Acupuncture for the Treatment of Dry Eye: A Multicenter Randomised Controlled Trial with Active Comparison Intervention (Artificial Teardrops) Proteomic analysis of tears following acupuncture treatment for menopausal dry eye disease by two-dimensional nano-liquid chromatography coupled with tandem mass spectrometry Development of an instrument to assess the quality of acupuncture: results from a Delphi process. [Clinical efficacy on xerosis conjunctivitis of liver and kidney yin deficiency treated with SHI's acupuncture manipulation]. Clinical curative effect of acupuncture therapy on xerophthalmia. Prevalence of and risk factors associated with dry eye: the Korea National Health and Nutrition Examination Survey 2010-2011. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. Indirect comparisons of competing interventions. [Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes: a randomized controlled trial]. [Effect of integral syndrome differentiation acupuncture on the tear film stability in the patient of xerophthalmia]. Effects and Mechanisms of Acupuncture and Moxibustion on Reproductive Endocrine Function in Male Rats with Partial Androgen Deficiency
Purpose To evaluate the effects of acupuncture compared to a control group using artificial tears . Methods Setting & design : multicenter r and omised controlled trial ( three local research hospitals of South Korea ) . Study Population : 150 patients with moderate to severe dry eye . Intervention : Participants were r and omly allocated into four weeks of acupuncture treatment ( bilateral BL2 , GB14 , TE 23 , Ex1 , ST1 , GB20 , LI4 , LI11 and single GV23 ) or to the artificial tears group ( sodium carboxymethylcellulose ) . Main Outcome Measure(s ) : The ocular surface disease index ( OSDI ) , tear film break-up time ( TFBUT ) , Schirmer Ι test , visual analogue scale ( VAS ) for self- assessment of ocular discomfort , general assessment ( by both acupuncture practitioners and participants ) and quality of life ( QOL ) through the Measure Yourself Medical Outcome Profile-2 ( MYMOP-2 ) . Results There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI ( MD −16.11 , 95 % CI [ −20.91 , −11.32 ] with acupuncture and −15.37 , 95 % CI [ −19.57 , −11.16 ] with artificial tears ; P = 0.419 ) , VAS ( acupuncture : −23.84 [ −29.59 , −18.09 ] ; artificial tears : −22.2 [ −27.24 , −17.16 ] , P = 0.530 ) or quality of life ( acupuncture : −1.32 [ −1.65 , −0.99 ] ; artificial tears : −0.96 [ −1.32 , −0.6 ] , P = 0.42 ) immediately after treatment . However , compared with artificial tears group , the OSDI ( acupuncture : −16.15 [ −21.38 , −10.92 ] ; artificial tears : −10.76 [ −15.25 , −6.27 ] , P = 0.030 ) and VAS ( acupuncture : −23.88 [ −30.9 , −16.86 ] ; artificial tears : −14.71 [ −20.86 , −8.55 ] , P = 0.018 ) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment . TFBUT measurements increased significantly in the acupuncture group after treatment . Conclusions Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears . Trial registration Clinical Trials.gov NCT01105221 Background The purpose of this study was to investigate whether acupuncture is effective at treating dry eye disease among postmenopausal women and to identify the possible mechanisms . Methods Twenty-eight postmenopausal women with dry eye disease were r and omly divided into two groups : an acupuncture plus artificial tears ( AC + AT ) group and an artificial tears ( AT ) only group . After baseline examination of clinical parameters and tear sample collection , each patient received the design ated modality of topical therapy for 2 months . Post-treatment documentation of clinical parameters was recorded , and tear sample s were collected . Tear sample s from the AC + AT group were subjected to two-dimensional nano-liquid chromatography coupled with t and em mass spectrometry ( 2D nano-LC-MS/MS ) . Western blot analysis was also performed on tear sample s from both groups . Results After treatment , the Ocular Surface Disease Index scores , symptom assessment scores , scores of sign assessment , and tear break-up time were significantly improved in both groups ( P=0.000 ) . Symptom assessment scores were significantly improved in the AC + AT group ( P=0.000 ) compared with the AT group . 