Application of "Sancai principle" for needle-knife treatment of bi syndrome of neck region / 中国针灸

Under the guidance of the "Sancai principle", based on the understanding of the etiology and pathogenesis of the imbalance of muscles and bones in bi syndrome of neck region, holistic treatment should be used. The needle-knife release therapy is applied at corresponding acupoints in the three parts i.e. head, neck and back including Tiancai points (Naohu [GV 17] and Naokong [GB 19]), Rencai points (neck Jiaji [EX-B 2]), and Dicai points (Dazhui [GV 14], Quyuan [SI 13] and Tianzong [SI 11]). According to the layers of the lesion's meridians and muscles, the needle-knife is inserted into skin, muscle and bone to relax the tendons and treat bone disorders, and restore the normal mechanical balance of neck.

Effect of needle-knife on chondrocyte apoptosis of knee joint in rabbits with knee osteoarthritis based on CircSERPINE2-miR-1271-5P-ERG axis / 中国针灸

OBJECTIVE@#To observe the effect of needle-knife on the chondrocyte apoptosis of knee joint in rabbits with knee osteoarthritis (KOA) based on the CircSERPINE2-miR-1271-5P-E26 specific transformation-related gene (ERG) axis, and to explore the mechanism of needle-knife for KOA.@*METHODS@#Thirty-six New Zealand white rabbits were randomly divided into a normal group, a model group, a needle-knife group and a sham needle-knife group, 9 rabbits in each group. The rabbits in the model group, the needle-knife group and the sham needle-knife group were treated with modified Videman method to prepare KOA model. After successful modeling, the rabbits in the needle-knife group were treated with needle-knife at cord adhesion and nodules near quadriceps femoris tendon and internal and external collateral ligament on the affected knee joint; the rabbits in the sham needle-knife group were treated with sham needle-knife baside the needle insertion point of the needle-knife group (needle-knife was only inserted, without any operation). The treatment was given once a week, 3 times in total. The Lequesne MG behavioral score was used to evaluate the knee joint damage in each group before and after intervention. After intervention, HE staining and transmission electron microscopy were used to observe the cartilage tissue morphology and ultrastructure of chondrocytes in the knee joint in each group; TUNEL method was used to detect the level of chondrocyte apoptosis in the knee joint; real-time fluorescence quantitative PCR was used to detect the expression of CircSERPINE2, miR-1271-5P and ERG mRNA in knee cartilage tissue in each group.@*RESULTS@#After intervention, compared with the normal group, the Lequesne MG behavioral score in the model group was increased (P<0.01). Compared with the model group and the sham needle-knife group, the Lequesne MG behavioral score in the needle-knife group was decreased (P<0.01). In the model group and the sham needle-knife group, the number of chondrocytes and organelles was decreased, the cell nucleus was shrunk, mitochondria was swelling or disappeared; in the needle-knife group, the number of chondrocytes and organelles was increased, the cell nucleus was not obviously shrunk and the mitochondria was not obviously swelling. Compared with the normal group, the level of chondrocyte apoptosis in the model group was increased (P<0.01); compared with the model group and the sham needle-knife group, the level of chondrocyte apoptosis in the needle-knife group was decreased (P<0.01, P<0.05). Compared with the normal group, the expression of CircSERPINE2 and ERG mRNA in the model group was decreased (P<0.01), and the expression of miR-1271-5P mRNA was increased (P<0.01); compared with the model group and the sham needle-knife group, the expression of CircSERPINE2 and ERG mRNA in the needle-knife group was increased (P<0.01), and the expression of miR-1271-5P mRNA was decreased (P<0.01).@*CONCLUSION@#Needle-knife could reduce the knee joint damage and chondrocyte apoptosis in KOA rabbits, which may be related to up-regulating the expression of CircSERPINE2 and ERG mRNA, and inhibiting the expression of miR-1271-5P mRNA.

