Clinical observation of virtual reality technology combined with isokinetic strength training for patients after anterior cruciate ligament reconstruction / 中国骨伤

OBJECTIVE@#To explore application value and effectiveness of virtual reality technology combined with isokinetic muscle strength training in the rehabilitation of patients after anterior cruciate ligament (ACL) reconstruction surgery.@*METHODS@#Forty patients who underwent ACL reconstruction surgery from December 2021 to January 2023 were selected and divided into control group and observation group according to treatment methods, 20 patients in each group. Control group was received routine rehabilitation training combined with isokinetic muscle strength training, including 15 males and 5 females, aged from 17 to 44 years old, with an average of (29.10±8.60) years old. Observation group was performed virtual reality technology combined with isokinetic muscle strength training, including 16 males and 4 females, aged from 17 to 45 years old with an average of (30.95±9.11) years old. Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups at 12 (before training) and 16 weeks (after training) after surgery were compared.@*RESULTS@#All patients were followed up for 1 to 6 months with an average of (3.30±1.42) months. There were no statistically significant difference in Lysholm knee joint score, peak knee extension peak torque, and peak knee flexion peak torque between two groups (P>0.05) before training. After training, Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque of both groups were improved compared to before training (P<0.05);there were significant difference in Lysholm knee joint score, knee extension peak torque, and knee flexion peak torque between two groups(P<0.05).@*CONCLUSION@#The application of virtual reality technology combined with isokinetic muscle strength training could promote recovery of knee joint function and enhance muscle strength in patients after ACL reconstruction surgery in further.

Influence of electroacupuncture on the expression of AMPA receptor subunit GluR1 in the spinal injured area of the rats with acute spinal cord injury / 中国针灸

OBJECTIVE@#To explore the influence of electroacupuncture (EA) on the expression of AMPA receptor subunit GluR1 in the rats with acute spinal cord injury (SCI) and explore the potential effect mechanism of EA in treatment of acute SCI.@*METHODS@#A total of 80 SD rats were randomly divided into five groups, i.e. a sham-operation group, a model group, an AMPA antagonist (DNQX) group, an EA group and a DNQX+EA group, 16 rats in each group. The modified Allen's impacting method was adopted to prepare the rat model of acute SCI at T@*RESULTS@#Compared to the sham-operation group in 6 h, 24 h and 48 h after modeling, the BBB scores were all significantly decreased in the model group (@*CONCLUSION@#The intervention with EA at "Dazhui" and "Mingmen" promotes the repair of the injured nerve in the spinal anterior horn probably through inhibiting GluR1 expression in the spinal injured area in the rats with acute SCI.

Evidence-based medicine research on low-back pain with sham-acupuncture controlled design and the analysis on dynamic acupoint positioning / 中国针灸

To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017. Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for arrival or palpation for point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.

Combination treatment with Gua Sha and Blood-letting causes attenuation of systemic inflammation, activated coagulation, tissue ischemia and injury during heatstroke in rats / 中国结合医学杂志

<p><b>OBJECTIVE</b>Gua Sha and Blood-letting at the acupoints were Chinese traditional therapies for heatstroke. The purpose of present study was to assess the therapeutic effect of Gua Sha on the DU Meridian and Bladder Meridian combined with Blood-letting acupoints at Shixuan (EX-UE 11) and Weizhong (BL 40) on heatstroke.</p><p><b>METHODS</b>Anesthetized rats, immediately after the onset of heatstroke, were divided into four major groups: Gua Sha group, Blood-letting group, Gua Sha combined with Blood-letting group and model group. They were exposed to ambient temperature of 43 °C to induce heatstroke. Another group of rats were exposed to room temperature (26 °C) and used as normal control group. Their survival times were measured. In addition, their physiological and biochemical parameters were continuously monitored.</p><p><b>RESULTS</b>When rats underwent heatstroke, their survival time values were found to be 21-25 min. Treatment of Gua Sha combined with Bloodletting greatly improved the survival time (230±22 min) during heatstroke. All heatstoke animals displayed and activated coagulation evidenced by increased prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, and decreased platelet count, protein C. Furthermore, the animals displayed systemic inflammation evidenced by increased the serum levels of cytokines interleukin-1ß (IL-1ß), tumor necrosis factor α (TNF-α) and malondialdehyde (MDA). Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen (BUN), creatinine, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and alkaline phosphatase (ALP) were all elevated during heatstroke. Core temperatures (Tco) were also increased during heatstroke. In contrast, the values of mean arterial pressure were signifificantly lower during heatstroke. These heatstroke reactions were all signifificantly suppressed by treatment of Gua Sha and Blood-letting, especially the combination therapy.</p><p><b>CONCLUSION</b>Gua Sha combined with Blood-letting after heatstroke may improve survival by ameliorating systemic inflflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.</p>

