[Mechanism of acupotomy on chondrocyte ferroptosis in rabbits with knee osteoarthritis based on HSPA5/GPX4 signaling pathway].

OBJECTIVE: To observe the effect of acupotomy on heat shock protein A family member 5 (HSPA5)/glutathione peroxidase 4 (GPX4) signaling pathway in the chondrocytes of the rabbits with knee osteoarthritis (KOA) and explore the mechanism of acupotomy on chondrocyte ferroptosis in KOA. METHODS: Twenty-seven New Zealand rabbits were randomly divided into a normal group, a model group and an acupotomy group, with 9 rabbits in each group. The left hind limb was fixed by the modified Videman method for 6 weeks to establish KOA model. After modeling, acupotomy was given in the acupotomy group, once a week and for consecutive 3 weeks. Using Lequesne MG score, the local symptoms, physical signs and functions of knee joint were evaluated. With HE staining and saffrane-solid green staining adopted, the morphology of chondrocytes and cartilage tissue was observed. Under transmission electron microscope, the mitochondrial structure of chondrocytes was observed. The iron content of cartilage tissue was detected by iron ion kit. The mitochondrial membrane potential (Δψm) and the reactive oxygen species (ROS) level in cartilage tissue were determined by flow cytometry, and the mitochondrial damage rate was calculated. The mRNA expression of HSPA5, GPX4, type Ⅱ collagen α1 chain (COL2A1), matrix metalloproteinases (MMP) 3 and MMP13 was detected by the real-time quantitative PCR; and the protein expression of HSPA5, GPX4, type Ⅱ collagen (COL-Ⅱ), MMP3 and MMP13 was detected by Western blot. The mean flourscence intensity of HSPA5 and GPX4 in cartilage tissue was determined by immunofluorescence. RESULTS: Before intervention, compared with the normal group, the Lequesne MG scores were increased in the model group and the acupotomy group (P<0.01). After intervention, the Lequesne MG score in the acupotomy group was decreased when compared with that in the model group. In comparison with that in the normal group, the number of chondrocytes was reduced and the cells were disarranged; the layers of cartilage structure were unclear, the tide lines disordered and blurred; the mitochondria were wrinkled and the mitochondrial crista decreased or even disappeared in the model group. Compared with the model group, the number of chondrocytes was increased, the layers of cartilage structure were clear, the tide lines recovered, the number of mitochondria elevated, with normal structure and more crista in the acupotomy group. The iron content of cartilage tissue was increased (P<0.01), the Δψm of chondrocytes was declined, the mitochondrial damage rate was increased (P<0.01), the average fluorescence intensity of ROS was increased (P<0.01); the mRNA and corresponding protein expression of HSPA5, GPX4 and COL2A1 was decreased (P<0.01), the mRNA and protein expression of MMP3 and MMP13 was increased (P<0.01) and the average fluorescence intensity of HSPA5, GPX4 was decreased (P<0.01) in the model group when compared with those in the normal group. Compared with the model group, the iron content in cartilage tissue was reduced (P<0.01), the Δψm of chondrocytes was increased, the mitochondrial damage rate was decreased (P<0.01), and the average fluorescence intensity of ROS was decreased (P<0.01); the mRNA and corresponding protein expression of HSPA5, GPX4 and COL2A1 was higher (P<0.01), and the mRNA and protein expression of MMP3 and MMP13 was lower, and the average fluorescence intensity of HSPA5, GPX4 was increased (P<0.01) in the acupotomy group. CONCLUSION: Acupotomy can alleviate cartilage injury of KOA rabbits, and its mechanism may be related to the regulation of HSPA5/GPX4 signaling pathway to maintain iron homeostasis in articular cartilage, thus inhibiting chondrocyte ferroptosis and relieving extracellular matrix degradation.

Operation Procedure and Precautions of Lingnan Fire-Needle Therapy in Osteoporosis Model Rats.

Compared to filiform needle therapy, fire-needle therapy has both the stimulation of needles and the warming effect of heat, making it have unexpected effects on some chronic diseases and incurable diseases. Osteoporosis (OP) has a high incidence in postmenopausal women and middle-aged and elderly men, and the treatment cycle is long. According to Traditional Chinese Medicine (TCM), Lingnan fire-needle therapy has shown potential in treating osteoporosis. However, there is still a long way to go before it can be widely used. This article focuses on the application of Lingnan fire-needle therapy in the intervention of OP in rats. It covers the selection of needle tools, acupuncture point selection, positioning of rats' bodies, and fixation methods. We also outline the steps and precautions to be taken during and after needling with fire needles. The experiment was done with three groups: a normal group, a model group, and a fire-needle group, each containing 10 rats. The rats in the fire-needle group were treated with fire-needle intervention for six sessions. After the intervention period, we collected femoral specimens and performed micro-CT scans. The results suggest that fire needling can enhance bone morphology and mineral density in OP rats. This information can serve as a methodological basis for conducting basic research on fire-needle therapy.

