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ObjectiveTo identify factors and assess to what extent they impact the magnitude of the treatment effect of acupuncture therapies across therapeutic areas.Data sourceMedline, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc, between 2015 and 2019.Study selectionThe inclusion criteria were trials with a total number of randomised patients larger than 100, at least one patient-important outcome and one of two sets of comparisons.Data analysisThe potential independent variables were identified by reviewing relevant literature and consulting with experts. We conducted meta-regression analyses with standardised mean difference (SMD) as effect estimate for the dependent variable. The analyses included univariable meta-regression and multivariable meta-regression using a three-level robust mixed model.Results1304 effect estimates from 584 acupuncture randomised controlled trials (RCTs) were analysed. The multivariable analyses contained 15 independent variables . In the multivariable analysis, the following produced larger treatment effects of large magnitude (>0.4): quality of life (difference of adjusted SMDs 0.51, 95% CI 0.24 to 0.77), or pain (0.48, 95% CI 0.27 to 0.69), or function (0.41, 95% CI 0.21 to 0.61) vs major events. The following produced larger treatment effects of moderate magnitude (0.2–0.4): single-centred vs multicentred RCTs (0.38, 95% CI 0.10 to 0.66); penetration acupuncture vs non-penetration types of acupuncture (0.34, 95% CI 0.15 to 0.53); non-pain symptoms vs major events (0.32, 95% CI 0.12 to 0.52). The following produced larger treatment effects of small magnitude (<0.2): high vs low frequency treatment sessions (0.19, 95% CI 0.03 to 0.35); pain vs non-pain symptoms (0.16, 95% CI 0.04 to 0.27); unreported vs reported funding (0.12, 95% CI 0 to 0.25).ConclusionPatients, clinicians and policy-makers should consider penetrating over non-penetrating acupuncture and more frequent treatment sessions when feasible and acceptable. When designing future acupuncture RCTs, trialists should consider factors that impact acupuncture treatment effects.

Methodological issues and challenges hinder the high-quality development of acupuncture clinical studies. To systematically summarize the methodological issues, challenges, and recommendations in acupuncture clinical research using the participant, intervention, comparison, outcome, and study design (PICOS) framework to generate a comprehensive list of methodological questions and recommendations. We searched seven databases for articles on the methodological aspects of clinical acupuncture research from their inception to March 24, 2023. Two researchers independently screened the titles, abstracts, and full text of each article. Data extraction and analyses were performed for the eligible studies. Finally, the methodological challenges and recommendations for acupuncture clinical studies are listed, and the frequency of methodological challenges is displayed in a sunburst chart. A total of 226 studies were included in the review, most of which originated in China (173, 77 %), followed by the United States (25, 11 %) and the United Kingdom (12, 5 %). Clinical research on acupuncture faces methodological challenges that span the five elements of the PICOS framework. The most frequently mentioned issues were related to comparison, followed by study design and interventions. If further categorized, the establishment of the control group is undoubtedly the most concerning issue for researchers. This review provides a comprehensive overview of the challenges and recommendations for each aspect of the PICOS framework in clinical acupuncture research.

To summarize and analyze the recommendations of acupuncture and moxibustion in the global guidelines/expert consensus of chemotherapy- and/or radiotherapy-induced nausea and/or vomiting, providing a basis for the development of clinical practice guidelines on acupuncture and moxibustion for chemotherapy- and/or radiotherapy-induced nausea and/or vomiting. We systematically searched 7 comprehensive databases, 7 guideline libraries and 4 websites of societies/associations. The retrieval period was from the inception to April 1, 2023. Two researchers independently screened the literature, extracted data, and used the Scientific, Transparent, and Applicable Rankings (STAR) tool to evaluate the quality of guidelines/expert consensus that contained acupuncture and moxibustion recommendations, and analyzed acupuncture and moxibustion recommendations in guidelines/expert consensus and their evidence base. A total of 56 guidelines/expert consensus related to the prevention and treatment of chemotherapy- and/or radiotherapy-induced nausea and/or vomiting were included, and 22 guidelines/expert consensus contained acupuncture and moxibustion recommendations, with a total of 34 recommendations on acupuncture and moxibustion (27 supports, 4 neutrals, 3 objections). The STAR evaluation (excluding 1 patient version of guideline) showed that none of the guidelines/expert consensus was with high quality, 95.24% (20/21) with medium quality, and 4.76% (1/21) with low quality. Although there were many recommendations of acupuncture and moxibustion in the existing guidelines/expert consensus, there was great heterogeneity among the acupuncture and moxibustion treatment regimens. Moreover, most of the guidelines/expert consensus did not describe the details of acupuncture and moxibustion treatment regimens, such as acupuncture and moxibustion manipulation, acupoint selection, course and timing of treatment, which is difficult to guide the clinical practice of acupuncture and moxibustion. Developing clinical practice guidelines of acupuncture and moxibustion for chemotherapy- and/or radiotherapy-induced nausea and/or vomiting according to the items of the STAR tool was urgent, so as to clarify the details of acupuncture and moxibustion regimens and provide standardized treatment regimens to guide the clinical practice of acupuncture and moxibustion.