Effect of needle knife on mTOR/Atg/ULK1/Beclin-1 axis and chondrocyte autophagy in rats with knee osteoarthritis / 中国针灸

OBJECTIVE@#To observe the effect of needle knife on chondrocyte autophagy and expressions of autophagy-related protein and mammalian target of rapamycin (mTOR) in rats with knee osteoarthritis (KOA), and to explore the possible mechanism of needle knife for KOA.@*METHODS@#A total of 42 SD rats were randomly divided into a normal group, a model group and a needle knife group, 14 rats in each group. Except for the normal group, the other two groups were injected with the mixture of papain and L-cysteine into the left hind knee joint to establish the KOA model. After modeling, the rats in the needle knife group were treated with needle knife at strip or nodule around the quadriceps femoris and medial and lateral collateral ligament on the affected side, once a week for 3 times (3 weeks). The changes of left knee circumference in each group were observed; the chondrocytes and ultrastructure of left knee joint were observed by HE staining and electron microscope; the mRNA and protein expressions of autophagy-related genes (Atg5, Atg12, Atg4a), Unc-51 like autophagy activated kinase 1 (ULK1), autophagy gene Beclin-1 and mTOR in left knee cartilage were detected by real-time fluorescence quantitative PCR and Western blot.@*RESULTS@#After modeling, the left knee circumferences in the model group and the needle knife group were increased compared with those before modeling and in the normal group (P<0.05); after intervention, the left knee circumference in the needle knife group was smaller than that in the model group and after modeling (P<0.05). Compared with the normal group, the number of chondrocytes was decreased, and a few cells swelled, nuclei shrank, mitochondria swelled and autophagosomes decreased in the model group; compared with the model group, the number of chondrocytes was increased , and most cell structures returned to normal, and autophagosomes was increased. Compared with the normal group, the mRNA and protein expressions of Atg5, Atg12, Atg4a, Beclin-1 and ULK1 in the knee cartilage in the model group were decreased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were increased (P<0.05). Compared with the normal group, the mRNA and protein expressions of mTOR in the knee cartilage in the model group were increased (P<0.05); compared with the model group, the expressions of the above indexes in the needle knife group were decreased (P<0.05).@*CONCLUSION@#The needle knife intervention could improve knee cartilage injury in rats with KOA, and its mechanism may be related to reducing the expression of mTOR and up-regulating the expressions of Atg5, Atg12, Atg4a, ULK1 and Beclin-1, so as to promote chondrocyte autophagy and delay the aging and degeneration of chondrocytes.

Different entry points of needle knife for lumbar disc herniation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).@*METHODS@#A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.@*RESULTS@#Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.@*CONCLUSION@#The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.

Microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome / 中国基层医药

Objective:To investigate the clinical efficacy of microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome. Methods:110 patients with lumbar and dorsal myofascial pain syndrome who received treatment between February 2019 and August 2020 in Haining People's Hospital were included in this study. They were randomly assigned to receive either electroacupuncture (control group, n = 55) or microacupotomy combined with Du pulse acupuncture (observation group, n = 55). Therapeutic effects were compared between the control and observation groups. Results:Before treatment, there were no significant differences in tenderness and Visual Analogue Scale scores between the control and observation groups (both P > 0.05). After treatment, tenderness and VAS scores in the observation group were (0.81 ± 0.11) points and (2.36 ± 0.25) points, respectively, which were significantly lower than those in the control group [(1.31 ± 0.10) points, (3.34 ± 0.19) points, t = 24.943 and 23.146, both P < 0.001]. Effective rate in the observation group was significantly higher than that in the control group [98.18% (54/55) vs. 81.82% (45/55), χ2 = 8.182, P < 0.05]. After treatment, tenderness scores of the gluteus medius, psoas quadratus and multifidus muscles in each group were increased, and these scores in the observation group were significantly higher than those in the control group ( t = 3.937, 2.963 and 3.633, all P < 0.05). Conclusion:Microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome can effectively decrease the degree of pain and strengthen clinical therapeutic effects.

Ultrasound anatomy and needle-knife insertion approach of common tendon lesions in knee osteoarthritis based on meridian sinew theory / 中国针灸

OBJECTIVE@#To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.@*METHODS@#Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.@*RESULTS@#The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.@*CONCLUSION@#The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.

