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Non‐pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non‐pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non‐pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen‐Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL‐AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta‐analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate‐certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: −7.13; 95% confidence interval [CI]: −13.22, −0.76) and ranked as the optimal treatment. For reduction in CSDD, with low‐ to moderate‐certainty evidence, massage plus TAU (MD: −15.26; 95% CI: −20.13, −10.52) and music plus TAU (MD: −2.40; 95% CI: −4.62, −0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate‐certainty evidence, aromatherapy plus massage (MD: −15.84; 95% CI: −29.76, −2.42) and massage plus music (MD: −13.12; 95% CI: −25.43, −0.76) were significantly more effective than TAU. For improvement in QoL‐AD, with critically low‐ to low‐certainty evidence, there were no statistical differences between any of non‐pharmacological treatments and TAU. Due to the limited number of included studies, network meta‐analysis was not performed for other outcomes. In conclusion, non‐pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non‐pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers. [ABSTRACT FROM AUTHOR]

Purpose: To assess the inhibitory effect of acupuncture on pain symptoms in migraine models, and to further summarize the potential mechanisms of acupuncture in regulating hyperalgesia in the treatment of migraine.Materials and Methods: Literature search in databases such as China National Knowledge Infrastructure (CNKI), PubMed, and Web of Science (WOS) etc. The quality was evaluated by the Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE) bias risk assessment tool and Collaborative Approach to Meta-analysis and Review of Animal Data from Experimental Studies (CAMARADES) checklist. Meta-analyses were performed using Stata 17.0 software.Results: Twenty-one studies involving 489 animals were identified. The qualitative score ranged from 3 to 9 points. Facial mechanical withdrawal threshold (FMWT) and paw mechanical withdrawal threshold (PMWT) measured by Von Frey filaments were selected as major outcomes, and serum calcitonin gene-related peptide (CGRP) levels measured by ELISA were selected as secondary outcome. Meta-analysis results revealed that true acupuncture (TA) group significantly increased FMWT, PMWT and CGRP compared to model group. TA group showed superior effect in FMWT, PMWT relative to sham acupuncture (SA) group. Subgroup analysis results showed that high risk of bias scores may be responsible for the high heterogeneity of FMWT; additionally, CGRP analysis suggests that acupoint selection and blood collection sites may be sources of heterogeneity. In the treatment of migraine pain symptoms, the underlying mechanism of acupuncture treatment is either the regulation of hyperalgesia and neurotransmitters, or the reduction of inflammatory factors.Conclusion: The results indicate that TA treatment effectively increased the pain threshold and reduced hyperalgesia in migraine rats. In summary, our study highlights the potential of TA as an effective treatment for migraine, but further investigation is required to fully comprehend its mechanism of action and optimize its clinical application. [ABSTRACT FROM AUTHOR]

Introduction: Depression is the most significant contributor to non-fatal health reductions worldwide. Acupuncture is the most commonly used complementary alternative therapy to relieve major depressive disorder (MDD) effectively. Nevertheless, the effects of acupuncture for MDD are uncertain. This review aimed to determine the efficacy and safety of acupuncture for MDD. Methods: Meta-analysis was performed for randomized controlled trials of acupuncture for MDD data from eight databases searched from inception until February 10, 2022. All RCTs with adult participants undergoing acupuncture treatment for MDD were included. The primary outcome measure was the Hamilton rating scale for depression (HAMD). We used random-effects meta-analysis to synthesize the results with a mean difference or odds ratio. Furthermore, the potential heterogeneity was tested through meta-regression/subgroup analyses/sensitive analysis. The quality of evidence for each outcome was assessed by the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Forty-three studies were included: 9 acupuncture versus sham acupuncture (n = 920), 26 acupuncture versus antidepressants (n = 2169), and 9 acupuncture plus antidepressants versus antidepressants (n = 667). Of the 43 high-quality articles, 24 and 8 were determined to have a low and moderate risk of bias, respectively. The pooled results for HAMD and SDS revealed the clinical benefits of acupuncture or acupuncture plus antidepressants compared to sham acupuncture or antidepressants, with high-quality evidence. Furthermore, high-quality evidence showed that acupuncture led to fewer adverse effects than antidepressants. Conclusions: Acupuncture or acupuncture plus antidepressants were significantly associated with reduced HAMD scores, with high-quality evidence. Also, more rigorous trials are needed to identify the optimal frequency of acupuncture for MDD and integrate such evidence into clinical care to reduce antidepressant use. [ABSTRACT FROM AUTHOR]