[Exploring the treatment strategy of liver-regulating wood-softening acupuncture method for psoriasis vulgaris based on the theory of "liver as the thief of five organs"].

Inspired by the theory of "liver as the thief of five organs", the authors believe that although psoriasis vulgaris manifests externally, its root cause lies internally in liver disharmony. During the active and stable phases, conventional acupuncture combined with liver-regulating wood-softening acupuncture method is used to regulate blood and harmonize the liver, addressing both the symptoms and the root cause. During the remission phase, liver-regulating wood-softening acupuncture method is employed to soothe the liver and restrain the yin, while also regulating and nurturing the emotional state. This study provides a clinical approach to acupuncture treatment for psoriasis vulgaris.

Press Needle: A Traditional Chinese Medicine Therapy for Myopia Patients with Dry Eye.

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with myopia. Needle prickling has been shown to be effective in providing symptom relief in patients with myopia and dry eye. Press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. The standard practice of needle insertion is very important for the treatment of myopia and dry eye. The specific steps include selecting the appropriate acupoints, piercing them with appropriate needles, and fixing them in the skin or subcutaneously at the acupoints, burying them for 2 days, resting for 1 day; the course of treatment lasts for 2 weeks. Specifically, the following indicators were assessed: uncorrected visual acuity and the ocular surface disease index. This article will explain how to standardize the operation of a press needle in the treatment of myopia and dry eye.

Plum-blossom needle tapping enhances the efficacy of ALA photodynamic therapy for facial actinic keratosis in Chinese population: a randomized, multicenter, prospective, and observer-blind study.

BACKGROUND: Photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) is a reliable treatment for actinic keratosis (AK), but its effect needs to be enhanced in thick lesions. Plum-blossom needle is a traditional Chinese cost-effective instrument for enhancing the transdermal delivery of ALA. However, whether it could improve the efficacy of AK treatment has not yet been investigated. OBJECTIVE: To compare the efficacy and safety of plum-blossom needle-assisted PDT in facial AK in the Chinese population. METHODS: In this multicenter, prospective study, a total of 142 patients with AKs (grades I-III) were randomized into the plum-blossom needle-assisted PDT group (P-PDT) and control PDT group (C-PDT). In the P-PDT group, each AK lesion was tapped vertically by a plum-blossom needle before the application of 10% ALA cream. In the C-PDT group, each lesion was only wiped with regular saline before ALA cream incubation. Then, 3 hours later, all the lesions were irradiated with light-emitting diode (LED) at a wavelength of 630 nm. PDT was performed once every 2 weeks until all lesion patients achieved complete remission or completed six sessions. The efficacy (lesion response) and safety (pain scale and adverse events) in both groups were evaluated before each treatment and at every follow-up visit at 3-month intervals until 12 months. RESULTS: In the P-PDT and C-PDT groups, the clearance rates for all AK lesions after the first treatment were 57.9% and 48.0%, respectively (P < 0.05). For grade I AK lesions, the clearance rates were 56.5% and 50.4%, respectively (P = 0.34). For grade II AK lesions, the clearance rates were 58.0% and 48.9%, respectively (P = 0.1). For grade III AK lesions, the clearance rates were 59.0% and 44.2%, respectively (P < 0.05). Moreover, grade III AK lesions in the P-PDT group required fewer treatment sessions (P < 0.05). There was no significant difference in the pain score between the two groups (P = 0.752). CONCLUSION: Plum-blossom needle tapping may enhance the efficacy of ALA-PDT by facilitating ALA delivery in the treatment of AK.

