| Background:Acupuncture point state is its response to external stimuli present different intensity of inherent characteristics. Acupoint sensitization research has become the hot topic of acupuncture and moxibustion science. Acupoint sensitization intrinsic likely brand-new life rules and regulation mechanism. Acupoint sensitization study is therefore to know acupuncture points, further consolidate acupuncture theory foundation, improve the acupuncture curative effect, clinical new vitality and may find a new living body-internal life regulation law has very important significance. Acupoint sensitization type is used the most, most studied in thermal. The resulting thermal moxibustion therapy has been widely used. A large amount of clinical evidence, but the mechanism research is extremely scarce.Methods:1. Through the literature review acupoint sensitization comprehensive analysis research; Reviewed in recent years, moxibustion treatment of knee osteoarthritis (KOA) research; Conclusion acupuncture point-the main research results of brain effect, literature basis for follow-up study.2. The adoption of evidence-based medicine system evaluation/Meta analysis of research methods, comprehensively collecting thermal moxibustion treatment at home and abroad of KOA randomized controlled trial (RCT), and the analysis of thermal effect and the curative effect of traditional moxibustion, moxibustion provide strong evidence of evidence-based support for the follow-up study.3. The resting state functional magnetic resonance technology (rfMRI), KOA as the research object, the observation of moxibustion stimulating calves brain response characteristics of the nasal cavity to produce thermal state, determine the central effect of thermal state and resting state, preliminary exploration moxibustion stimulating thermal state the brain mechanisms of acupoint treating diseases.Objective:1. The literature researchAcupoint sensitization literature research according to the theoretical, clinical and experimental class analysis; Moxibustion treatment of knee osteoarthritis literature research according to the classification of the clinical and experiment; Points-brain effect in accordance with the healthy people, pathology, stimulating factors and mechanism of acupuncture analgesia, treatment were summarized.2. The evidence-based researchWidely retrieve large literature database at home and abroad, supplemented by manual retrieval. Comprehensive collection of thermal moxibustion clinical randomized controlled trials for the treatment of knee osteoarthritis, by two evaluators independently extracted data and according to the Cochrane Review faced to evaluate quality of5.1. Statistical analysis using RevMan5.0.20software.3. The experimental studyIn60patients conforming patients with knee osteoarthritis. One side of his left knee, right-handed. Using the parallel group design related events. According to the left when the nasal cavity thermal phenomena of the presence of divided into thermal chemical group (n=30) and static state interest group (n=30). Baseline data by general data, visual analog pain scale (VAS) and evaluate the WOMAC joint inventory. USES the model to Sign HDx3.0T magnetic resonance imaging equipment. Two groups of scanning structure like respectively, moxibustion before and after moxibustion function as the resting state. Looking for thermal group sustained activation of the brain regions, conventional moxibustion thermal group7days, then moxibustion function as scanning. Image preprocessing using DPARSFA2.2and REST V1.8software. Ordinal data format conversion, remove in time, time correction, head of nmo correction, image registration, image segmentation, spatial standardization, spatial smoothing, to linear drift and filtering and other steps. Using low frequency amplitude (mfALFF) technical analysis whole brain before moxibustion sensitization, resting state group and moxibustion after sensitizing group relative to the resting state of spontaneous brain function activities. The Rest Slice Viewer and obtain the corresponding image adjustment for multiple comparison, each Cluster block threshold volume (Cluster) is greater than or equal to85individuals, monomer, threshold (P<0.05(adjusted) areas of the brain region is defined as the difference statistically significant. Using local consistency analysis (ReHo) sensitized after moxibustion group relative to the resting state, thermal moxibustion group7days after the coordination of the local brain activity of high and low. The REST software separately for each group after Fisher Z transform the individual zReHo figure for groups within a single sample t-test, observed the function of each set of local connectivity, using multiple comparisons AlphaSim correction, correction after P critical value of0.01. Select the anterior cingulate (ACC) as the seed zone, explore other brain regions and its functional connection strength. The REST software eparately for each group after Fisher Z transform individuals receive zFC figure for single sample t-test in the group, observation seed points respectively connected to the whole brain all voxel function, multiple comparisons with AlphaSim correction, correction after P critical value of0.01.Results:1.15RCT, a total of1228cases. Most into the test quality is not high. Meta analysis showed that thermal effect versus traditional moxibustion, moxibustion WMD VAS score=1.76,95%CI (2.33,1.18), P<0.00001; GPCRND-WMD KOA score=2.36,95%CI (3.42,1.30), P<0.0001; WMD Lysholm score=13.61,95%CI (7.60,19.61), P<0.00001). Thermal effect VS acupuncture moxibustion, Lysholm scale WMD=6.19,95%CI (0.01, 11.37], P=0.02; Thermal moxibustion acupuncture VS temperature WMD WOMAC