2D nano-LC-MS/MS identified 2,411 proteins , among which 142 were downregulated and 169 were upregulated . After combined AC + AT treatment , the abundance of secreted proteins was increased , whereas that of cytoplasmic proteins decreased ( Pearson ’s χ2 test , P=0.000 , P=0.000 , respectively ) . Proteins involved in immunity and regulation were also more abundant ( Pearson ’s χ2 test , P=0.040 , P=0.016 , respectively ) , while components and proliferation-related proteins were downregulated ( Pearson ’s χ2 test , P=0.003 , P=0.011 , respectively ) . Conclusion AC + AT treatment increased protein synthesis and secretion , and improved clinical symptoms . These results indicate that acupuncture may be a complimentary therapy for treating postmenopausal dry eye disease BACKGROUND Quality acupuncture influences the outcomes of clinical research , and issues associated with effective administration of acupuncture in r and omized controlled trials need to be addressed when appraising studies . OBJECTIVE The study objective was to achieve consensus on domains and items for inclusion in a rating scale to assess quality acupuncture administered in clinical research . STUDY DESIGN AND SUBJECTS An active group of Australian acupuncture research ers initially identified a pool of items assessing quality . The Delphi consensus process was then used to select and reduce the number of items , and an additional expert panel of 42 research ers were invited to participate . Participants initially ranked items along a five-point scale for the first Delphi round , and indicated an agree or disagree response during the second round . For an item to be retained into the second round , an item had to attain greater than 80 % agreement that the item described a dimension of quality acupuncture and related study design . RESULTS Thirty-two ( 32 ) experts agreed to participate in the study . After two rounds of the Delphi process , consensus was reached on 14 domains and 26 items relating to quality acupuncture . Domains , items , and minimum st and ards related to study design ; rationale of the intervention ; criteria relating to needling stimulation either manual or electrostimulation ; duration and frequency of treatment ; and practitioner training . CONCLUSIONS Items for inclusion in an instrument to assess quality  acupuncture in clinical research were identified . Further development of the instrument including relative weighting of items and reliability testing is under way OBJECTIVE To compare the efficacy of the patients of xerosis conjunctivitis with liver and kidney yin deficiency among the combined therapy of acupuncture and Shi 's manipulation , common acupuncture and artificial tears therapy . METHODS One hundred and eight patients were r and omized into an acupuncture group , a SHI 's manipulation group and an artificial tears group , 36 cases in each group . A total of 15 cases dropped out before the end of the study , including 4 cases in the acupuncture group , 6 cases in the SHI 's manipulation group , and 5 cases in the artificial tears group . In the acupuncture group , acupuncture was applied to Jingming ( BL 1 ) and Qiuhou ( EX-HN 7 ) on the affected side , and the bilateral Sanyinjiao ( SP 6 ) and Taixi ( KI 3 ) . The needles were retained for 20 min . In the SHI 's manipulation group , on the basis of the treatment as the acupuncture group , Shuigou ( GV26 ) was added and stimulated with SHI 's acupuncture manipulation . In these two groups , acupuncture was given 3 times a week totally for 3 weeks . In the artificial tears group , sodium hyaluronate eye drops were used , 5 times a day , for 3 weeks totally . Separately , before treatment , at the moment after the 1st treatment and 3 weeks after treatment , the subjective symptom score , Schirmer I test , breakup time ( BUT ) of tear film were observed in each group . RESULTS ( 1 ) Subjective symptom score : at the moment after the 1st treatment and 3 weeks after treatment , the scores in each group were all reduced significantly as compared with those before treatment ( all P < 0.05 ) . At the moment after the 1st treatment , the score in the SHI 's manipulation group and the artificial tears group was reduced apparently as compared with that in the acupuncture group ( both P < 0.05 ) . In 3 weeks of treatment , the score in the SHI 's manipulation group was reduced apparently as compared with the acupuncture group and the artificial tears group ( both P < 0.05 ) . ( 2 ) For Schirmer I test , at the moment of the 1st treatment , the result in the SHI 's manipulation group and the artificial tears group was improved significantly as compared with that before treatment ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group group was improved significantly as compared with that before treatment ( both P < 0.05 ) . At the moment of the 1st treatment , the result in the artificial tears group was improved significantly as compared with the acupuncture group and the SHI 's manipulation group ( both P < 0.05 ) . In 3 weeks of treatment , the result in the acupuncture group and the SHI 's manipulation group was better than that in the artifi-cial tears group separately ( both P < 0.05 ) . ( 3 ) For BUT , the result in the acupuncture group and the SHI 's manipulation group was prolonged significantly as compared with that before treatment and was prolonged apparently as compared with that in the artificial tears group ( both P < 0.05 ) in 3 weeks of treatment . CONCLUSION The intervention of SHI 's acupuncture manipulation relieves the subjective symptoms of xerosis conjunctivitis