Práticas integrativas e complementares na odontologia / Integrative and complementary practices in dentistry / Prácticas integradoras y complementarias en odontología

As Práticas Integrativas e Complementares (PICs) apresentam-se como métodos coadjuvantes, auxiliando na obtenção de sucesso em determinados tratamentos clínicos e/ou cirúrgicos, atuando na prevenção, auxiliando na cura e no equilíbrio psicossomático com a finalidade de reestabelecer concordância entre mente e corpo. O Conselho Federal de Odontologia (CFO) regulamentou práticas como acupuntura, hipnose, terapia floral e fitoterapia, entretanto, suas aplicabilidades dependem da emissão de uma habilitação e seu devido registro no Conselho (Resolução CFO 82/2008). Para a Odontologia, as PICs proporcionam novas ferramentas para exercer um atendimento integral do ser humano. Neste trabalho, propõe-se fazer uma revisão de literatura sobre as PICs e Odontologia. Esta revisão de literatura foi realizada por meio de busca de artigos na base de dados Scielo, PubMed e Scholar Google no período de 2000 a 2021. Foram encontrados artigos sobre as seguintes PICs atuando conjuntamente com a Odontologia: terapias florais, acupuntura, hipnodontia, ozonioterapia, laserterapia, fitoterapia, homeopatia e odontologia antroposófica. Essas práticas apresentam grande valia, pois promovem o bem-estar sem causar dano ao indivíduo, apresentando poucos ou nenhum efeito colateral possibilitando maior segurança aos pacientes, além de favorecer a relação entre paciente e cirurgião-dentista, otimizando o tempo de trabalho no consultório odontológico e reduzindo custos.

Integrative and Complementary Practices (PICs) are presented as supporting methods, helping to achieve success in certain clinical and/or surgical treatments, acting in prevention, assisting in healing and psychosomatic balance in order to reestablish agreement between mind and body. . The Federal Council of Dentistry (CFO) has regulated practices such as acupuncture, hypnosis, floral therapy and herbal medicine, however, their applicability depends on the issuance of a license and its proper registration with the Council (Resolution CFO 82/2008). For Dentistry, PICs provide new tools to provide comprehensive care to human beings. In this work, we propose to review the literature on PICs and Dentistry. This literature review was carried out by searching articles in the Scielo, PubMed and Scholar Google databases from 2000 to 2021. Articles were found on the following PICs working together with Dentistry: floral therapies, acupuncture, hypnodontics, ozone therapy , laser therapy, phytotherapy, homeopathy and anthroposophic dentistry. These practices are of great value, as they promote well-being without causing harm to the individual, presenting few or no side effects, allowing greater safety for patients, in addition to favoring the relationship between patient and dentist, optimizing working time in the dental office and reducing costs.

Las Prácticas Integrativas y Complementarias (PIC) se presentan como métodos coadyuvantes, ayudando a obtener el éxito en determinados tratamientos clínicos y/o quirúrgicos, actuando en la prevención, ayudando en la cura y en el equilibrio psicosomático con el fin de restablecer la concordancia entre mente y cuerpo. El Consejo Federal de Odontología (CFO) ha regulado prácticas como la acupuntura, la hipnosis, la terapia floral y la fitoterapia, sin embargo, su aplicabilidad depende de la emisión de un título y su correcto registro en el Consejo (Resolución CFO 82/2008). Para la odontología, los PIC aportan nuevas herramientas para la atención integral del ser humano. En este trabajo, nos proponemos hacer una revisión bibliográfica sobre los PIC y la Odontología. Esta revisión bibliográfica se realizó mediante la búsqueda de artículos en las bases de datos Scielo, PubMed y Scholar Google desde el año 2000 hasta el 2021. Se encontraron artículos sobre los siguientes CFP que actúan conjuntamente con la Odontología: terapias florales, acupuntura, hipnodoncia, ozonoterapia, terapia láser, fitoterapia, homeopatía y odontología antroposófica. Estas prácticas tienen un gran valor porque promueven el bienestar sin causar daño al individuo, presentando pocos o ningún efecto secundario, proporcionando mayor seguridad a los pacientes, y favoreciendo la relación entre el paciente y el dentista, optimizando el tiempo de trabajo en el consultorio y reduciendo los costos.

[An auxiliary device for double-blind placebo acupuncture research].

This device is an auxiliary device with reasonable design for placebo acupuncture research, so as to make double-blind placebo acupuncture control possible. This new auxiliary acupuncture device includes an acupuncture device and a placebo acupuncture device with exactly the same appearance. Both of them are composed of a hemispherical base and a telescopic tube. Through the rotation of the telescopic tube in the notch of the base, the insertion angle of needles can be adjusted from 15 degrees to 165 degrees. The operation of twisting and lifting and inserting can be carried out through the horizontal rotation and vertical sliding of the telescopic tube. A silicone needle pad is arranged in the base, which can simulate the blocking feeling of skin and muscle during needle insertion. The bottom of the base is attached with hydrogel, which has good fixity. The auxiliary device is applicable to multiple parts of the human body and can effectively reduce the risk of unblinding.