Effect of needle-knife as adjunctive therapy on dry eye syndrome / 中国针灸

OBJECTIVE@#To observe the clinical effect of needle-knife at cervical spine area as adjunctive therapy on dry eye syndrome.@*METHODS@#A total of 84 patients with dry eye syndrome were randomized into 3 groups, named group A, group B and group C, 28 cases in each one (1 case dropped off in the group A, 2 cases dropped off in both group B and C). In the group A, needle-knife was applied at the margo inferior of external occipital protuberance, the range of 4 cm bilateral to external occipital protuberance, the spinous process of C, the range of 3 cm bilateral to 2 cm above C spinous process, the range of 2 cm bilateral to C, C, C spinous process for once a week; acupuncture was applied at Jingming (BL 1), Cuanzhu (BL 2), Zusanli (ST 36), Sanyinjiao (SP 6), Taixi (KI 3), Yanglao (SI 6), Ganshu (BL 18), Shenshu (BL 23), etc. for once a day, 6 times a week; sodium hyaluronate eye drop was given one drop once, 5-6 times a day. Treatment of acupuncture and sodium hyaluronate eye drop was given in the group B, sodium hyaluronate eye drop was given in the group C, the acupoints selection and the manipulation of acupuncture, the dosage of sodium hyaluronate eye drop were the same as the group A. One week was as one course and 3 courses were required in the 3 groups. SchirmerⅠtest (SⅠT), break-up time (BUT), scores of corneal fluorescein staining (CFS) and eye symptom before and after treatment were observed, the clinical effect was evaluated in the 3 groups.@*RESULTS@#SⅠT was increased, BUT was prolonged, scores of CFS and eye symptom were reduced after treatment in the group A and group B (<0.01); scores of CFS and eye symptom were reduced after treatment in the group C (<0.01). The variations of SⅠT, BUT and the scores of CFS and eye symptom in the group A were greater than those in the group B and the group C (<0.01); the variations of above indexes in the group B were greater than those in the group C (<0.05, <0.01). The total effective rate was 94.4% (51/54) in the group A, which was superior to 78.8% (41/52) in the group B and 48.1% (25/52) in the group C (<0.01), and the total effective rate in the group B was superior to the group C (<0.01).@*CONCLUSION@#Needle-knife at cervical spine area as adjunctive therapy can relieve the clinical symptoms and improve the function of lacrimal gland in patients with dry eye syndrome.

Needle-knife therapy combined with intra-articuiar injection of salvia injection for treating osteoarthritis in rabbit models / 中国组织工程研究

BACKGROUND: Salvia injection and needle-knife therapy are commonly used techniques in the treatment of osteoarthritis in clinical practice. At present, there is no research on the combination of the two methods. OBJECTIVE: To compare the effects of needle-knife therapy and salvia injection and their combinations in the treatment of osteoarthritis in rabbit models. METHODS: The study was approved by the Laboratory Animal Ethical Committee of Heilongjiang University of Chinese Medicine. Fifty New Zealand white rabbits were divided into five groups: Blank control, model, salvia injection, needle-knife, and combination groups. The rat models of osteoarthritis were established in all groups except for blank control group. After successful modeling, medial and lateral patellar retinaculums, medial and lateral knee eyes, suprapatellar bursa, muscle belly of each quadriceps femoris, muscle belly and ending point of gracilis, muscle belly and ending point of adductor and area surrounding the tibial plateau of rats in the needle-knife group received needle-knife release. The rabbits in the blank control and model groups underwent the intra-articuiar injection of normal saline (0.3 mL). The rabbits in the salvia injection group were given the intra-articuiar injection of salvia (0.3 mL). The rabbits in the combination group received needle-knife release, followed by intra-articuiar injection of salvia (0.3 mL). All interventions were conducted weekly, for 5 consecutive weeks. The knee articular cartilage underwent gross observation and histological observation. The levels of interleukin-1 and tumor necrosis factor-alpha in synovial fluid were detected by ELISA. RESULTS AND CONCLUSION: (1) Gross observation: The worn artificial knee in the model group was serious, and was slight in the salvia injection, needle-knife, and combination groups. (2) Pathological scores: The scores in the salvia injection group were slightly higher than those in the needle-knife and combination groups. (3) ELISA results: The levels of interleukin-1 and tumor necrosis factor-alpha in the combination group were significantly lower than those in the salvia injection and needle-knife groups (P < 0.05). (4) In summary, needle-knife therapy combined with intra-articuiar injection of salvia is superior to needle-knife therapy alone or intra-articuiar injection of salvia in reducing the levels of interleukin-1 and tumor necrosis factor-alpha in rabbit models of osteoarthritis.