Effect of electroacupuncture on the pathomorphology of the sciatic nerve and the sensitization of P2X₃ receptors in the dorsal root ganglion in rats with chronic constrictive injury / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the effect of electroacupuncture (EA) on the pathomorphology of the sciatic nerve and the role of P2X3 receptors in EA analgesia.</p><p><b>METHODS</b>The chronic constriction injury (CCI) model was adopted in this study. A total of 32 rats were randomly divided into four groups: sham CCI, CCI, CCI plus contralateral EA (CCI + conEA) and CCI plus ipsilateral EA (CCI + ipsEA). Mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) were measured. EA began at day 7 after the CCI operation and was applied to the Zusanli (ST 36) and Yanglingquan acupoints (GB 34). At day 14, the pathomorphologic changes of the operated sciatic nerve were demonstrated by hematoxylin and eosin staining. In addition, dorsal root ganglion (DRG) neurons isolated from rats were examined by electrophysiological recording to determine if the P2X3 receptor agonists, adenosine 5'-triphosphate disodium (ATP) and α,β-methylen-ATP (α,β-meATP) evoked inward currents.</p><p><b>RESULTS</b>Pain thresholds in the CCI group were obviously decreased post CCI surgery (P<0.01). In the EA groups, thermal and mechanical threshold values were increased after the last EA treatment (P<0.05, P<0.01). There was no significant difference in light microscopic examination among the four groups (P>0.05). Current amplitude after application of ATP and α,β-meATP in DRG neurons were much larger in the CCI group compared to those obtained in sham CCI (P<0.05). ATP and α, β-meATP invoked amplitudes in the CCI + EA groups were reduced. There was no signififi cant difference between the CCI + conEA group and the CCI + ipsEA group (P>0.05).</p><p><b>CONCLUSION</b>EA analgesia may be mediated by decreasing the response of P2X3 receptors to the agonists ATP and α,β-meATP in the DRG of rats with CCI. No pathological changes of the sciatic nerve of rats were observed after EA treatment.</p>

Electroacupuncture for post-stroke urinary incontinence: a multi-center randomized controlled study / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of electroacupuncture(EA) for apoplectic urinary incontinence.</p><p><b>METHODS</b>Two hundred and four cases of apoplectic urinary incontinence were randomized into an EA group (136 cases) and an indwelling catheter group (68 cases). The EA was applied at Qugu (CV 2), Zhongji (CV 3), Shuidao (ST 28), Qihai (CV 6) and Guanyuan (CV 4), etc. in the EA group,5 times a week. Indwelling catheter was applied in the indwelling catheter group at intervals of 2-4 hours, and periodic bladder irrigation along with bladder rehabilitation training were also given. The efficacies were evaluated after 4 weeks of treatment. Before and after treatment, the urination diary (including the interval of urination, nocturia frequency, urination difficulty, urinary incontinence severity), bladder capacity, patients' satisfaction of the two groups were observed and the efficacy was evaluated.</p><p><b>RESULTS</b>The total effective rate was 96.2% (125/130) in the EA group, which was apparently superior to 87.5% (56/64) in the indwelling catheter group (P < 0.05); except for nocturia frequency in the indwelling catheter group, the total score and the subitem score in the urination diary were all improved significantly after treatment in both groups (all P < 0.001), which were more obvious in the EA group (P < 0.001, P < 0.05); the patients' satisfaction and bladder capacity were all improved significantly after treatment in both groups (all P < 0.001), which were more obvious in the EA group (both P < 0.001).</p><p><b>CONCLUSION</b>The EA has an obvious effect for apoplectic urinary incontinence in urinary incontinence alleviation and bladder capacity increase, which has better efficacy than indwelling catheter therapy.</p>