The body of research on acupuncture as a treatment strategy for fibromyalgia (FM) is steadily growing. This evidence map identifies, describes, and summarizes the current status of studies conducted to evaluate the efficacy of acupuncture for FM, identify research gaps, and provide information that could guide the design of future studies. Seven electronic databases–Cochrane Library, PubMed, Embase, China Biomedical Literature Database, VIP, Wanfang Database, and Chinese National Knowledge Infrastructure–were searched for relevant articles on acupuncture for FM. The search period was from the dates of inception of the databases to December 19, 2022. Original clinical studies and systematic reviews on the use of acupuncture-related modalities for the treatment of FM were included. The basic information, quality assessments, and evidence maps of the included studies are presented as charts and bubble plots. The quality assessment tools used for evaluating the different types of studies included in the present study were Cochrane Collaboration's tool, Canadian Institute of Health Economics quality appraisal tool, and A MeaSurement Tool to Assess systematic Reviews 2. Fifty studies were included in this study. Of these, 39 (78.00%) were randomized controlled trials (RCTs), 6 (12.0%) were case series, and 5 (10.0%) were systematic reviews. The included studies focused on manual acupuncture and conventional treatment in the treatment and control groups, respectively. The outcomes analyzed in the RCTs included pain (94.9%), sleep quality (46.2%), depression (46.2%), physical function (46.2%), stiffness (35.9%), well-being (35.9%), work status (35.9%), anxiety (33.3%), fatigue (33.3%), quality of life (17.9%), and overall effective rate (10.3%). The methodological quality of most of the studies was low or critically low regardless of the study design. In most studies, the therapeutic effect of acupuncture was significantly superior to that of the comparator. This evidence map suggests that acupuncture-related modalities may be promising options for FM management. However, various studies on this topic have a high risk of bias or are of low quality. Further evidence-based research should be conducted to rigorously examine the efficacy of acupuncture for FM and promote generalizability of the findings.

Background The effects of acupuncture have varied in different randomized controlled trials (RCTs), and there are many factors that influence treatment effect of acupuncture in different outcomes, with conflicting results. Objective To identify factors and their impact on the treatment effect of acupuncture in different outcomes. Methods Acupuncture RCTs were searched from 7 databases including Medline (PubMed), Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, VIP Database, and China Biology Medicine disc between January 1st, 2015 and December 31st, 2019. Eligible studies must compare acupuncture to no acupuncture, sham acupuncture, or waiting lists, and report at least 1 patient-important outcome. A multi-level meta-regression was conducted using a 3-level robust mixed model and univariate analyses were performed for all independent variables, even those excluded from the multivariable model due to collinearities. We used thresholds of 0.2 and 0.4 for the difference of standardized mean differences (SMDs), categorising them as small (<0.2), moderate (0.2–0.4), or large (>0.4) effects. Results The pain construct analysis involved 211 effect estimates from 153 studies and 14 independent variables. High-frequency acupuncture treatment sessions produced larger effects compared to low-frequency sessions [large magnitude, the difference of adjusted SMDs 0.46, 95% confidence interval (CI) 0.07 to 0.84; P =0.02]. The non-pain symptoms construct analysis comprised 323 effect estimates from 231 studies and 15 independent variables. Penetrating acupuncture showed moderately larger effects when compared to non-penetrating acupuncture (0.30, 95% CI 0.06 to 0.53; P =0.01). The function construct analysis included 495 effect estimates from 274 studies and 14 independent variables. Penetrating acupuncture and the flexible acupuncture regimen showed moderately larger effects, compared to non-penetrating acupuncture and fixed regimen, respectively (0.40, 95% CI 0 to 0.80; P =0.05; 0.29, 95% CI 0.06 to 0.53; P =0.01). Conclusions High-frequency acupuncture sessions appear to be a more effective approach to managing painful symptoms. Penetrating acupuncture demonstrated greater effect in relieving non-painful symptoms. Both penetrating acupuncture type and flexible acupuncture regimen were linked to significant treatment effects in function outcomes. Future studies should consider the factors that are significantly associated with the effects of acupuncture in patient-important outcomes.

Objective To summarize and identify the available instruments/methods assessing the adequacy of acupuncture in randomized controlled trials (RCTs) for proposing a new improved instrument. Methods A systematic literature search was carried out in 7 electronic databases from inception until 21st November 2022. Any study evaluating the adequacy or quality of acupuncture, specifying specific acupuncture treatment-related factors as criteria of subgroup analysis, or developing an instrument/tool to assess the adequacy or quality of acupuncture in an RCT was included. Basic information, characteristics and contents of acupuncture adequacy assessment were presented as frequencies and percentages. Results Forty studies were included in this systematic review. Thirty-five studies (87.50%) were systematic reviews, none of which used formal methods to develop the assessment instruments/methods of acupuncture adequacy; of 5 methodological studies, only 1 study used a relatively formal method. Thirty-two studies (82.05%) assessed the components of acupuncture, while 7 (17.95%) assessed the overall quality of acupuncture. An independent assessment instrument/method was used to assess acupuncture adequacy in 29 studies (74.35%), whereas as one part of a methodological quality assessment scale in 10 (25.65%). Only 9 (23.00%) studies used the assessment results for subgroup analysis, sensitivity analysis or the criteria for inclusion in the meta-analysis. Conclusion Assessment contents for adequacy or quality of acupuncture in RCTs hadn’t still reached consensus and no widely used assessment tools appeared. The methodology of available assessment instruments/scales is far from formal and rigorous. A new instrument/tool assessing adequacy of acupuncture should be developed using a formal method.