score=10.14,95%CI (17.47,2.81), P=0.007).2. The whole experiment process without subjects fall off or lost. Two groups of subjects in age, sex, course of the disease, illness, VAS score, WOMAC scores were not statistically significant, comparable (P>0.05).3. Low frequency amplitude analysis (mfALFF)(1) compared with the general population, thermal chemical group, white matter in the left temporal lobe and frontal brain regions mfALFF significantly enhanced (P<0.05); And in the right brain, the occipital lobe brain regions mfALFF significantly reduced (P<0.05). One of the highest increase brain regions is the left temporal lobe, followed by white matter. The strongest is the occipital lobe, the second is the frontal lobe, right brain. Compared with normal group, the resting state groups on the left occipital lobe, right frontal last time, the left frontal medial back, back, on the right side of the cerebellum posterior lobe of the slope in the left frontal mfALFF significantly reduce the areas of the brain and the right superior temporal gyrus. Weaken the strongest is on the right side of the cerebellum posterior lobe of the slope, followed by the right superior temporal gyrus.(2) after moxibustion stimulating, thermal chemical group relative to the resting state mfALFF right brain regions are significantly enhanced the left cerebellum, outer core, brain, left brain, white matter (P<0.05). Significantly reduce the areas of the brain that is the central front, frontal lobe, occipital lobe (P<0.05).4. The local consistency analysis (ReHo)(1) thermal before moxibustion group, the resting state before moxibustion group, after thermal moxibustion group and moxibustion after resting state group much more difference (P<0.05). The distribution of the mass of a frontal lobe, the frontal last time, back in his forehead, inferior frontal gyrus, anterior cingulate, limbic lobe, insula. Mass distribution of temporal lobe, superior temporal gyrus, parahippocampal gyrus. Mass three distribution of the parietal lobe, cingulate gyrus. ReHo analytical range is the first largest group, the second is the third group, the smallest is the second group. Activate the strongest is the first group, the second is the third group, the smallest is the second group. There ReHo value significantly higher amount of last time, back in the left frontal, anterior cingulate, after the left superior temporal gyrus, cingulate gyrus (P<0.01). ReHo value significantly reduced the have the right amount of hui, inferior frontal gyrus, parahippocampal gyrus (P<0.01). Left and right sides of the corresponding brain regions, usually on the left side of the range of voxel is greater than the right, the left side of the ReHo values higher than the right, of course, there are not consistent, such as in the right frontal ReHo value lower back, back in the left frontal ReHo increased value. There are ReHo value about equal, there are differences between the scope of voxel. Different brain regions, voxel is the largest range of frontal lobe, parietal lobe, followed by other brain regions in order for the anterior cingulate, parietal lobe, temporal lobe, insula, after the cingulate gyrus, inferior frontal gyrus, parahippocampal gyrus, superior temporal gyrus, edge, back in his forehead, the forehead last time. The frontal lobe, limbic lobe, parietal lobe, temporal lobe range too diffuse.(2) to compare two groups ReHo the moxibustion. Brain areas concentrated in the guide vane and the anterior cingulate (P<0.01). ReHo analysis scope biggest briquette is the first group, followed by the second group. Activate a mass a, negative mass and strength. The ReHo value is significantly higher with the anterior cingulate. ReHo value significantly reduced is the insula. Left and right sides of the corresponding brain regions, usually on the left side of the range of voxel is greater than the right, the left side of the ReHo values higher than the right, of course, there are not consistent, such as the left side of the guide vane voxel is higher than the right side of the guide vane, but ReHo value about equal. Different brain regions, scope of voxel the largest is the temporal lobe, followed by anterior cingulate, other brain regions respectively the insula, parietal lobe, the frontal lobe, cerebellum. The scope of frontal lobe, cerebellum, parietal lobe, temporal lobe too diffuse.(3) a week after thermal treatment are compared ReHo group before and after treatment. Brain areas concentrated in the anterior cingulate area and white matter (P<0.01). Before and after treatment group comparison, ReHo analysis scope biggest briquette is the second group, the second is the first group. Activate a mass a, negative mass and strength of the weaker. Anterior cingulate ReHo value higher than that of white matter the corpus callosum. Left and right sides of the corresponding brain regions, usually on the left side of the range of voxel is greater than the right, the left side of the ReHo values higher than the right, of course, there are not consistent, such as the right side of the corpus callosum department voxel is higher than the left side of the corpus callosum department, but ReHo value about equal. Different brain regions, voxel is the largest range of brain white matter area, followed by anterior cingulate, other brain areas of frontal lobe, parietal lobe, temporal lobe, cerebellum. The frontal lobe, parietal lobe, temporal lobe, cerebellum range too diffuse. Area are mainly concentrated in the brain white matter around the corpus callosum.5. The brain functional connectivity analysis(1) choose the anterior cingulate (ACC) as a seed for the brain functional connectivity analysis. Much more differences