Data_Sheet_1_Decision tree model based prediction of the efficacy of acupuncture in methadone maintenance treatment.pdf

BackgroundPatients with MMT often face difficulties such as sleep disturbance, headaches, and difficulty in complete abstinence from drugs. Research has shown that acupuncture can mitigate side effects while attenuating methadone dependence. It also has a synergistic and attenuated effect on methadone maintenance treatment (MMT). Exploring the predictors of the efficacy of acupuncture intervention in MMT might help clinicians and patients promote acupuncture-assisted participation in MMT, and improve clinical treatment strategies for MMT.ObjectiveTo describe the effect of potential predictors on MMT after acupuncture intervention by building a decision-tree model of data from A Clinical Study of Acupuncture-assisted MMT.Design, setting, and participantsIn this randomized controlled trial, 135 patients with MMT underwent acupuncture at the Substance Dependence Department of Guangzhou Huiai Hospital in Guangzhou, Guangdong Province, China.InterventionA total of 135 patients were 1:1 randomly assigned to either an acupuncture plus routine care group (acupuncture plus methadone) or a routine group (methadone only) for 6 weeks, and followed up for 10 weeks. Sex, age, education level, route of previous opioid use, years of opioid use, and MMT time were recorded before the trial.Outcome measurements and statistical analysisAll analyses were based on the intention-to-treat (ITT) population. The two decision tree models used the change of methadone dosage and the VAS score for opioid desire as response variables, respectively, and the evaluation criteria were positive effect (decreased by ≥20%) and no effect (decreased by ResultsThe overall accuracy of methadone reduction and psychological craving VAS scoring decision trees were 0.63 and 0.74, respectively. The Methadone Dosage Efficacy decision tree identified years of opioid use (weight = 0.348), acupuncture (weight = 0.346), and route of previous opioid use (weight = 0.162) as key features. For the VAS Score decision tree, acupuncture (weight = 0.618), MMT time (weight = 0.235), and age (weight = 0.043) were the important features.ConclusionExploratory decision tree analysis showed that acupuncture, years of opioid use, route of previous opioid use, MMT time, and age were key predictors of the MMT treatment. Thus, acupuncture-assisted MMT strategy should consider the relevant influencing factors mentioned above.Patient summaryUnderstanding patient characteristics and the impact of acupuncture regimens on methadone dosage reduction in MMT patients may help physicians determine the best treatment regimen for patients. An analysis of data from our clinical trial showed that acupuncture, years of opioid use, route of previous opioid use, age, and MMT time were key predictors of progressive recovery in patients with MMT. Eligible patients may benefit most from the MMT rehabilitation that reduces consumption and psychological cravings for methadone.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900026357.</p

Table_1_Effectiveness of acupuncture combined with rehabilitation training vs. rehabilitation training alone for post-stroke shoulder pain: A systematic review and meta-analysis of randomized controlled trials.pdf

BackgroundPost-stroke shoulder pain (PSSP) is characterized by shoulder pain on the hemiplegic side, which can limit physical activity in patients with stroke. Acupuncture combined with rehabilitation training (AR) has been widely used in PSSP, but the evidence of its effectiveness is still unclear.ObjectiveThe study aimed to evaluate the effect and safety of AR vs. rehabilitation training (RT) alone on PSSP.MethodsWe searched PubMed, the Cochrane Library, the Chinese Biological Medicine Database (CBM), the Chinese Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and the WAN FANG database for relevant studies from their inception to February 2022. Only randomized controlled trials (RCTs) comparing the effect of AR with RT alone on PSSP were considered. The primary outcome was shoulder pain. Secondary outcomes included upper limb motor function, activities of daily living (ADL), shoulder range of motion (ROM), and adverse events (AEs). Subgroup analysis and sensitivity analysis were also conducted. Quality assessment was implemented based on Cochrane risk of bias (ROB) criteria, which consist of seven items. When more than four items in a study were judged as low ROB, the overall quality of this study was considered low risk.ResultsA total of 40 studies were included in the qualitative analysis, and 35 (87.5%) studies with 2,554 patients were included in the meta-analysis. Of the 40 studies, 14 (35.0%) were of moderate-to-high quality. The meta-analysis results showed that AR is better than RT alone in reducing shoulder pain (MD −1.32, 95% CI −1.58 to −1.07), improving upper limb motor function (MD 6.81, 95% CI 4.95–8.67), ADL (MD 11.17, 95% CI 9.44–12.91), and shoulder ROM (internal rotation: MD 10.48, 95% CI 8.14–12.83; backward extension: MD 7.82, 95% CI 6.00–9.64; anteflexion: MD 12.88, 95% CI 5.47–20.29; external rotation: MD 11.40, 95% CI 6.17–16.64; abduction: MD 16.96, 95% CI 8.61–25.31) without obvious AEs.ConclusionAR may be better than RT alone for the improvement of shoulder pain, upper limb motor function, ADL, and shoulder ROM, without obvious AEs in patients with PSSP. However, considering the clinical and statistical heterogeneity, our findings need to be interpreted with caution. More rigorous RCTs in this area should be conducted in the future.Systematic review registration[www.crd.york.ac.uk], identifier [CRD42022326763].</p