An auxiliary device for double-blind placebo acupuncture research / 中国针灸

This device is an auxiliary device with reasonable design for placebo acupuncture research, so as to make double-blind placebo acupuncture control possible. This new auxiliary acupuncture device includes an acupuncture device and a placebo acupuncture device with exactly the same appearance. Both of them are composed of a hemispherical base and a telescopic tube. Through the rotation of the telescopic tube in the notch of the base, the insertion angle of needles can be adjusted from 15 degrees to 165 degrees. The operation of twisting and lifting and inserting can be carried out through the horizontal rotation and vertical sliding of the telescopic tube. A silicone needle pad is arranged in the base, which can simulate the blocking feeling of skin and muscle during needle insertion. The bottom of the base is attached with hydrogel, which has good fixity. The auxiliary device is applicable to multiple parts of the human body and can effectively reduce the risk of unblinding.

The efficacy and safety of fire needle for cervical spondylotic radiculopathy: A protocol for systematic review and meta-analysis.

BACKGROUND: Cervical spondylotic radiculopathy (CSR) is one of the most common types of cervical spondylosis, and its treatments are mainly for relieving radicular pain and improving dysfunction. The existing randomized controlled trials (RCTs) suggest that fire needle may be a potential therapy in the treatment of CSR, but there is no evidence-based medical evidence to date. Therefore, this study will systematically evaluate the efficacy and safety of fire needle in the treatment of CSR. METHODS: We will search for 7 electronic databases (PubMed, EMBASE, Cochrane library, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Sinomed, and Wanfang Database) and 2 trial registration platforms (ClinicalTrials.gov and Chinese Clinic Trials.gov) to collect eligible studies. The RCTs related to fire needle for CSR and published up to June 30, 2021 will be included, regardless of language. We will consider the visual analogue scale as the primary outcome and the secondary outcome will include cervical range of motion, assessment of muscle strength, neck disability index, the MOS item short from health survey, activities of daily living, total efficiency, and adverse reactions. We will use the standard proposed in Cochrane Handbook 5.1.0 to assess the quality and bias risk of every RCT, and all analyses will be conducted through RevMan software V5.3 (Copenhagen: Nordic Cochrane Center, Cochrane, Collaborative Organization, 2014). RESULTS: This systematic review and meta-analysis will provide a convincing synthesis of existing evidences on the efficacy and safety of fire needle for CSR, and the results will be submitted to a peer-reviewed journal for publication. CONCLUSION: The results of this study will provide high-quality evidence of fire needle in the treatment of CSR for clinical decision-making. INPLASY REGISTRATION NUMBER: INPLASY202170041.

Laser acupuncture versus oral glucose administration for pain prevention in term neonates: an observer-blinded non-inferiority randomized controlled clinical trial.

BACKGROUND: Neonates undergoing intensive care are routinely submitted to minor painful procedures such as heel lances. Pharmacological treatment is limited in neonatal care and not recommended for minor painful interventions. Hence, non-pharmacological acute pain management is an important subject. Acupuncture could be a new strategy for neonatal pain prevention. Accordingly, the aim of the present study was to investigate whether laser acupuncture is non-inferior to oral sweet solutions in pain prevention. METHODS: In total, 96 healthy term neonates were randomly assigned to receive either laser acupuncture with 10 mW at LI4 bilaterally (AG, acupuncture group) or 30% oral glucose solution (GG, glucose group) before heel lance for metabolic screening. The primary outcome was the difference in premature infant pain profile (PIPP) score between groups in a non-inferiority concept. Secondary outcomes were changes in heart rate and crying time. RESULTS: Median (interquartile range) PIPP scores were comparable in the AG and GG (12 (10-14) vs 12 (9-14), p = 0.981). Nevertheless, the 95% confidence interval (CI) of location shift exceeded the predefined margin for non-inferiority of 1 (95% CI: -1.000006 to 1.000059). Heart rate was found to be significantly lower after intervention (p = 0.048) and after heel lance (p = 0.015) in the AG versus GG. There was no difference in crying time between groups (p = 0.890). CONCLUSION: Laser acupuncture was not shown to be non-inferior to an oral glucose solution, possibly due to the higher than expected variability in PIPP scores within the studied groups. Future neonatal laser acupuncture studies for pain prevention with higher sample sizes are therefore warranted.

The efficacy and safety of silver needle in the treatment of rheumatoid arthritis: A protocol of randomized controlled trial.