Anatomical characters and classification of acupoint / 中国针灸

<p><b>OBJECTIVE</b>To explore the essence of acupoints by studying its anatomical characteristics and classification.</p><p><b>METHODS</b>Based on numerous previous anatomic researches of acupoints, an adult male and a female corpses infused with red rubber at the location of acupoints were selected in order to observe the level and sectional anatomy of the acupoints, especially the specificity of the known structural distribution of acupoints.</p><p><b>RESULTS</b>(1) The distribution of acupoints has two primary elements. Firstly, it is neurovascular bundles or connective tissue containing abundant nerves and blood vessels, which has the function of qi and blood infusion. It is considered as the acupoint kernel. Secondly, it is the cleft or the tunnel that formed by bones, muscles or fascia, which is also held as the acupoint shell. Different conditions of the human body can influence the opening and closing of the shell, control as well as regulate the function of the kernel so as to regulate the qi and blood circulation. (2) Based on anatomical characteristics, acupoints can be classified into 3 types: the type of cleft, the type of tunnel, and the terminal type. Points of the cleft and tunnel types can be mainly found in the twelve regular meridians which are composed of the kernel and the shell. The points of terminal type are on the Conception Vessel, the Governor Vessel and auricular point, the superficial fascia is the confluence of cerebro-spinal nerve terminal ramus and its concomitant vessels, and it is the site where the qi and blood of meridians distribute to the body surface.</p><p><b>CONCLUSION</b>Acupoints is the pore formed by bone, muscle or fascia where neurovascular bundles or connective tissue containing abundant nerves and blood vessels pass through and the position where the terminal branch of cranial and spinal nerves and their accompanying by blood vessels emerge and converge at the supiyeficial layer of central body axis. Acupoints are the nodes and terminal point where the zang-fu organs and meridians and qi and blood infused to body surface.</p>

Characteristics of anatomical structures and clinical significance of lumbar Jiaji (EX-B 2) points / 中国针灸

<p><b>OBJECTIVE</b>To observe the anatomical structure of Jiaji (EX-B 2) points at the level of lower lumbar region so as to provide evidence for the insertion angle and depth.</p><p><b>METHODS</b>Thirty spine samples of male adults were adopted, and perpendicular insertion of the needle was applied at 3 locations including 1 cun, 0.5 cun and 0.3 cun lateral to the lower border of the spinous process of the lumbar vertebra. The needles were fixed at the local region. Structures and the adjacent major blood vessels and nerves were observed during the anatomy.</p><p><b>RESULTS</b>When the needle was inserted perpendicularly at the point 1 cun lateral to the lower border of the spinous process of the lumber vertebra with the insertion depth of (35.77 +/- 5.86) mm, the zygapophyseal joints, the adjacent osteo-fibrous canal and osteo-fibrous aperture were touched by the tip of the needle, and the medial ramus of dorsal primary ramus of spinal nerve and concomitant vessels were stimulated. Then, needles were inserted perpendicularly 0.5 cun and 0.3 cun lateral to the lower border of the spinous process of the lumber vertebra with the insertion depth of (32.89 +/- 4.79)mm for both. When needle was inserted 0.5 cun lateral, the medial ramus of dorsal primary ramus of spinal nerve and the concomitant vessels were touched by the tip of the needle at where they across the lamina periosteum and erector spinae. When needle was inserted 0.3 cun lateral, the body of the needle reached the terminal branches of the medial ramus of dorsal primary ramus of spinal nerve and the concomitant vessels through the deep paraspinal muscles and the thoracolumbar fascia.</p><p><b>CONCLUSION</b>The medial ramus of dorsal primary ramus of lumbar spinal nerve and concomitant vessels distributed at the region 1 cun, 0.5 cun and 0.3 cun beside the lower border of each lumbar spinous process. Therefore, the location of Jiaji (EX-B 2) points can be considered in the region from 0.3 cun to 1 cun beside the lower border of each spinous process.</p>