Background. Knee osteoarthritis (KOA) can cause chronic pain and seriously affect the quality of patient lives. The continued emergence of high-quality RCTS requires us to update the quality of evidence. This study aims to evaluate the efficacy of acupuncture for KOA patients and calculate the required information size (RIS) to determine whether further clinical studies are required. Methods. We searched PubMed, Embase, WOS, CBM, CNKI, VIP, WHO ICTRP, ChiCTR, and Grey literature to collect randomized controlled trials (RCTs) of acupuncture for KOA from inception to December 2021. A meta-analysis was performed according to the Cochrane systematic review method by using Review Manager 5.4 and TSA 0.9.5.10 beta, and GRADE was used to evaluate the quality of the evidence. Trial sequential analysis was used to control random errors and calculate the required information size. Results. Eleven RCTs with 2484 patients were included in our meta-analysis, meeting the inclusion criteria for the meta-analysis. The meta-analysis indicated that acupuncture had beneficial effect on knee osteoarthritis in reducing pain [ n = 2387 ; SMD = − 0.12 , 95% CI (-0.20, -0.04); I 2 = 0 % ] and improved patients function activities [ n = 2408 ; MD = − 1.25 , 95% CI (-1.97, -0.53); I 2 = 0 % ], but true acupuncture showed no significant effect in relieve patient's stiffness [ n = 1337 ; MD = − 0.07 , 95% CI (-0.30, 0.15); I 2 = 0 % ]. We pooled the studies which found no significant difference in improving the quality life of mental [ n = 1462 ; SMD = 0.02 , 95% CI (-0.23, 0.27); I 2 = 78 % ] and patients physical health (SF-36 or SF-12) [ n = 1745 ; SMD = 1.01 , 95% CI (-0.08, 2.11); I 2 = 0 % ] compared with sham acupuncture. The pain and function TSA graphs indicated that cumulative Z-curves intersected with the traditional level of statistical favoring acupuncture, and more RCTs will required in the future studies. Conclusion. Acupuncture has beneficial effect on pain relief and improves function activities, and this treatment can be recommended as a beneficial alternative therapy in patients with KOA, particularly for chronic patients and those currently undergoing long-term pain and help them increasing quality of life. But it should be further verified through more RCTs in function. Available studies suggested that acupuncture was superior to sham acupuncture in reduce pain and function as verified by TSA. [ABSTRACT FROM AUTHOR]