BACKGROUND: Rheumatoid arthritis is a kind of chronic crippling disease, the condition is complex, the course of the disease is repeated, seriously affecting the quality of life of patients. Adverse reactions and drug resistance associated with conventional treatment can no longer meet the clinical need. Therefore, complementary and alternative therapies need to be explored. The evidence shows that silver needle therapy has advantages in the treatment of rheumatoid arthritis, but there is a lack of standard clinical studies to verify this conclusion. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of silver needles in the treatment of rheumatoid arthritis. Approved by the Clinical Research Ethics Committee of our hospital. The patients are randomly divided into a treatment group (silver needle treatment group) or control group (routine western medicine treatment group). The patients are followed up for 2 months after 4 weeks of treatment. Observation indicators include: TCM symptom score, HAQDI score, DAS-28 score, laboratory indicators, adverse reactions and so on. Data will be analyzed using the statistical software package SPSS version 18.0 (Chicago, IL). DISCUSSION: This study will evaluate the clinical efficacy of a silver needle in the treatment of rheumatoid arthritis. The results of this study will provide a reliable reference for the clinical use of a silver needle in the treatment of rheumatoid arthritis. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/4X5QB.

Acupuncture for blunt chest trauma: A protocol for a double-blind randomized control trial.

INTRODUCTION: Blunt chest trauma (BCT) accounts for up to 65% of polytrauma patients. In patients with 0 to 2 rib fractures, treatment interventions are typically limited to oral analgesics and breathing exercises. Patients suffering from BCT experience symptoms of severe pain, poor sleep, and inability to perform simple daily life activities for an extended period of time thereafter. In this trial, we aim to investigate the efficacy of acupuncture as a functional and reliable treatment option for blunt chest trauma patients. METHODS: The study is designed as a double-blind randomized control trial. We will include 72 patients divided into 2 groups; the acupuncture group (Acu) and placebo group (Con). The acupuncture group will receive true acupuncture using a uniquely designed press tack needle. The control group will receive placebo acupuncture treatment through the use of a similarly designed press tack needle without the needle element. The acupoints selected for both groups are GB 34, GB 36, LI 4, LU 7, ST 36, and TH 5. Both groups will receive 1 treatment only following the initial visit to the medical facility and upon diagnosis of BCT. Patient outcome measurements include: Numerical Rating Scale, Face Rating Scale, respiratory function flowmeter, Verran Snyder-Halpern sleep scale, and the total amount of allopathic medication used. Follow-up time will be scheduled at 4 days, 2 weeks, and lastly 3 months. EXPECTED OUTCOME: The results of this study can potentially provide a simple and cost-effective analgesic solution to blunt chest trauma patients. This novel study design can serve as supporting evidence for future double-blind studies within the field of acupuncture. OTHER INFORMATION: The study will be conducted in the thoracic surgical department and acupuncture department in China Medical University Hospital, Taichung, Taiwan. The study will be conducted on blunt chest trauma patients and is anticipated to have minimum risk of adverse events. Enrollment of the patients and data collection will start from March 2020. Study completion time is expected in March 2022. PROTOCOL REGISTRATION: (CMUH109-REC1-002), (NCT04318496).

Little needle-scalpel for piriformis syndrome: A protocol for systematic review and meta-analysis.

BACKGROUND: Piriformis syndrome (PS) is a condition in which the sciatic nerve is compressed when passing through the inferior mouth of the piriformis muscle, mainly caused by pain in one hip and leg. In severe cases, patients may experience severe buttock and lower limb pain, discomfort, difficulty walking, and claudication. It is estimated that the annual incidence of low back pain and sciatica is about 40 million cases, and the annual incidence of piriformis syndrome is about 2.4 million cases. The aim of this systematic review is to assess the effectiveness and safety of Little needle-scalpel therapy for Piriformis syndrome. METHODS: Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists, and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. If it is appropriate for a meta-analysis, RevMan 5.4 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of Little needle-scalpel with piriformis syndrome. CONCLUSIONS: The conclusions of our study will provide an evidence to judge whether Little needle-scalpel is an effective and safe intervention for patients with piriformis syndrome. ETHICS AND DISSEMINATION: This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized. TRIAL REGISTRATION NUMBER: INPLASY2020110092.

Fire needle therapy for blood stasis syndrome of plaque psoriasis: A protocol for systematic review and meta-analysis.

