupuncture.

Outcome Measures:The research team measured the Glasgow Outcome Score (GOS), wake-promoting rates, as well as the Glasgow Coma Score (GCS).

Results:Of 884 potentially relevant trials, 24 RCTs met the inclusion criteria. The results of the meta-analysis suggested that the acupuncture group's coma state was significantly lessened after treatment compared with the control on GOS (RR, 1.95, 95% CI [1.64 to 2.31], P<.01; I² = 0%), wake-promoting rates (RR, 1.48, 95% CI [1.19 to 1.83], P<.01; I² = 52%), and GCS (MD, 1.78, 95% CI [1.10 to 2.45], P<.01; I² = 52%) .

Conclusion:The systematic review and meta-analysis has suggested that acupuncture can be an effective treatment for patients unconscious following TBI. However, the evidence was too weak for medical practitioners to routinely recommend acupuncture for clinical treatment; further large, rigorously designed studies are needed.

OBJECTIVES:Neuropathy and its associated pain pose great therapeutic challenges. While there has been a recent surge in acupuncture use and research, little remains known about its effects on nerve function. This review aims to assess the efficacy of acupuncture in the treatment of neuropathy of various etiologies.

METHODS:The Medline, AMED, Cochrane, Scopus, CINAHL, and clintrials.gov databases were systematically searched from inception to July 2015. Randomized controlled trials (RCTs) assessing acupuncture's efficacy for poly- and mononeuropathy were reviewed. Parallel and crossover RCTs focused on acupuncture's efficacy were reviewed and screened for eligibility. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to assess RCT quality. RCTs with score of>9 and active control treatments such as sham acupuncture or medical therapy were included.

RESULTS:Fifteen studies were included: 13 original RCTs, a long-term follow-up, and a re-analysis of a prior RCT. The selected RCTs studied acupuncture for neuropathy caused by diabetes, Bell's palsy, carpal tunnel syndrome, human immunodeficiency virus (HIV), and idiopathic conditions. Acupuncture regimens, control conditions, and outcome measures differed among studies, and various methodological issues were identified. Still, the majority of RCTs showed benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell's palsy, and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy, and there is insufficient evidence for its benefits in idiopathic neuropathy. Acupuncture appears to improve nerve conduction study parameters in both sensory and motor nerves. Meta-analyses were conducted on all diabetic neuropathy and Bell's palsy individual subject data (six RCTs; a total of 680 subjects) using a summary estimate random effects model, which showed combined odds ratio of 4.23 (95% confidence interval 2.3-7.8; p < 0.001) favoring acupuncture over control for neuropathic symptoms.

CONCLUSIONS:Acupuncture is beneficial in some peripheral neuropathies, but more rigorously designed studies using sham-acupuncture control are needed to characterize its effect and optimal use better.

OBJECTIVE:In this meta-analysis the authors evaluated the effectiveness of acupuncture in improving functional communication and language function in post-stroke aphasia (PSA) patients.

METHODS:Data sources: MEDLINE, EMBASE, CENTRAL, AMED, SinoMed, CNKI, VIP, and Wanfang databases, ICTRP, ISRCTN, EUCTR, ClinicalTrials.gov, and Stroke Trials Registries. A search was carried out for randomized controlled trials (RCTs) investigating the effects of acupuncture compared with no treatment or placebo acupuncture on post-stroke aphasia (PSA). The searched records were independently screened by two authors, who extracted the data, and assessed risk of biasof the included RCTs. Data aggregation and risk of bias evaluation were conducted on Review Manager Version 5.3. The protocol was registered in the PROSPERO database (CRD42016037543).

RESULTS:A total of 28 RCTs involving 1747 patients (883 patients in the treatment group and 864 patients in the control group) were included in the quantitative synthesis. The results demonstrated significant effects of acupuncture in improving PSA functional communication (P < 0.00001, standardized mean difference (SMD) = 1.01 [0.81, 1.20]), severity of impairment (P < 0.0001, SMD = 0.64 [0.45, 0.84]), spontaneous speech (P = 0.0002, SMD = 1.51 [0.71, 2.32]), auditory comprehension (P < 0.0001, SMD = 0.84 [0.43, 1.26]), repetition (P < 0.00001, SMD = 1.13 [0.75, 1.52]), naming (P = 0.03, SMD = 0.65 [0.08, 1.23]), reading (P < 0.0001, SMD = 1.56 [0.83, 2.29]), and writing (P = 0.009, SMD = 1.03 [0.25, 1.80]).

CONCLUSION:Acupuncture seems to be effective in improving PSA functional communication and language function.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) is highly prevalent around the world and has a large impact on its patients, leading to a poor health-related quality of life (HRQL) and exercise capacity. Even under optimal medications, there are still many patients with poor HRQL. Body acupuncture therapy (BAT) is a non-invasive and a popular therapy. Therefore, we aimed to comprehensively analyze the effects of BAT in COPD.

MATERIALS AND METHODS:Eight electronic databases were searched. We included randomized controlled trials (RCTs) that evaluated the effect of BAT, medication (M), and pulmonary rehabilitation (PR). The primary outcome was HRQL evaluated by St. George's respiratory questionnaire (SGRQ) or COPD assessment test (CAT).

RESULTS:Of the 922 articles, 12 studies were included with attesting a total of 798 participants. The result obtained indicated a significant improvement that favored the BAT + M group over the M group in CAT scores (MD: -4.77; 95% CI: -6.53 to -3.01; p < 0.00001).

CONCLUSIONS:BAT is an effective adjunctive non-pharmacological treatment to improve HRQL in patients under medical treatment for COPD. We suggested that BAT should be considered as one of the methods of management in patients with COPD.