Data_Sheet_1_Effectiveness of acupuncture combined with rehabilitation training vs. rehabilitation training alone for post-stroke shoulder pain: A systematic review and meta-analysis of randomized controlled trials.pdf

BackgroundPost-stroke shoulder pain (PSSP) is characterized by shoulder pain on the hemiplegic side, which can limit physical activity in patients with stroke. Acupuncture combined with rehabilitation training (AR) has been widely used in PSSP, but the evidence of its effectiveness is still unclear.ObjectiveThe study aimed to evaluate the effect and safety of AR vs. rehabilitation training (RT) alone on PSSP.MethodsWe searched PubMed, the Cochrane Library, the Chinese Biological Medicine Database (CBM), the Chinese Scientific Journal Database (VIP), China National Knowledge Infrastructure (CNKI), and the WAN FANG database for relevant studies from their inception to February 2022. Only randomized controlled trials (RCTs) comparing the effect of AR with RT alone on PSSP were considered. The primary outcome was shoulder pain. Secondary outcomes included upper limb motor function, activities of daily living (ADL), shoulder range of motion (ROM), and adverse events (AEs). Subgroup analysis and sensitivity analysis were also conducted. Quality assessment was implemented based on Cochrane risk of bias (ROB) criteria, which consist of seven items. When more than four items in a study were judged as low ROB, the overall quality of this study was considered low risk.ResultsA total of 40 studies were included in the qualitative analysis, and 35 (87.5%) studies with 2,554 patients were included in the meta-analysis. Of the 40 studies, 14 (35.0%) were of moderate-to-high quality. The meta-analysis results showed that AR is better than RT alone in reducing shoulder pain (MD −1.32, 95% CI −1.58 to −1.07), improving upper limb motor function (MD 6.81, 95% CI 4.95–8.67), ADL (MD 11.17, 95% CI 9.44–12.91), and shoulder ROM (internal rotation: MD 10.48, 95% CI 8.14–12.83; backward extension: MD 7.82, 95% CI 6.00–9.64; anteflexion: MD 12.88, 95% CI 5.47–20.29; external rotation: MD 11.40, 95% CI 6.17–16.64; abduction: MD 16.96, 95% CI 8.61–25.31) without obvious AEs.ConclusionAR may be better than RT alone for the improvement of shoulder pain, upper limb motor function, ADL, and shoulder ROM, without obvious AEs in patients with PSSP. However, considering the clinical and statistical heterogeneity, our findings need to be interpreted with caution. More rigorous RCTs in this area should be conducted in the future.Systematic review registration[www.crd.york.ac.uk], identifier [CRD42022326763].</p

DataSheet_1_Aberrant metabolic processes promote the immunosuppressive microenvironment in multiple myeloma.pdf

IntroductionMultiple myeloma (MM) is still an incurable plasma cell malignancy. The efficacy of immunotherapy on MM remains unsatisfactory, and the underlying molecular mechanisms still are not fully understood.MethodsIn this study, we delineated the dynamic features of immune cell in MM bone marrow (BM) along with elevated tumor cell infiltration by single-cell RNA sequencing (scRNA-seq), and investigated the underlying mechanisms on dysfunction of immune cells associated with myelomagenesis.ResultsWe found that immune cells were activated in those patients with low infiltration of tumor cells, meanwhile suppressed with elevated infiltration of MM cells, which facilitated MM escaping from immune surveillance. Besides PD-1, abnormal expression of PIM kinases, KLRB1 and KLRC1 were involved in the defect of immune cells in MM patients. Importantly, we found aberrant metabolic processes were associated with the immunosuppressive microenvironment in MM patients. Disordered amino acid metabolism promoted the dysfunction of cytotoxicity CD8 T cells as well as lipid metabolism disorder was associated with the dysregulation of NK and DCs in MM. As metabolic checkpoints, PIM kinases would be potential effective strategies for MM immunotherapy.DiscussionIn summary, redressing the disordered metabolism should be the key points to get promising effects in immune-based therapies.</p

Image_1_Aberrant metabolic processes promote the immunosuppressive microenvironment in multiple myeloma.jpeg

IntroductionMultiple myeloma (MM) is still an incurable plasma cell malignancy. The efficacy of immunotherapy on MM remains unsatisfactory, and the underlying molecular mechanisms still are not fully understood.MethodsIn this study, we delineated the dynamic features of immune cell in MM bone marrow (BM) along with elevated tumor cell infiltration by single-cell RNA sequencing (scRNA-seq), and investigated the underlying mechanisms on dysfunction of immune cells associated with myelomagenesis.ResultsWe found that immune cells were activated in those patients with low infiltration of tumor cells, meanwhile suppressed with elevated infiltration of MM cells, which facilitated MM escaping from immune surveillance. Besides PD-1, abnormal expression of PIM kinases, KLRB1 and KLRC1 were involved in the defect of immune cells in MM patients. Importantly, we found aberrant metabolic processes were associated with the immunosuppressive microenvironment in MM patients. Disordered amino acid metabolism promoted the dysfunction of cytotoxicity CD8 T cells as well as lipid metabolism disorder was associated with the dysregulation of NK and DCs in MM. As metabolic checkpoints, PIM kinases would be potential effective strategies for MM immunotherapy.DiscussionIn summary, redressing the disordered metabolism should be the key points to get promising effects in immune-based therapies.</p