Effect of needle knife intervention on tensile mechanics of femoral quadriceps tendon in rabbits with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To observe the effects of acupotomy intervention on the behavior, morphology and tensile mechanics of knee osteoarthritis (KOA) rabbits, and to explore the biomechanical effects of acupotomy on KOA.@*METHODS@#Twenty-four New Zealand male rabbits were randomly divided into four groups: normal group, model group, electroacupuncture group and needle-knife group, with 6 rabbits in each group. In each model group, rabbit KOA model was established by fixing Videman's left hind limb in straight position for 6 weeks. In the electroacupuncture group, rats were treated left on Liang Qiu, Xue Hai, Nei Xi Yan and Wai Xi Yan 3 times a week for 3 weeks. In the acupotomology group, the left quadriceps femoris tendon was released with acupotomology, and the treatment was once a week for 3 weeks. Behavioral tests were performed using Lequesne MG knee joint evaluation method one week after the end of modeling and one week after the end of treatment, and HE staining and mechanical tests were performed one week after the end of treatment.@*RESULTS@#Behavioral observation before treatment showed that there were significant differences in local pain, gait response, joint activity and joint swelling between the normal group and the model group(0.05). After treatment, the results showed that there were significant differences in local pain, gait response, joint activity and joint swelling among model group, electro-acupuncture group and needle-knife group compared with normal group(0.05); there was significant difference between needle knife group and model group(0.05). In gait change, there was significant difference between model group and electro-acupuncture group(0.05). In joint activity, there was significant difference between electro-acupuncture group and model group(0.05). Mechanics: Compared with the blank group, the ultimate load of the model group decreased significantly(0.05), and the ultimate load of the needle-knife group increased(>0.05). Compared with the model group, the ultimate load of the electro-acupuncture group increased significantly(0.05). Compared with the blank group, the maximum displacement of the model group decreased significantly(0.05). Compared with the model group, the maximum displacement of the electro-acupuncture group increased(>0.05), and the maximum displacement of the needle-knife group increased significantly(0.05). There was no significant difference in stiffness among groups(>0.05).@*CONCLUSIONS@#Acupotomy intervention can significantly change the behavior and morphology, significantly improve the mechanical properties of quadriceps femoris tendon stretch, and exert its biomechanical effects to achieve the purpose of treating KOA.

Observation on therapeutic effect of needle-knife for dry mouth and eyes symptoms of primary Sjögren's syndrome / 中国针灸

OBJECTIVE@#To compare the clinical efficacy of needle-knife and hydroxychloroquine sulfate in the treatment of dry mouth and eyes symptoms of primary Sjögren's syndrome.@*METHODS@#A total of 60 patients with primary Sjögren's syndrome were randomly divided into an observation group and a control group, 30 cases in each group. In the observation group, needle-knife was used in the range of 2 cm and 2-3 cm below the occipital protuberance, the left and right lateral bone edges of the C spinous process, between and within the range of 1.5-3 cm beside the C and C spinous processes, points between the left and right mandibular angle and the mastoid, the treatment was given 1 time a week for 8 times. The hydroxychloroquine sulfate was applied 0.2 g each time, 2 times daily, 4 weeks as a course and a total of 2 courses in the control group. The changes of salivary flow rate, tear volume, serum immunoglobulin IgG, IgA, IgM contents and Chinese medicine symptom score were observed before and after treatment in the two groups, and the efficacy was evaluated.@*RESULTS@#The total effective rate in the observation group was 86.7% (26/30), which was better than 70.0% (21/30) in the control group (0.05).@*CONCLUSION@#Needle-knife is superior to hydroxychloroquine sulfate in improving dry mouth and eyes symptoms and reducing serum IgG content in patients with primary Sjögren's syndrome.