Morphologic characteristics and clinical significance of Neiguan (PC 6) / 中国针灸

<p><b>OBJECTIVE</b>To provide appropriate needling angle and depth for the acupuncture and acupoint injection at Neiguan (PC 6), and to avoid damaging nerves and vessels so as to produce its maximum effect.</p><p><b>METHODS</b>Thirty adults' upper-limb samples were used to dissect and observe the referred hierarchical structure and adjoining crucially nerves and vessels in needling Neiguan (PC 6) according to the national standard Acupoint Location (GB 12346-90).</p><p><b>RESULTS</b>In this punctuation region, there are three parts rich in connective tissues containing the nerves and blood vessels. The surface part is between the skin and the musculus flexor digitorum superficialis and it is the tissue which contains medial and lateral antebrachial cutaneous nerve and its nutrient artery. The middle part is between the musculus flexor digitorum superficialis and the flexor digitorum profundus muscle and contains the median nerve, its palmar branch of and artery. The deep part is between the pronator quadratus muscle and the interosseous membrane and contains the anterior interosseous nerve. When perpendicular needling, the depth of needling the body from skin to the superficial surface of the musculus flexor digitorum superficialis and to the superficial surface of the flexor digitorum profundus muscle is (6.68 +/- 0.64) mm and (12.37 +/- 0.87) mm respectively. The depth of needling the body from skin to the superficial surface of the pronator quadratus muscle and to the superficial surface of the anterior interosseous terminal branch of the nerves is (17.83 +/- 1.00) mm and (30.87 +/- 1.85) mm respectively, and the proportional cun is (2.20 +/- 0.14) cm. The ulnaris cord of median nerves are located at the radial of the needle. The deep layers could touch the anterior interosseous nerve ending.</p><p><b>CONCLUSION</b>Perpendicularly needling Neiguan (PC 6) for 3 fen (6.68 mm), 5 fen (12.37 mm) and 1.4 cun (30.87 mm) will stimulate the nervus vascularis of the rich part of surface, middle and deep connective tissues respectively and produce the acupuncture effect. During the acupoint injection, perforating the needle perpendicularly at the middle point of the two tendons or deviating slightly to the direction of tendon of palmaris longus can avoid the damage of the median nerve cord.</p>

Effects of acupuncture on different acupoints in combination with rehabilitation on hemiplegic muscle spasticity in hemiplegia patients / 中国针灸

<p><b>OBJECTIVE</b>To observe the clinical effect of hemiplegic muscle spasticity treated with acupuncture on different acupoints in combination with rehabilitation.</p><p><b>METHODS</b>Ninety cases of post-stroke muscle spasticity were randomized into a corresponding and central axis acupuncture group (group A), a conventional acupuncture group (group B) and a rehabilitation group (group C), 30 cases in each one. In group A, the acupoints on the Governor Vessel were mainly selected, as well as those on Hand-Shaoyang meridian and Foot-Taiyang meridian. In group B, the conventional needling and rehabilitation training were applied in combination, of which, the acupoints were mainly from Hand and Foot-Yangming meridians, associated with the acupoints of Shaoyang meridian. In group C, only rehabilitation training was applied. The assessments according to modified Ashworth scale and CSS score were performed before treatment, after 2 weeks and 4 weeks treatment respectively.</p><p><b>RESULTS</b>The level of modified Ashworth scale of the flexor of elbow and wrist was reduced apparently after treatment in group A as compared with that before treatment (P < 0.01). The level of modified Ashworth scale of the flexor of elbow was reduced apparently after treatment in group C as compared with that before treatment (P < 0.05). There was significant difference on the level change in modified Ashworth scale for the flexor of elbow between group A and group C after 4 weeks treatment (P < 0.05). CSS score decreased significantly in group A as compared with that before treatment (P < 0.01), the improvement after treatment in group A was apparent as compared with the other two groups (P < 0.01).</p><p><b>CONCLUSION</b>The corresponding and central axis acupuncture can improve muscle tone of hemiplegic limb, which is superior to the effect achieved by the conventional acupuncture in combination with rehabilitation training and the simple rehabilitation training.</p>

Study on vascular morphology of integument tissues of the channel area in the leg / 中国针灸