Chronic Obstructive Pulmonary Disease (COPD) is a globally common chronic respiratory disease with a high morbidity and mortality rate. Acupuncture has been proven effective for COPD. A dose-response meta-analysis was conducted to assess the correlation between the acupuncture temporal parameters(session, frequency, and duration) and its effectiveness in patients with stable COPD. Acupuncture randomized controlled trials on COPD were searched in eight databases from their inception to June 2023. The "doses" were defined as the acupuncture session, frequency, and duration. The outcomes mainly included Forced Expiratory Volume in one-second rate (FEV1%) and Six-minute Walking Distance (6MWD). The assessment of bias risk and literature quality were conducted independently using the Cochrane risk of bias tool and the Standards for reporting interventions in clinical trials of acupuncture. The dose-response relationship was modeled using robust error element regression, and meta-analysis was operated by R 4.3.1 and Stata 15.0. The protocol was registered in PROSPERO with the registration number CRD42023401406. Out of 1669 records, 17 RCTs with 1165 participants were finally included in the meta-analysis. There was notable heterogeneity among the studies, but sensitivity analysis demonstrated good robustness. The findings revealed a significant improvement in the following outcomes for stable COPD patients in the acupuncture group: FEV1% (MD=3.50, 95%CI: 2.05–4.95), 6MWD (MD=47.39, 95%CI: 29.29–65.50), St. George's respiratory questionnaire (SGRQ; MD=−8.25, 95%CI: −11.38 to −5.12); COPD assessment test (CAT; MD=−2.91, 95%CI: −3.99 to −1.83). The relationship between the acupuncture session, duration, and FEV1%, 6MWD followed a "Λ" curve pattern, while the relationship between acupuncture frequency and FEV1%, 6MWD exhibited logarithmic growth. Firstly, After 12 acupuncture sessions, FEV1% and 6MWD increased by 7.06% (95%CI: 4.56–9.55) and 36.28 m (95%CI: 20.37–52.20), respectively. The peak improvement in FEV1% and 6MWD was observed after 18 acupuncture sessions (MD=7.89, 95% CI: 5.33–10.45) and 45 sessions (MD=125.43, 95% CI: 72.80–178.07) each. Additionally, weekly acupuncture resulted in a 4.14% improvement in FEV1% (95% CI: 2.55–5.72) and a 42.49 m increase in 6MWD (95%CI: 17.16–67.81). Notably, the maximum effects on FEV1% and 6MWD improvement were achieved with different acupuncture frequencies, specifically three times a week (MD=6.00, 95% CI: 5.34–6.66) and once a day(MD=112.41, 95% CI: 77.27–147.56), respectively. Furthermore, after a 28-day duration of acupuncture treatment, FEV1% increased by 4.74% (95% CI: 3.73–5.75) and 6MWD increased by 47.34 m (95%CI: 22.01–72.67). During 60 days of acupuncture treatment, the FEV1% and 6MWD improvement reached their highest levels at 8.76% (95% CI: 7.05–10.47) and 88.06 m (95% CI: 45.96–130.16), respectively. Acupuncture was effective in improving FEV1%, 6MWD, SGRQ, and CAT in patients with stable COPD. There was a dose-response relationship between the time parameters of acupuncture (session, frequency, and duration) and the efficacy of COPD treatment (FEV1% and 6MWD). The minimal clinically important difference could be achieved after 12 acupuncture sessions. Acupuncture with a medium-frequency (2–3 times per week) over 60 days may result in the greatest improvement in FEV1%, while higher-frequency acupuncture (5–7 times per week) for 2 months may lead to the maximum improvements in 6MWD. It indicated that the optimal acupuncture duration for different indicators remains consistent, while the optimal frequencies may differ. To confirm these results, it is necessary to conduct multicenter, large-scale randomized controlled trials. Ethical approval is not required for literature-based studies. The results will be published in peer-reviewed journals or conferences. • Acupuncture 12 sessions achieved the minimal clinically important difference in COPD patients. • Acupuncture sessions of 2–3 times and 5–7 times per week for 60 days improve FEV1% and 6WMD maximally, respectively. • This is the first comprehensive dose-response Meta-analysis of acupuncture session, frequency, and duration. • This article provides an optimized acupuncture schedule for COPD treatment. [ABSTRACT FROM AUTHOR]

Objectives. As current evidence of the effectiveness on acupuncture for primary dysmenorrhea (PD) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews (SRs). Methods. SRs of randomized controlled trials (RCTs) concerning acupuncture and PD were searched in four databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and latest Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists were used to assess reporting characteristics and methodological quality, respectively. Results. The literature search yielded 38 potential records, of which five met the inclusion criteria. The total average (SD) for PRISMA was 20.60 (1.14) out of 27. All five SRs have more than one critical weakness in AMSTAR2, so their methodological qualities were considered as critically low. The most frequent problems included nonregistration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. The three studies of higher methodological quality reported positive results in pain relief. Conclusion. The reporting and methodological quality of systematic reviews and meta-analysis studies were suboptimal, which demands further improvement. More efforts are needed to improve validity of systematic reviews and RCTs in this area. [ABSTRACT FROM AUTHOR]

Background: Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease. Methods: Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted. Results: Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group. Conclusion: The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary. [ABSTRACT FROM AUTHOR]

Background. Primary trigeminal neuralgia (PTN) is a clinical refractory disorder characterized by excruciating pain that severely impacts the quality of life. Several studies have shown that acupuncture can improve PTN pain. However, the comparative efficacy and safety of acupuncture are unknown. Herein, a systematic review was conducted to compare the efficacy and safety of various acupuncture methods for PTN treatment. Methods. Relevant randomized controlled trials (RCTs) published up to 1 August 2021 were obtained from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, CQVIP Database, Wanfang Database, Allied and Alternative Medicine Database, and related registration platforms. Two authors independently selected the studies and obtained data. Cochrane Handbook was used to assess the methodological quality. We put the pain relief as the primary outcome and the response rate and adverse events as the secondary outcomes. Review Manager v5.3, ADDIS v1.16.8, and STATA v15.0 software were used for data analysis. The intraclass correlation coefficient was used to assess the consistency of the two investigators. Results. A total of 58 RCTs with 4,126 participants were obtained. The meta-analysis indicated that five acupuncture methods were superior to conventional medicine (carbamazepine) in pain reduction intensity and response rate. Meanwhile, electronic acupuncture plus manual acupuncture was the most effective therapy since it reduced pain intensity in 11 methods and improved the response rate in 10 interventions. Moreover, six interventions had acceptable adverse events, and none of the included studies reported severe adverse events. However, most pieces of evidence were ranked as critically low. Conclusion. These findings show that acupuncture methods can be effective and safe for PTN. Moreover, electronic acupuncture plus manual acupuncture maybe the best acupuncture treatment for PTN and should be administered to PTN patients. However, additional well-designed and high-quality RCTs should be conducted to verify the above findings in the future. The systematic review is registered with CRD42020221456. [ABSTRACT FROM AUTHOR]