Treatment of degenerative medial meniscus injury of knee joint by arthroscopy combined with small needle knife to release superficial medial collateral ligament of knee joint / 中国骨伤

OBJECTIVE@#To explore the clinical effect of arthroscopic combined with small needle knife in the treatment of degenerative medial meniscus (MM) injury of knee joint by releasing the superficial layer of medial collateral ligament (SMCL).@*METHODS@#From February 2016 to November 2018, 56 patients (56 knees) with limited pain, strangulation and flexion in medial knee joint space were selected. X-ray Kellgren-Lawrence grading was I-II. MRI showed medial meniscus injury(III degree) of knee joint. There were 30 males(30 knees) and 26 females(26 knees). Arthroscopic MM plasty and small needle knife were used to release SMCL. The Lysholm knee score was used to evaluate the effect of operation.@*RESULTS@#All 56 patients were followed up, and the duration ranged from 3 to 24 months, with an average of 10 months. According to the Lysholm knee score standard, the final follow-up was compared with that of before operation. The results showed that the preoperative knee score was 37.24±1.32, the latest follow-up knee score was 85.72±5.28, the knee score was higher than that before the operation(<0.05).@*CONCLUSIONS@#Arthroscopy combined with small needle knife release of superficial medial collateral ligament in the treatment of degenerative medial knee meniscus injury can effectively improve the mechanical balance of the knee joint, improve Lysholm knee score in patients with knee meniscus injury, and promote the recovery of knee joint function, which has clinical value.

Effect of the small needle knife through the Zusanli(ST 36) on behavior and hippocampal expression of NLRP3 and IL-1β in myalgia comorbid depressed rats / 中国骨伤

OBJECTIVE@#To observe the effect of the small needle knife through the Zusanli(ST 36) on behavior and hippocampal expression of NLRP3 and IL-1β in myalgia comorbid depressed rats.@*METHODS@#The rat models of myalgia comorbid depression were prepared by intraperitoneal injection of acute reserpine. Twenty-four SD male rats were randomly divided into control group, model group, small needle knife group and amitriptyline group, 6 rats in each group. The open field behavior and mechanical pain threshold of each group were detected. The thermal pain threshold was detected by intelligent hot plate test. The expression of NLRP3 and IL-1β in hippocampus of rats was detected by Western blotting.@*RESULTS@#Compared with the model group, the mechanical pain threshold of the foot was significantly improved in the small needle knife group (0.05). The expressions of NLRP3 and IL-1β in the hippocampus of the model group were significantly increased(0.05).@*CONCLUSIONS@#Small needle knife can improve the pathological state of myalgia comorbid depression caused by reserpine in rats. The mechanism may be related to the inhibition of NLRP3 inflammasome and IL-1β expression in central hippocampus.

Ultrasound-guided needle-knife for trigger finger / 中国针灸

OBJECTIVE@#To explore the efficacy of ultrasound-guided needle-knife with precise three-dimensional stereotactic localization of points for stenosing tenosynovitis of flexor tendon (trigger finger).@*METHODS@#A total of 74 patients were randomly divided into an observation group and a control group, 37 cases in each group. The patients in the observation group were treated with ultrasound-guided intrathecal injection and releasing method of needle-knife, while the patients in the control group were treated with ultrasound-guided intrathecal injection. The self-made 9-score scale of trigger finger was recorded before treatment, immediately after treatment, 1 month and 3 months after treatment; the curative effect of the two groups was evaluated.@*RESULTS@#The results of self-made 9-score scale in the observation group immediately after treatment, 1 month and 3 months after treatment were lower than that before treatment (all <0.01); the scores in the observation group were lower than those in the control group at each time point after treatment (all <0.01). The excellent and good rate immediately after treatment was 100.0% (37/37) in the observation group, which was superior to 8.1% (3/37) in the control group (<0.05); the cured rates in the observation group were 100.0% (37/37) 1 month after treatment and 97.3% (36/37) 3 months after treatment, which were superior to 13.5% (5/37) and 10.8% (4/37) in the control group, respectively (<0.05).@*CONCLUSION@#The needle-knife with three-dimensional stereotaxic location of point could significantly improve the symptoms of trigger finger, with superior immediate and long-term efficacy.