<p><b>OBJECTIVE</b>To observe the distribution of the blood vessels in the integument tissue of the channel area of legs.</p><p><b>METHODS</b>The integument tissue of the lower limbs in the 12 cadavers were dissected with macro-and micro-dissection, radiographical technique of systemic artery and technique of image pattern analysis to observe and analyze the origins, branches and anastomoses in the integument tissues along the channels of legs.</p><p><b>RESULTS</b>The distributional density of the blood vessels in the integument tissues of legs along the channel area of the three-yin meridians of the foot, the Gallbladder Meridian, and the Urinary Bladder Meridian was higher than that in the other parts. They formed an obvious nutrient vascular chain on the arteriogram. The distributional density in the channel area of the Stomach Meridian was not obviously increased and the obvious nutrient vascular chain could not be seen.</p><p><b>CONCLUSION</b>An obvious nutrient vascular chain is formed in the integument tissue along the channel area of legs except the Stomach Meridian.</p>

Anatomical study on Jingming (BL 1) / 中国针灸

<p><b>OBJECTIVE</b>To explore the anatomical structures, and depth and direction of needling at Jingming (BL 1), so as to provide anatomical basis for its clinical application.</p><p><b>METHODS</b>Forty-eight adult orbital specimens were observed by dissection.</p><p><b>RESULTS</b>When a needle was vertically inserted into Jingming (BL 1), the needle tip will past through the skin, subcutaneous tissue, medial palpebral ligament, medialis rectus and orbital adipose body. Above the body of the needle, there are ophthalmic artery, anterior ethmoidal artery and nasociliary nerve. The average distance between the skin at the punctured point and the anterior ethmoidal artery is (18.25 +/- 4.45) mm, with an angle of (12.5 +/- 5.5) degrees, and the average distance between the skin at the punctured point and the optic nerve tunnel frontal point is (43.37 +/- 7.84) mm.</p><p><b>CONCLUSION</b>To avoid bleeding caused by injuring the anterior ethmoidal artery, acupuncture at Jingming (BL 1) should avoid deeply inserting needled back-upwards and upwards, and the needling depth should not exceed 30.36 mm to avoid injury of the optic nerve tunnel frontal point.</p>

Study on angle and depth of needle insertion in acupuncture at Zusanli (ST 36) / 中国针灸

<p><b>OBJECTIVE</b>To provide an appropriate angle and depth of needle insertion in acupuncture at Zusanli (ST 36) and avoid injuring the nerve and blood vessel and exert the most effect.</p><p><b>METHODS</b>Eighty adult lower-limb samples were used to dissect and observe the relative layered structures and adjoining important nerves and blood vessels in needling Zusanli (ST 36) according to the national standard.</p><p><b>RESULTS</b>The needling depth from the skin to the interosseous membrane and from the skin to posterior border of tibialis posterior is (2.22 +/- 0.31) cm and (4.42 +/- 0.53) cm, respectively. There are flabellate branches of anterior tibial arteries and deep peroneal nerves around the needle in the superficial layer of interosseous membrane. The vessel and nerve bundles containing tibial nerve and posterior tibial vessels can be touched when the needle body past through tibialis posterior.</p><p><b>CONCLUSION</b>It is recommended that ideal average depth of acupuncture is 2.22 cm and the maximum depth is 4.42 cm for oblique needling Zusanli (ST 36). When it is injected, the needle should be perpendicularly inserted or deviated slightly to the direction of tibia and paralleled to medial surface of tibia. And the safe needling depth is generally less than 5 cm. The point of the body surface between tibialis anterior and extensor digitorum longus at 3 cun below Dubi (ST 35) is also an effectively stimulating point.</p>

Study on laws of clinical and basic integration acupuncture / 中国针灸

<p><b>OBJECTIVE</b>To explore effective ways of integrated clinical and basic studies.</p><p><b>METHODS</b>Try to sum up clinically basic laws of acupuncture from the study thinking of clinical and basic integration.</p><p><b>RESULTS</b>Some laws of clinical acupuncture were raised based on classical theories of the channel and a great of clinical experiences, in combination with basic studies of modern neuroanatomy and physiology.</p><p><b>CONCLUSION</b>The clinical symmetry-corresponding law, the segmental innervation law, the central-axial law, the distal limb dominance law, the law of sallow-deep correlation and the law of local feedback confirm with classical theories of the channels and clinical experiences.</p>