of liver and kidney yin deficiency and achieves the same efficacy as the common acupuncture and artificial tears treatment . It does not present the apparent advantages as the common acupuncture in the short term for promoting the tear secretion and tears film repair This study observes changes in symptoms of xerophthalmia pre- and post-acupuncture therapy and compares the results of the acupuncture therapy ( AT ) group and the artificial tear control ( ATC ) group . Parallel comparative studies were carried out on 44 patients with xerophthalmia , who were divided into the AT group ( n = 20 ) and the ATC group ( n = 24 ) . A 10-session acupuncture therapy program was performed for the AT group while Dextran 70 was used for the ATC group with each course of treatment lasting 21 day . Examinations were made on the day when a patient was chosen to join the study , 1 hour after completion of treatment , and 3 weeks after stopping treatment . There was no statistically significant difference in terms of the reduction of the symptoms and sign score ( SSS ) 1 hour after completion of treatment between the AT group and the ATC group . Three weeks after completion of treatment , the reduction of SSS for the AT group was larger than that of the ATC group , with the difference achieving statistical significance . Both acupuncture therapy and artificial tear therapy have an immediate positive effect on the symptoms of xerophthalmia , but acupuncture therapy has a longer continuous effect than that of artificial tears PURPOSE To investigate the prevalence of and risk factors associated with  dry eye syndrome ( DES ) in South Korea . DESIGN Cross-sectional study . METHODS In 2010 and 2011 , 11,666 subjects , ranging in age from 19 to 95 , were r and omly selected as nationally representative participants in the Korea National Health and Nutrition Examination Survey ( KNHANES ) . Subjects were divided into 2 groups : 1 with clinical ly  diagnosed DES and 1 with symptoms of dry eye . We determined the prevalence of and risk factors for dry eyes in a Korean population .  Health-related quality of life ( HRQoL ) , measured by the EuroQoL-5 dimension ( EQ-5D )  , was evaluated in patients with dry eyes . RESULTS The mean age was 49.9 years . The overall prevalence of diagnosed DES was 8.0 % ( 95 % confidence interval [ CI ] , 7.3 % to 8.7 % ) , and of dry eye symptoms the prevalence was 14.4 % ( 95 % CI , 13.1 to 15.7 ) . Age ( adjusted odds ratio [ aOR ] = 1.8 , 1.6 ) , female ( aOR = 2.8 , 1.9 ) ; history of eye surgery ( aOR = 2.6 , 2.2 ) ; stress ( aOR = 1.7 , 1.6 ) ; thyroid disease ( aOR = 1.7 , 1.5 ) ; and high education level ( aOR = 1.6 , 1.5 ) were common risk factors in the groups . Subjects who had undergone ptosis , cataract or refractive surgery were more likely to have dry eye than subjects with no history of eye surgery . Means of pain and anxiety dimensions in the EQ-5D and the Euro Quality of Life Visual Analog Scale ( EQ-VAS ) were significantly higher in the group with diagnosed DES than in the normal group . CONCLUSIONS The risk factors were mostly similar in both groups . It is thought there are more patients with DES who have not been diagnosed by doctors . Doctors should identify whether a patient has any risk factors for dry eye . Patients need to be educated about the modifiable factors of DES OBJECTIVES The objective of this study was to investigate whether typical acupuncture methods such as needle placement , needle stimulation , and treatment frequency were important factors in fibromyalgia symptom improvement . DESIGN / SETTING S/SUBJECTS : A single-site , single-blind , r and omized trial of 114 participants diagnosed with fibromyalgia for at least 1 year was performed . INTERVENTION Participants were r and omized to one of four treatment groups : ( 1 ) T/S needles placed in traditional sites with manual needle stimulation ( n = 29 ) : ( 2 ) T/0 traditional needle location without stimulation ( n = 30 ) ; ( 3 ) N/S needles inserted in nontraditional locations that were not thought to be acupuncture sites , with stimulation ( n = 28 ) ; and ( 4 ) N/0 nontraditional needle location without stimulation ( n = 2 7 ) . All groups received treatment once weekly , followed by twice weekly , and finally three times weekly , for a total of 18 treatments . Each increase in frequency was separated by a 2-week washout period . OUTCOME MEASURES Pain was assessed by a numerical rating scale , fatigue by the Multi-dimensional Fatigue Inventory , and physical function by the Short Form-36 . RESULTS Overall pain improvement was noted with 25%-35 % of subjects having a clinical ly significant decrease in pain ; however this was not dependent upon " correct " needle stimulation ( t = 1.03 ; p = 0.307 ) or location ( t = 0.76 ; p = 0.450 ) . An overall dose effect of treatment was observed , with three sessions weekly providing more analgesia than sessions once weekly ( t = 2.10 ; p = 0.039 ) . Among treatment responders , improvements in pain , fatigue , and physical function were highly codependent ( all p < or = 0.002 ) . CONCLUSIONS Although needle insertion led to analgesia and improvement in other somatic symptoms , correct needle location and stimulation were not crucial OBJECTIVES To survey the frequency of use of indirect comparisons in systematic review s and evaluate the methods used in their analysis and interpretation . Also to identify alternative statistical approaches for the analysis of indirect comparisons , to assess the properties of different statistical methods used for performing indirect comparisons and to compare direct and indirect estimates of the same effects within review s. DATA SOURCES Electronic data bases . REVIEW METHODS The Data base of Abstract s of Review s of Effects ( DARE ) was search ed for systematic review s involving meta- analysis of r and omised controlled trials ( RCTs ) that reported both direct and indirect comparisons , or indirect comparisons alone . A systematic review of MEDLINE and other data bases was carried out to identify published methods for analysing indirect comparisons . Study design s were created using data from the International Stroke Trial . R and om sample s of patients receiving aspirin , heparin or placebo in 16 centres were used to create meta-analyses , with half of the trials comparing aspirin and placebo and half heparin and placebo . Methods for indirect comparisons were used to estimate the contrast between aspirin  and  heparin . The whole process was repeated 1000 times and the results were compared with direct comparisons and also theoretical results . Further detailed case studies comparing the results from both direct and indirect comparisons of the same effects were undertaken . RESULTS Of the review s identified through DARE , 31/327 ( 9.5 % ) included indirect comparisons . A further five review s including indirect comparisons were identified through electronic search ing . Few review s carried out a formal analysis and some based analysis on the naive addition of data from the treatment arms of interest . Few method ological papers were identified . Some valid approaches for aggregate data that could be applied using st and ard software were found : the adjusted indirect comparison , meta-regression and , for binary data only , multiple logistic regression ( fixed effect models only ) . Simulation studies showed that the naive method is liable to bias and also produces over-precise answers . Several methods provide correct answers if strong but unverifiable assumptions are fulfilled . Four times as many similarly sized trials are needed for the indirect approach to have the same power as directly r and omised comparisons . Detailed case studies comparing direct and indirect comparisons of the same effect show considerable statistical discrepancies , but the direction of such discrepancy is unpredictable . CONCLUSIONS Direct evidence from good- quality RCTs should be used wherever possible . Without this evidence , it may be necessary to look for indirect comparisons from RCTs . However , the results may be susceptible to bias . When making indirect comparisons within a systematic review , an adjusted indirect comparison method should ideally be used employing the r and om effects model . If both direct and indirect comparisons are possible within a review , it is recommended that these be done separately before considering whether to pool data . There is a need to evaluate methods for the analysis of indirect comparisons for continuous data and for empirical research into how different methods of indirect comparison perform in cases where there is a large treatment effect . Further study is needed into when it is appropriate to look at indirect comparisons and when to combine both direct and indirect comparisons . Research into how evidence from indirect comparisons compares to that from non-r and omised studies may also be warranted . Investigations using individual patient data from a meta- analysis of several RCTs using different protocol s and an evaluation of the impact of choosing different binary effect measures for the inverse variance method would also be useful BACKGROUND With the underst and ing of the immune inflammatory response in the pathogenesis of dry eyes , and the limitations of widely used artificial tears and numerous pharmaceuticals and methods to promote tear secretion , clinicians pay more attention to the therapies that can promote tear secretion actively . Acupuncture treatment for dry eye may meet this requirement . OBJECTIVE To observe the clinical efficacy of acupuncture treatment on dry eye and the effects on duration , and to examine the mechanisms of acupuncture in treating patients with dye eyes . DESIGN , SETTING , PARTICIPANTS AND INTERVENTIONS The study was performed at Department of Ophthalmology , Shuguang Hospital , Shanghai University of Traditional Chinese Medicine from August 2010 to May 2011 . Patients with the primary diagnosis of dry eye were enrolled . Sixty-five patients were r and omly divided into treatment group and control group , and were given 3 weeks of acupuncture treatment or artificial tear therapy respectively . MAIN OUTCOME MEASURES The enzyme-linked immunosorbent assay was used to detect the lactoferrin content of the tears before and after treatment . In order to evaluate the efficacy of the treatment methods , the Schirmer I test and break-up time were also measured . RESULTS Compared with before treatment , the lactoferrin content in the tears of patients in the treatment group increased , break-up time was prolonged and the result of the Schirmer I test showed improvement after 3 weeks of treatment . The indexes mentioned above did not change in the control group after treatment . There were no significant differences in tear lactoferrin and Schirmer I test between one week after treatment and after 3-week treatment in the treatment group , but break-up time was significantly shortened . The result of Schirmer I test in the treatment group was significantly higher than that in the control group one week after treatment . CONCLUSION Acupuncture can increase tear lactoferrin level , extend tear film break-up time and promote tear secretion in patients with dry eye in a time-limited trial . With the end of treatment , the effect decreased OBJECTIVE To probe into a treatment method for increasing clinical therapeutic effect on xerophthalmia . METHODS Forty-five cases were r and omly divided into acupuncture group 1 , acupuncture group 2 and control group . The acupuncture group 1 were treated with acupuncture based on syndrome types , and the acupuncture group 2 with acupuncture at local acupoints , and the control group with dripping of artificial tears .  Local symptoms of eyes , S1 T , BUT and FL were observed before and after treatment . RESULTS S1 T and BUT increased after treatment in the two groups ( P < 0.01 , P < 0.05 ) , but did not significantly change in the control group ( P > 0.05 ) . There were significant differences in change of FL as the control group compared with the acupuncture group 1 and 2 . The total effective rate was 86.7 % , 66.7 % and 33.3 % in the acupuncture group 1 , 2 and the control group , respectively . CONCLUSION The integral syndrome differentiation acupuncture can improve secretion of tear , increase stability of tear film , improve local symptoms of eyes with a therapeutic effect better than acupuncture at local acupoints and artificial tears Objectives Partial and rogen deficiency of the aging male ( PADAM ) is characterised by a deficiency in serum and rogen levels . Both electroacupuncture ( EA ) and mild moxibustion ( MM ) can raise serum testosterone levels in PADAM . We investigated the mechanisms underlying the use of EA and MM in a rodent model of PADAM . Methods Fifty rats received cyclophosphamide injection  over 5 consecutive days to induce PADAM , which was verified by comparing total testosterone ( TT ) and free testosterone ( FT ) levels with 10 non-PADAM healthy control rats ( CON ) . Successful modelling was confirmed in 43 of 50 rats , 40 of which were r and omly divided into untreated ( PADAM ) , EA-treated ( PADAM+EA ) , MM-treated ( PADAM+MM ) , and and rolin (AD)-treated ( PADAM+AD ) groups ( n=10 each ) . EA and MM were administered at BL23 and CV4 acupuncture points for 8 weeks , and no treatment was given to rats in the PADAM and CON groups . Serum levels of luteinising hormone ( LH ) and follicle-stimulating hormone ( FSH ) , mRNA expression of cytochrome P450c17 ( P450c17 ) and 3β-hydroxysteroid dehydrogenase 1 ( 3β-HSD1 ) , and protein levels of cytochrome P450 side chain cleavage ( P450scc ) , 17β-hydroxysteroid dehydrogenase 3 ( 17β-HSD3 ) and steroidogenic factor 1 ( SF-1 ) were evaluated after 8 weeks . Results Both EA and mild MM significantly increased serum TT and FT levels with MM displaying superiority . P450scc , 17β-HSD3 and SF-1 protein expression , and P450c17 and 3β-HSD1 mRNA expression , were significantly increased and serum LH and FSH levels were significantly decreased in PADAM+EA and PADAM+MM relative to PADAM rats . Moreover , serum LH and FSH levels were significantly lower and 17β-HSD3 protein expression significantly higher in PADAM+MM relative to PADAM+EA rats . Conclusions EA and MM at the BL23 and CV4 acupuncture points appear to be effective treatments for PADAM , and MM displays superior efficacy to EA
Abstract s Background In a former meta- analysis review , acupuncture was considered a potentially effective treatment for dry eye syndrome ( DES ) , but there were heterogeneities among the outcomes .
We up date d the meta- analysis and conducted subgroup analysis to reduce the heterogeneity and suggest the most effective acupuncture method based on clinical trials .