Phosphorylated Focal Adhesion Kinase, Phosphinositides 3 Kinase and Aggrecan Genes and Proteins in Cartilage Cells Are Probably Involved in Needle Knife Intervention Induced Improvement of Knee Osteoarthritis in Rabbits / 针刺研究

OBJECTIVE: We have demonstrated that needle knife (acupotomy) treatment can improve knee osteoarthritis (KOA) in rabbits. The present study was designed to examine its effect on expression of phosphorylated focal adhesion kinase (p-FAK), phosphinositides 3 kinase (p-PI 3 K) and Aggrecan genes and proteins in the knee-joint cartilage tissues of KOA rabbits, so as to explore its partial molecular mechanism underlying improvement of KOA. METHODS: Forty-nine New Zealand male rabbits were randomly divided into normal control, model, model +inhibitor, needle knife, needle knife+ inhibitor, electroacupuncture (EA), EA +inhibitor groups (n=7 in each). The KOA model was established by modified Videman method (left hindlimb extension immobilization and ankle dorsal flexion 60°). Acupotomy relaxing manipulation was applied to the lateral collateral ligament and patellar ligament of the left knee-joint, two times a week for 4 weeks, and EA (2 Hz/100 Hz, 3 mA) was applied to the left "Liangmen" (ST 21), "Xuehai" (SP 10), "Neixiyan " (EX-LE 4) and "Dubi" (ST 35) for 20 min, three times a week, for 4 weeks. About 2 h before every needle-knife or EA treatment or at the corresponding time-point, intra-articular cavity injection of PF-562271(a specific antagonist of FAK, 200 μmol/L, 0.5 mL)was performed in the three inhibitor groups. The expression levels of p-FAK, p-PI 3 K, Aggrecan genes and proteins in the cartilage tissues were measured with quantitative Real-time PCR and Western blot, separately. RESULTS: After modeling, the expression levels of p-FAK and p-PI 3 K genes and proteins were significantly up-regulated (P<0.05, P<0.01), while those of Aggrecan protein and mRNA considerably down-regulated in the model group in comparison with the normal group (P<0.01). Following 4 weeks' needle-knife or EA treatment, the expression levels of p-FAK and p-PI 3 K and Aggrecan proteins in both EA and needle-knife groups, and Aggrecan mRNA in the needle knife group were significantly up-regulated (P<0.05, P<0.01). After administration of p-FAK antagonist, modeling-induced upregulation of expression of p-FAK mRNA and protein and p-PI 3 K protein, as well as modeling-induced down-regulation of Aggrecan mRNA and protein were significantly suppressed in the model+inhibitor group (P<0.05, P<0.01), and needle knife-induced and EA-induced up-regulation of expression of p-FAK, p-PI 3 K and Aggrecan mRNAs and proteins was notably suppressed respectively in comparison with the needle knife and EA groups (P<0.05, P<0.01). The effect of needle knife was significantly superior to that of EA in up-regulating p-PI 3 K and Aggrecan mRNAs as well as p-FAK, p-PI 3 K and Aggrecan proteins (P<0.05, P<0.01). CONCLUSION: Needle knife intervention can up-regulate the expression levels of p-FAK, p-PI 3 K and Aggrecan proteins and mRNAs in the cartilage tissue of the knee-joint in KOA rabbits, suggesting an involvement of FAK-PI 3 K signaling in the needle knife-induced improvement of KOA.

