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      Combination of Acupoints in Treating Patients with Chronic Obstructive Pulmonary Disease: An Apriori Algorithm-Based Association Rule Analysis

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          Abstract

          Chronic obstructive pulmonary disease (COPD) is highly prevalent and a major burden on the healthcare system worldwide. It has a severe impact on patients due to poor health-related quality of life (HRQL), dyspnea, and exertional intolerance. Our previous meta-analysis revealed that body acupuncture therapy had adjuvant benefits of improving HRQL in COPD patients undergoing optimal medical treatment. Previous studies indicated that treatment with combinations of acupoints was more effective than single acupoint treatment. The association rule analysis has been widely used to explore relationships in acupoint combination. Therefore, we aimed to investigate the potential core acupoint combination in COPD treatment by mining the association rules from the retrieved randomized control trials (RCTs) of the previous meta-analyses. This study was conducted based on Apriori algorithm-based association rule analysis, which is a popular data mining method available in software R. We extracted acupoints as binary data from the 12 included RCTs for analysis. There were 27 acupoints extracted from 12 RCTs. The top 10 frequently selected acupoints were BL12, BL13, BL20, BL23, BL43, CV17, EXB1, LU5, LU7, and ST36. We investigated 2444 association rules, and the results showed that {ST36, BL12} ≥ {CV17}, {ST36, BL12} ≥ {EXB1}, {CV17, BL12} ≥ {ST36}, and {EXB1, BL12} ≥ {ST36} were the most associated rules in the retrieved RCTs. The acupoint combinations of ST36, BL12, and CV17 and ST36, BL12, and EXB1 could be considered as the core of acupoint combination for further acupuncture treatment of COPD.

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          Most cited references16

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          Acupuncture and regulation of gastrointestinal function.

          In China, acupuncture has been considered an effective method for treating gastrointestinal (GI) dysfunction diseases for thousands of years. In fact, acupuncture has gained progressive acceptance from both practitioners and patients worldwide. However, the therapeutic effects and underlying mechanisms in treating GI dysfunction have not yet been established due to a lack of systematic and comprehensive review articles. Therefore, the aim of this review is to discuss the efficacy of acupuncture as a treatment for GI dysfunction and the associated underlying mechanisms. A search of PubMed was conducted for articles that were published over the past 10 years using the terms "acupuncture", "gastrointestine", and other relevant keywords. In the following review, we describe the effect and underlying mechanisms of acupuncture on GI function from the perspectives of GI motility, visceral sensitivity, the GI barrier, and the brain-gut axis. The dual regulatory effects of acupuncture may manifest by promoting gastric peristalsis in subjects with low initial gastric motility, and suppressing peristalsis in subjects with active initial motility. In addition, the regulation of acupuncture on gastric motility may be intensity-dependent. Our findings suggest that further studies are needed to investigate the effects and more systematic mechanisms in treating GI dysfunction, and to promote the application of acupuncture for the treatment of GI diseases.
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            Effects and mechanisms of acupuncture based on the principle of meridians.

            Acupuncture has been practiced in China for over 2000 years to treat a variety of diseases based on the "meridian theory" as described in the Yellow Emperor's Classic of Internal Medicine. To this date, the meridian theory continues to be an important guide for traditional Chinese medicine practitioners to diagnose and treat patients. Although the meridians have not been identified reliably as actual anatomical structures, they appear to serve as a road map to identify the location of various acupoints. Research has shown that acupoints overlie major neuronal bundles. The meridians extensively studied in the cardiovascular realm are the pericardial meridians (P) 5, 6, which overlie the deep median nerve. Meridians involved with gastrointestinal processes are (St) 36, 37, which overlie the deep peroneal nerve. Acupuncture needles, either manipulated manually or stimulated using a low current and frequency, have been documented to be a neurophysiological basis for modulating the activity of peripheral and central neural pathways. This review describes our current understanding of acupoints and meridians from a physiological aspect.
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              Pulmonary rehabilitation improves heart rate variability at peak exercise, exercise capacity and health-related quality of life in chronic obstructive pulmonary disease.

              Patients with chronic obstructive pulmonary disease (COPD) appear to have impaired cardiac autonomic modulation with depressed heart rate variability (HRV). Pulmonary rehabilitation (PR) is recommended as an integral part of the management. However, the effect of PR on HRV at peak exercise remains unclear. Sixty-four patients with COPD participated in a 12-week, 2 sessions-per-week, hospital-based PR program. Baseline and post-PR status were evaluated by spirometry, HRV, health-related quality of life (HRQL, St. George's Respiratory Questionnaire, SGRQ), cardiopulmonary exercise test, respiratory muscle strength, and dyspnea Borg's scale. After PR, there were significant improvements in the time and frequency domains of HRV with increased standard deviation of the normal R-R intervals, difference between adjacent normal R-R intervals within a given time minus one, high-frequency and decreased low-frequency, as well as concurrent improvements in HRQL, exercise capacity, dyspnea score, and respiratory muscle strength (all p < 0.05). PR results in significant improvements in autonomic function, with concurrent improvements in HRQL and exercise capacity. Copyright © 2014 Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Evid Based Complement Alternat Med
                Evid Based Complement Alternat Med
                ECAM
                Evidence-based Complementary and Alternative Medicine : eCAM
                Hindawi
                1741-427X
                1741-4288
                2020
                20 May 2020
                20 May 2020
                : 2020
                : 8165296
                Affiliations
                1Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
                2School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
                3Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
                4School of Medicine, Tzu-Chi University, Hualien, Taiwan
                5Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
                Author notes

                Academic Editor: Juntra Karbwang

                Author information
                https://orcid.org/0000-0002-0416-8797
                https://orcid.org/0000-0002-8529-919X
                https://orcid.org/0000-0001-5242-6343
                https://orcid.org/0000-0002-9047-8141
                https://orcid.org/0000-0002-5702-5730
                https://orcid.org/0000-0001-6840-3082
                https://orcid.org/0000-0002-1399-3553
                https://orcid.org/0000-0002-9270-3832
                https://orcid.org/0000-0001-9376-6539
                Article
                10.1155/2020/8165296
                7256717
                4c08f1ac-9904-4b5a-9901-d517e29eaf40
                Copyright © 2020 Po-Chun Hsieh et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 21 March 2020
                : 6 May 2020
                Funding
                Funded by: Taipei Tzu Chi Hospital
                Funded by: Buddhist Tzu Chi Medical Foundation
                Award ID: TCRD-TPE-109-64
                Award ID: TCRD-TPE-108-RT-4(2/3)
                Categories
                Research Article

                Complementary & Alternative medicine
                Complementary & Alternative medicine

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