Objective To assess the use of evidence-based research (EBR) approach in randomized controlled trials (RCTs) of acupuncture-related therapies for primary dysmenorrhea (PD). Methods PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Database, and China Science and Technology Journal Database were searched from January 2013 to December 2022 for RCTs of acupuncture on PD. The full text and references of each RCT were read to assess whether systematic reviews (SRs) or other types of studies with similar research questions and end-users’ perspectives were cited to justify and design the trial. In addition, the discussion section were analyzed to evaluate whether trials placed the new result in the existing SRs to draw a conclusion. Multivariable logistic regression was used to find variables that associated with 3 aspects of EBR approach: (1) citing clinical studies for justification, (2) citing relevant studies that obtain the perspectives of end users, and (3) citing clinical studies for results discussion. Results Of 473 RCTs included, 45.67% (216) of the trials cited relevant similar studies, 21.56% (102) referenced to the studies that collected end-users’ perspectives, and 10.99% (52) placed result in the context of the previous research. Few RCTs appropriately applied EBR approach. Among all the included studies, 3.17% (15) of the trials used SRs to inform study questions but none of them used updated SRs with acceptable quality; 1.05% (5) of the trials cited SRs of end-user’s perspectives in the justification and design of the study, and only 1 trial added results in existing SR to draw a conclusion. Year of publication, language, funding, registration, ethical approval and number of sites were significantly associated with 1 of the 3 aspects of EBR approach. Conclusions Few RCTs in acupuncture-related therapies for PD used the EBR approach to minimize research redundancy. Researchers, research institutes, funding agencies, ethics committees, journals and peer reviewers in acupuncture should make efforts to use and promote the EBR approach to ensure the value of new trials.

Objective: The body of research on acupuncture as a treatment strategy for fibromyalgia (FM) is steadily growing. This evidence map identifies, describes, and summarizes the current status of studies conducted to evaluate the efficacy of acupuncture for FM, identify research gaps, and provide information that could guide the design of future studies. Methods: Seven electronic databases-Cochrane Library, PubMed, Embase, China Biomedical Literature Database, VIP, Wanfang Database, and Chinese National Knowledge Infrastructure-were searched for relevant articles on acupuncture for FM. The search period was from the dates of inception of the databases to December 19, 2022. Original clinical studies and systematic reviews on the use of acupuncture-related modalities for the treatment of FM were included. The basic information, quality assessments, and evidence maps of the included studies are presented as charts and bubble plots. The quality assessment tools used for evaluating the different types of studies included in the present study were Cochrane Collaboration's tool, Canadian Institute of Health Economics quality appraisal tool, and A Measurement Tool to Assess systematic Reviews 2. Results: Fifty studies were included in this study. Of these, 39 (78.00%) were randomized controlled trials (RCTs), 6 (12.0%) were case series, and 5 (10.0%) were systematic reviews. The included studies focused on manual acupuncture and conventional treatment in the treatment and control groups, respectively. The outcomes analyzed in the RCTs included pain (94.9%), sleep quality (46.2%), depression (46.2%), physical function (46.2%), stiffness (35.9%), well-being (35.9%), work status (35.9%), anxiety (33.3%), fatigue (33.3%), quality of life (17.9%), and overall effective rate (10.3%). The methodological quality of most of the studies was low or critically low regardless of the study design. In most studies, the therapeutic effect of acupuncture was significantly superior to that of the comparator. Conclusion: This evidence map suggests that acupuncture-related modalities may be promising options for FM management. However, various studies on this topic have a high risk of bias or are of low quality. Further evidence-based research should be conducted to rigorously examine the efficacy of acupuncture for FM and promote generalizability of the findings.

In this paper, an experimental research on the influence of the biomimetic surface morphology on the bending fatigue resistance of gear is carried out. The biomimetic surface morphology was prepared on the gear surface by a 4.5-kW Nd:YAG pulsed laser. The results showed that the fatigue lives of all of the biomimetic gears were much longer than that of the as-received gear. The bending fatigue resistance was improved by the biomimetic surface morphology. The bending fatigue resistant mechanism of biomimetic gear is discussed.

The purpose of this investigation was to explore the influence of the biomimetic surface morphology on the modal properties of gear. Firstly, a involute cylinder gear model had been created, and the biomimetic surface morphology had been established on the gear tooth flanks. Secondly, the modal analysis of the ordinary gear and biomimetic gear has been investigated separately through FEM method. Results showed that the maximum amplitudes and the ten natural frequencies of biomimetic gear were obviously lower than that of the ordinary gear, but the modal shape of the two kinds of gears were almost the same. The biomimetic surface morphology could improve the dynamic characteristics and reliability of gear in the future.