between groups (P <0.01), brain connections are mainly distributed in three mass, the largest is the mass of a activation range, followed by clumps three, the last is two, but after the gap is very small. Activate the strength of briquette one, clumps of three, two, mass two weakest. Connected to ACC brain function strengthen the areas of the brain, in turn, has the precuneus, angular gyrus, cingulate after top lobule, and occipital lobe. Connected to the ACC brain function abate areas of the brain on the left side of the guide vane, superior temporal gyrus, right guide vane, in return, the temporal parahippocampal gyrus. The most weak the parahippocampal gyrus. ACC is the largest range of parietal lobe of the brain functional connectivity, followed by the occipital lobe, and then followed by the temporal lobe, hat with lobular, insula, cingulate gyrus, parahippocampal gyrus, after edge of leaf, in return, precuneus, superior temporal gyrus, temporal angular gyrus. Part of the brain left and right sides is symmetrical, ACC connection strength is mostly a brain function Of course, there are not consistent brain regions, such as the insula, in return, the superior temporal gyrus, temporal lobule. But the parietal lobe connection range too diffuse. (2) the two groups compare the moxibustion brain areas concentrated in the guide vane and parahippocampal gyrus. Brain connections are mainly distributed in two mass, the largest is the mass of a activation range, but also the highest intensity. No analysis to the ACC brain connections increase areas of the brain. Connected to the ACC brain function abate areas of the brain guide vane, parahippocampal gyrus. The one on the left side of the parahippocampal gyrus is weak, the rest equally. ACC is the largest range of the temporal lobe of brain connections, followed by the insula, the rest of the brain regions due to the mass range of different connections. Part of the brain left and right sides is symmetrical, ACC brain function connection strength most consistent, mostly about inequality.(3) a week after thermal treatment are compared ReHo group before and after treatment. Brain areas concentrated in the left anterior cingulate and white area. Before and after treatment group comparison, brain connections are mainly distributed in two mass, the largest is the mass of a negative activation range, intensity is strongest. Connected to the ACC brain function enhancement areas of the brain on the left side of the cingulate. cortex, the rest, in turn, for the corpus callosum, the left side of the island. Connected to the ACC brain function abate areas of the brain is on the right side of the insula. Connected to the ACC brain function range of the biggest is cerebral white matter area, followed by the cerebellum, the rest of the left insula, frontal lobe, temporal lobe, parietal lobe. Part of the brain left and right sides is symmetrical, the right side of the insula connected to the ACC brain function is weak, the scope, the left side of the insula is relatively stronger, broader. The ministry of the right side of the corpus callosum and ACC brain function connection strength and the left side of the corpus callosum, but on the right side of the corpus callosum scope is bigger.Conelusion:1. Thermal moxibustion treatment of knee osteoarthritis clinical curative effect affirmation, is superior to the traditional moxibustion. But higher quality multi-center RCT is needed to confirm.2. acupoint sensitization state and resting state of disease in the different pain default network there may be differences. Brain regions both thermal chemical groups of spontaneous neural activity enhancement, are also part of spontaneous neural activity. But resting state groups are basically spontaneous reduce the neural activity of the brain regions. This suggests that the state of the meridians may onto the brain pain default network, so as to produce certain effect.3. Moxibustion stimulating thermal points higher nervous activity effects on the brain is widely, show the immediate stress and consolidation. It shows that moxibustion brain effect of the thermal state point could be the result of a central network control, universality in a influence to some extent, explain the "little stimulation, big reaction" acupoint sensitization theory. Another inhibition may be related to the frontal moxibustion sensitizing the analgesic effect of acupuncture and comfortable emotional experience have a connection.4. The anterior cingulate (ACC) may be acupuncture point state transition to the thermal state, help moxibustion thermal mineralization points to obtain the curative effect of key brain regions.5. Moxibustion heat sensitive points more is through the medial pain system works, cingulate-insula before implementation for key center for pain, especially the emotional part of the network central control. Moxibustion as a means of sensory stimulation, and emotional there may be some relevant brain pain matrix. Moxibustion analgesia may cingulate before the insula and change the default network characteristic to realize central control. This study provides the brain mechanism of moxibustion analgesia is quite significant scientific basis. Compared with resting state meridians, sensitization state points onto the brain pain default network is also different. Embodied in thermal state acupoint specificity reduces the insula area coordination, improved the anterior cingulate area coordination. Anterior cingulate analysis of brain connections for seed amount-top-temporal-(ACC)-of the insula and frontal-top-temporal-(ACC)-the cerebellum parahippocampal gyrus were weakened sexual mode... |
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