BACKGROUND: Plaque psoriasis (PSO) is a common clinical chronic inflammatory skin disease. The incidence rate is increasing year by year due to the fast pace of work and unhealthy diet. Fire needle has been widely used in the treatment of PSO. However, the efficacy of fire needle for PSO is uncertain. Thus, the purpose of this systematic review is to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome). METHODS: The following electronic databases will be searched from inception to October 2020:PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure, WangFang Database, Chinese Science Journal Database, Chinese Biomedical Literature Database. In addition, other documents that meet the requirements will be manually searched, including conference papers, dissertations, etc. All randomized controlled trials using fire needle to treat PSO (blood stasis syndrome) that meet the criteria for inclusion will be included. The primary outcomes are clinical efficacy, Psoriasis area and severity index. Secondary outcomes include Itchy, TCM evaluation standard syndrome score, Dermatological quality of life index, and adverse events. To complete data synthesis and assess the risk of bias, we will use the RevMan V.5.3 software. RESULTS: The review results will be published in a peer-reviewed journal. CONCLUSION: This study will provide high-quality evidence based medicine to evaluate the effectiveness and safety of fire needle for PSO (blood stasis syndrome), and further seek its scientific and effective chinese medicine treatment methods. INPLASY REGISTRATION NUMBER: INPLASY202120007.

Safety analysis of percutaneous needle electrolysis: a study of needle composition, morphology, and electrical resistance.

BACKGROUND: Percutaneous needle electrolysis (PNE) consists of a galvanic current combined with the insertion of a solid needle into the tissues of the musculoskeletal system. The application of a galvanic current through a needle can alter the morphology and composition during treatment application. This procedure may also provoke a localized temperature increase. AIM: The aim was to evaluate the safety of the PNE procedure by analyzing possible alterations of the needles employed. METHODS: Physio Invasiva® and AguPunt EPI® brand needles, commonly used for the application of this technique, were analyzed in response to three different treatment protocols. Temperature changes were evaluated with the needles immersed in a test tube containing Ringer's solution, and electrical resistance was evaluated with a multimeter. The morphology of the needles, pre- and post-treatment, was examined with a scanning electron microscope (FEI Quanta 600), and the composition of the needles was evaluated using RX diffusion with Oxford Instruments software. RESULTS: Ringer's solution contained in the test tubes examined did not present temperature changes. No changes were observed in the needles under investigation with respect to electrical resistance, morphology, or composition with a protocol applying 3-mA intensity for 3 s and three applications. However, important morphological alterations were observed that affected needle composition after 50 applications (at 3 mA for 3 s). CONCLUSION: PNE, applied according to conventional protocols, appeared to be safe and athermal, and did not provoke a loss of metal particles or modify the morphology of the needles used when studied in vitro.

Electrophysiologically verified effects of acupuncture on diabetic peripheral neuropathy in type 2 diabetes: The randomized, partially double-blinded, controlled ACUDIN trial.

BACKGROUND: Acupuncture is commonly used in Traditional Chinese Medicine for treatment of diabetic peripheral neuropathy (DPN), but data from randomized controlled trials are rare. METHODS: This randomized, placebo-controlled, partially double-blinded clinical trial randomly assigned adults with confirmed type 2 diabetes-induced DPN to receive 10 sessions of needle acupuncture, laser acupuncture, or placebo laser acupuncture for 10 consecutive weeks. Treatment was provided at bilateral acupoints Ex-LE-10 (Bafeng), Ex-LE-12 (Qiduan), and ST-34 (Lianqiu). Neurological assessments, including nerve conduction studies (NCS) of sural and tibial nerves, were performed at baseline and weeks 6 and 15. Primary outcome was delta of sural sensory nerve action potential (SNAP). Secondary outcomes included further NCS values, clinical scores, and patient-reported outcome measures (PROMs). RESULTS: Of 180 participants, 172 completed the study. Sural SNAP and sural and tibial nerve conduction velocities improved significantly after 10 treatments when comparing needle acupuncture to placebo. Needle acupuncture showed earlier onset of action than laser acupuncture. PROMs showed larger improvements following needle and laser acupuncture than placebo, reaching significant differences for hyperesthesia and cramps following needle acupuncture and for heat sensation following laser acupuncture. CONCLUSIONS: Classical needle acupuncture had significant effects on DPN. Improvement in NCS values presumably indicates structural neuroregeneration following acupuncture.

Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40.

OBJECTIVES: The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI). METHODS: One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle. RESULTS: Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%-19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%-15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%-94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°-10.55°) and 9.75° ± 3.46° (95% CI, 9.10°-10.41°), respectively. CONCLUSION: We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.