Clinical Observations on Knife Needle Microinvasive Operation for Cervical Spondylotic Arteriopathy / 上海针灸杂志

Objective To investigate the clinical efficacy of knife needle microinvasive operation for cervical spondylotic arteriopathy. Method Sixty patients with cervical spondylotic arteriopathy were randomized, in order of admission times, to observation and control groups, 30 cases each. The observation group received three-step knife needle microinvasive operation and the control group, single suboccipital deltoid muscle lysis. The therapeutic effects were compared between the two groups of patients. Result In the two groups of patients the score changed significantly at the end of and three months after treatment compared with before and had a tendency towards gradual increase (P<0.05). The score difference values between pre-treatment and post-treatment and between post-treatment and three-month follow-up were significantly higher in the observation group than in the control group (P<0.05). Repeated measurement analysis integrogram showed significant differences in the scores between the two groups. The total efficacy rate was significantly higher in the observation group (96.7%) than in the control group (76.7%) (P<0.05). Conclusion Knife needle microinvasive operation has clinically a marked therapeutic effect on cervical spondylotic arteriopathy.

Is the Isolated-Tip Needle-Knife Precut as Effective as Conventional Precut Fistulotomy in Difficult Biliary Cannulation?

BACKGROUND/AIMS: Needle-knife precut fistulotomy (NK-F) is a well-known freehand technique for difficult biliary cannulation (DBC). Another approach involves the use of Iso-Tome®, a modified precutting device with an insulated needle tip to prevent direct thermal injury. This comparative study aimed to evaluate the efficacy of the Iso-Tome® precut (IT-P) compared to that of NK-F for DBC. METHODS: Patients with a naive papilla who underwent early IT-P or NK-F for DBC were enrolled. DBC was defined as failure to achieve selective biliary access by wire-guided cannulation despite 5 minutes of attempted cannulation, ≥5 papillary contacts, or a hook-nose-shaped papilla. The primary endpoint was the primary technical success rate, which was based on a noninferiority model. RESULTS: A total of 239 DBC cases were enrolled. The primary technical success rates were 74.7% (89/119) in the IT-P group and 91.6% (110/120) in the NK-F group (lower limit of 90% confidence interval, −0.23; p=0.927 for a noninferiority margin of 10%). The total technical success rates were 87.4% and 95.0%, respectively (p=0.038). The mean precutting times for successful biliary access were 11.2 minutes for IT-P and 7.3 minutes for NK-F (p < 0.01). The procedure-related adverse event rates were 9.2% for IT-P and 5.8% for NK-F (p=0.318). The rates of post-endoscopic retrograde cholangiopancreatography pancreatitis were 4.2% and 2.5%, respectively (p=0.499). CONCLUSIONS: IT-P failed to exhibit noninferiority compared with NK-F regarding the primary technical success rate of DBC, but there was no difference in the frequency of adverse events.

Treatment of Clunial Nerve Entrapment Syndrome with Needle Knife Based on Principle of "Staging, Segmenting and Layering" / 中国中医药信息杂志

Treatment of clunial nerve entrapment syndrome with needle knife has the advantages of quick efficacy and easy application. However, because of the surgeons' lack of knowledge of the disease and the operation of different proficiency, there are differences in the treatment effects. This article introduced the guidance principle of"staging, segmenting and layering", which can improve the efficacy during treatment and be beneficial to the clinical application of all levels of clinical doctors.

Clinical Study on Tendons Layer Overall Release Treatment by Needle Knife for Third Lumbar Transverse Process Syndrome / 中国中医药信息杂志