Purpose. The purpose of this systematic review and meta-analysis was to comprehensively evaluate the efficacy and safety of electroacupuncture as an effective adjunctive therapy for patients with depression. Methods. Randomized controlled trials (RCTs) about the treatment of depression by electroacupuncture therapy from inception to September 2021 were searched and collected in eight databases. HAMD, SDS, and Adverse Reactions were used as outcome indicators. The quality of relevant articles was evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each outcome was assessed through the Grading of Recommendations Assessment and the Development and Evaluation approach. Stata 15.0 software was used for data analysis. Results. A total of 16 depression-related RCTs were included in this meta-analysis. For the main outcome, electroacupuncture significantly reduced HAMD scores (I2:0.0%, SMD: −2.28% (95% CI−3.16 to −1.39)), and the quality of evidence was moderate. The improvement effect of electroacupuncture plus antidepressants was better than that of western drugs in patients with depression (I2:26.2%, SMD: −1.18% (95% CI−1.42 to −0.94)), and the quality of evidence was moderate. Electroacupuncture significantly reduced HAMD scores without significant heterogeneity (I2:0.0%, SMD: −3.76% (95%CI−5.78−1.73)). Studies with very low quality of evidence found that electroacupuncture was as effective as antidepressants in reducing SDS scores (I2:36.4%, WMD: −1.15% (95%CI−2.93–0.63)), and electroacupuncture was found to be more effective than sham electroacupuncture stimulation as well. Moderate quality evidence showed no statistical difference between electroacupuncture plus antidepressants/electroacupuncture and antidepressants (I2:0%, RR:1.05% (95%CI 0.73 to 1.53)). Conclusions. Our meta-analysis shows that electroacupuncture reduces HAMD scores. It is suggested to use electroacupuncture plus antidepressants to improve the curative effect and effectively reduce drug side effects. [ABSTRACT FROM AUTHOR]

Background. Alzheimer's disease (AD) is a progressive neurodegenerative disease. Numerous cases have illustrated that the acupuncture method could improve AD patients' cognitive function and daily living ability. However, the optimal acupuncture treatments remain controversial. Therefore, we aimed to conduct a systematic review to compare the efficacy of multiple acupuncture therapies for AD and identify the optimal acupuncture intervention for delaying AD progression. Methods. To select potentially concerned randomized controlled trials (RCTs), we searched four English databases, four Chinese databases, and additional sources from 1 May 2021. Two independent reviewers conducted study screening, data extraction, and methodological quality assessment. The primary outcome was global cognitive function improvement. Pairwise and Bayesian network meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to assess the quality of evidence. Results. This study included 34 RCTs with 2,071 participants. Regarding global cognitive function improvement, the pairwise meta-analysis confirmed that electronic acupuncture (EA) plus conventional medicine (CM) and manual acupuncture (MA) plus CM were statistically significantly different from CM, and EA plus CM was ranked as the best combination in the network meta-analysis. In terms of response rate, MA outperformed CM statistically significantly; warm acupuncture (WA) was ranked as the best in the network meta-analysis. Regarding activity of daily living improvement, EA plus CM, MA plus CM, and fire acupuncture plus CM, MA, and scalp acupuncture were statistically significantly different from CM, and EA plus CM was ranked as the best combination in the network meta-analysis. However, the evidences were ranked as low to critically low. Conclusions. Acupuncture, as a monotherapy or an adjuvant therapy, may have a beneficial effect on efficacy for AD. EA plus CM may be the optimal acupuncture therapy for AD and should be administered to AD patients. It may aid and support patient, operative, and societal decision-making. Due to the dearth of high-quality evidence, additional high-quality studies should be conducted to ensure these findings in the future. This study is registered with PROSPERO (CRD42021252305). [ABSTRACT FROM AUTHOR]