Obesity is a growing chronic health problem worldwide. Studies about acupuncture for obesity treatment are many. But there are some doubts about the effectiveness of acupuncture versus sham acupuncture in treating obesity due to its lack of medical evidence. Therefore, the aim of this study is to assess the efficacy of acupuncture for obesity treatment and provide clinic evidence. Four English databases (PubMed, EMBASE, Web of Science and Cochrane Central Register of Controlled Trials) and four Chinese databases (China National Knowledge Infrastructure, Chinese BioMedical Database, Chinese Scientific Journal Database and Wan-Fang Data) were searched from their receptions to August 2019. Randomized controlled trials (RCTs) using the comparison between acupuncture and sham acupuncture to treat simple obesity were included. The primary outcome of body mass index (BMI) would be used to measure the effect of acupuncture on obesity. According to the trial data extraction form based on the Cochrane Handbook, two reviewers separately extracted the data. Risk of bias of the RCTs was assessed by the Cochrane Risk of Bias Tool. The study included 8 RCTs with 403 patients. When compared with sham acupuncture, acupuncture showed obviously effect in BMI reduction (MD=1.0kg/m2, 95% CI=0.6 to 1.4, P<0.001). There was also significant reduction in body weight (MD=1.85kg, 95%CI=0.82 to 2.88, p<0.001), WC (MD=0.97cm, 95%CI=0.24 to 1.71, p=0.01) and body fat mass percentage (MD=1.01, 95%CI=0.25 to 1.77, p<0.05). However, WHR (MD=0.01, 95%CI=0 to 0.03, p>0.05) was not statistically and significantly different between the acupuncture and control groups. Adverse effects were reported in 3 studies. The review suggests that acupuncture is an effective therapy for simple obesity rather than a placebo effect. This potential benefit needs to be further evaluated by longer-term and more rigorous RCTs.

BACKGROUND:Several studies investigated the effects of caffeine supplementation on movement velocity in resistance exercise. However, these studies presented inconsistent findings.

OBJECTIVE:This paper aimed to: (a) review the studies that explored the effects of caffeine supplementation on movement velocity in resistance exercise; and (b) pool their results using a meta-analysis.

METHODS:A search for studies was performed through seven databases. Random-effects meta-analyses of standardized mean differences (SMD) were performed to analyze the data. Sub-group meta-analyses explored the effects of caffeine on different velocity variables (i.e., mean and peak velocity), different loads (i.e., low, moderate, and high loads), and upper- and lower-body exercises.

RESULTS:Twelve studies met the inclusion criteria. In the main meta-analysis, in which we pooled all available studies, the SMD favored the caffeine condition (SMD = 0.62; 95% confidence interval [CI]: 0.39-0.84; p < 0.001). Sub-group analyses indicated that caffeine significantly enhances mean (SMD = 0.80; 95% CI: 0.48-1.12; p < 0.001) and peak velocity (SMD = 0.41; 95% CI: 0.08-0.75; p = 0.014), movement velocity with low loads (SMD = 0.78; 95% CI: 0.41-1.14; p < 0.001), moderate loads (SMD = 0.58; 95% CI: 0.25-0.91; p = 0.001), and high loads (SMD = 0.70; 95% CI: 0.33-1.07; p < 0.001), as well as in lower-body (SMD = 0.82; 95% CI: 0.42-1.23; p < 0.001) and upper-body exercises (SMD = 0.59; 95% CI: 0.37-0.82; p < 0.001).

CONCLUSION:Acute caffeine supplementation is highly ergogenic for movement velocity in resistance exercise. Sub-group analyses indicated that caffeine ingestion is ergogenic: (a) for both mean and peak velocity; (b) for movement velocity when exercising with low, moderate and high loads, and (c) for movement velocity in both lower- and upper-body exercises. Previous meta-analyses that explored the effects of caffeine on various aspects of resistance exercise performance (i.e., muscular strength and endurance) reported trivial to moderate ergogenic effects (effect size range: 0.16-0.38). In the present meta-analysis, the pooled effect size ranged from 0.41 to 0.82. From a resistance exercise performance standpoint, this suggests that caffeine has the most pronounced performance-enhancing effects on movement velocity.

BACKGROUND:Frailty is a common geriatric syndrome in old people. It remains controversial whether Mediterranean diet could prevent old people from developing into frailty. The aim of this study is to summarize the relevant studies and assess the effectiveness of adherence to Mediterranean diet on frailty in old people.

METHOD:A systematic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials was conducted to identify all relevant studies up to Oct 2017. We included studies regarding the associations between adherence to Mediterranean diet and risk of frailty among elders. A meta-analysis was performed to explore the effects of Mediterranean diet on frailty.

RESULTS:Six studies matched the inclusion criteria, of which five were prospective and one was cross-sectional. A total of 10,210 participants from the five prospective cohort studies were included to perform the meta-analyses. In comparison with lowest adherence to Mediterranean diet, elders with highest adherence to Mediterranean diet were significantly associated with lower risk of frailty in the future (RR= 0.56, 95% CI=0.36-0.89, p=0.015). Furthermore, the pooled estimates from four studies performed among participants in western countries (European and North American) showed that higher adherence to Mediterranean diet was associated with a 52% reduced risk of frailty (RR= 0.48, 95% CI=0.32-0.72, p<0.001). However, one study showed no association between Mediterranean diet and frailty among Asian elders (RR=1.06, 95% CI=0.83-1.36, p=0.638).

CONCLUSION:A higher adherence to Mediterranean diet is associated with a lower risk of frailty in old people. Meanwhile, the benefits may be more obvious among elders from western countries.