Objective To observe the clinical efficacy of tendons layer overall release treatment by needle knife for the third lumbar transverse process syndrome (TLTPS). Methods Totally 66 cases of TLTPS patients were divided into control group and experimental groups by using random number table method, with 33 cases in each group. L3 spinous process opened 3 cm looking for tenderness. Control group received lumbar transverse pressure tender point knife release treatment. On the basis of control group, experimental group received tendons layer overall release treatment by needle knife. Both control group and experimental group received treatment once. VAS and ODI before treatment and after treatment of 1, 2 and 3 months were observed. Clinical efficacy was evaluated. Adverse reactions and complications were observed. Results The experimental group and control group lost 1 and 2 cases, respectively. Compared with before treatment, the VAS and ODI in both groups after treatment decreased (P<0.05). After treatment, the VAS and ODI in the experimental group were lower than those of the control group, with statistical significance (P<0.05). The total effective rate of clinical efficacy was 96.88% (31/32) in the experimental group and 93.55% (29/31) in the control group, with experimental group better than the control group (Z=-2.756, P=0.006). There were no adverse reactions or complications in both groups. Conclusion Tendons layer overall release treatment combined with lumbar transverse pressure tender point knife release treatment for TLTPS can significantly improve the clinical efficacy of TLTPS, with long effects.

A retrospective study of emergency endoscopic needle-knife sphincterotomy for acute severe cholangitis resulting from impacted common bile duct stones at duodenal papilla / 中华消化内镜杂志

Objective To evaluate the application value of emergency endoscopic needle-knife sphincterotomy(NKS) on acute cholangitis of severe type (ACST) resulting from impacted common bile duct stones at duodenal papilla. Methods A retrospective study was performed on the data of 90 ACST cases with impacted common bile duct stones at the native papilla and undergoing emergency NKS between January 2011 and January 2017 in Tianjin Nankai Hospital. The completion of treatment, mean operating time, impacted stone clearance rate, changes of laboratory indexes before and after endoscopic procedure, and complications were analyzed. Results All the 90 patients underwent emergency NKS successfully, with a total success rate of 100. 0％. The mean operating time was 25. 2±11. 7 min. The impacted stone clearance rate was 95. 6％(86/90). The complication rate was 5. 6％(5/90), including 3 cases of hemorrhage and 2 cases of post-ERCP pancreatitis. There was no procedure-related mortality. The postoperative white blood cell count, serum procalcitonin, total bilirubin, direct bilirubin, and glutamic-pyruvic transaminase decreased significantly compared with pre-operation ( all P<0. 001) . Conclusion Emergency NKS is effective and safe for treatment of ACST resulting from impacted common bile duct stones at duodenal papilla with a relative high application value.

Needle-knife therapy combined with moxa stick pressure moxibustion for cervical vertigo: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the effect difference between needle-knife therapy combined with moxa stick pressure moxibustion and western medicine for cervical vertigo.@*METHODS@#A total of 60 cervical vertigo patients were randomized into an observation group and a control group, 30 cases in each group. The patients in the observation group were treated with needle-knife therapy combined with moxa stick pressure moxibustion at Baihui (GV 20), Shenting (GV 24), Tianzhu (BL 10), Yuzhen (BL 9), Touwei (ST 8), etc. The needle-knife therapy was given once a week, 1-3 times. The pressure moxibustion was given once a day, 6 times a week. The patients in the control group were received 12 mg of betahistine mesylate, twice a day, and 75 mg of diclofenac sodium double release capsule, once daily for oral treatment. The treatment was given for 3 weeks in both groups. The symptom and functional evaluation scale of cervical vertigo were observed before and after treatment and 3 months after treatment. The long-term effect was observed 3 months after treatment.@*RESULTS@#The total effective rate in the observation group was 93.3% (28/30), which was significantly higher than 63.3% (19/30) in the control group (<0.05). Compared with those before treatment, the scores of vertigo symptom and functional evaluation scale, dizziness, neck and shoulder pain, headache, daily life, psychological and social adaptability were increased in the two groups (<0.05, <0.01). Except for a slight decrease in headache and total score at the follow-up period in the observation group, the remaining 4 individual scores were higher than those after treatment (all <0.05). At follow-up, the total score and five individual scores were lower than those after treatment in the control group (<0.05, <0.01). Compared with those in the control group, the vertigo scale scores and the five individual scores in the observation group were increased significantly after treatment and at follow-up (<0.05, <0.01).@*CONCLUSION@#Needle-knife therapy combined with moxa stick pressure moxibustion can significantly relieve dizziness, headache, neck and shoulder pain in patients with CV, and can improve the quality of life . The combination therapy are better than western medicine, and have a better long-term effect.