Minimally Invasive Widening of the Facet Joints in Cervical Radiculopathy by Modified Needles： Technical Report

Surgical treatment and ESI （epidural steroid injection） are widely used forms of treatment for cervical radiculopathy but they are controversial and burdensome for patients. To relief pain fast without side effects, we devised a new minimally invasive treatment method that widens the facet joints to decompress nerve roots and release the muscle spasm in cervical radiculopathy with acupuncture needles with blunt tip and mini-scalpel, and named it modified acupuncture procedure. MAP （Modified acupuncture procedure） was administered for 37 patients （mean age = 53.1 years, follow-up = 14.2 months） with cervical radiculopathy who did not recover from 4 weeks of nonsurgical treatment. We analyzed clinical outcomes of patients before and after the procedure through VAS （Visual Analogue Scale） and NDI （Neck Disability Index）. On average, patients received 1.4 MAP （modified acupuncture procedures）. The VAS score difference on the day after procedure and at 1 year follow-up was 36.8 ± 26.5 （from 60.1 ± 25.3 at the baseline to 25.3 ± 17.8 at the reading） （P 〈 0.01） and 31.0 ± 30.4 （29.0 ± 21.8 at the reading） respectively. The NDI value dropped by 19.9 ± 18.3 （from 37.2 ± 19.7 at the baseline to 17.2 ± 15.0 at the reading） （P〈 0.01） on 1 year follow up. MAP was found to have clinical efficacy for cervical radiculopathy.

Promotion and Mechanism of Acupotomy on Chondrocyte Autophagy in Knee Osteoarthritis Rabbits

Objective:To explore the effect of acupotomy intervention on autophagy of chondrocytes in rabbits with knee osteoarthritis(KOA),and to determine the possible mechanisms of acupotomy to alleviate cartilage degeneration.Methods:The modified Videman method was used to construct a KOA rabbit model.After modeling,40 rabbits were randomly divided into 4 groups by a random number table:control;KOA(model);KOA+acupotomy(acupotomy),and KOA+sham acupotomy(sham),10 in each group.After a 3-week treatment course,the knee joint activity was determined by the modified Lequesne MG index.Hematoxylin-eosin staining staining was used to examine the morphological changes of chondrocytes.Autophagy of chondrocytes was observed by transmission electron microscopy.The surface morphology of cartilage tissue was observed by scanning electron microscope.The mRNA and protein levels of AMP kinase/mammalian target of rapamycin/Unc-51(AMPK/mTOR/ULK1)signal pathway key proteins,autophagy-related factor Beclin-1 and microtubule-associated protein 1A/1B light chain 3(LC3)in rabbit knee cartilage were assessed by real-time fluorescence quantitative polymerase chain reaction and Western blot,respectively.Results:The modified Lequesne MG score of acupotomy group was significantly lower than that of model group(P<0.05).Pathological results showed that chondrocyte autophagy decreased and cartilage surface was rough in the model group,which recovered after acupotomy treatment.The mRNA expressions of AMPK,ULK1,Beclin-1 and the protein levels of p-AMPK,p-ULK1,Beclin-1,and LC3Ⅱ/LC3Ⅰwere decreased in the model group,while the mRNA and protein expressions of mTOR were increased(P<0.01).However,acupotomy treatment reversed these abnormal changes(P<0.05).Conclusions:Acupotomy could effectively up-regulate the expressions of AMPK,ULK1 and Beclin1,reduce the expression of mTOR,promote autophagy,and alleviate joint degeneration.Acupotomy is a promising complementary and alternative therapy for KOA.

Effect and safety of acupotomy in treatment of knee osteoarthritis:a systematic review and Meta-analysis

OBJECTIVE: To evaluate the clinical efficacy and safety of acupotomy in treatment of knee osteoarthritis(OA).METHODS: Extensive literature searches were carried out in PubMed, EMBASE, Cochrane Library(Issue 5, 2017), Chinese Biomedical Literature Database, China National Knowledge Infrastructure Database, China Science and Technology Journal Database and Wanfang Database. All databases were retrieved from their inception until May 31, 2017.Randomized controlled trials incorporating acupotomy versus intra-articular sodium hyaluronate for knee osteoarthritis were included. According to Cochrane Reviews’ Handbook(5.2), two reviewers screened each article and extracted data independently and were blinded to the findings of each reviewer. Meta-analysis was performed by the Cochrane Collaboration’s RevMan 5.3 software.RESULTS: We identified 12 studies involving 1150 patients aged between 40 and 78 years old. The pooled analysis indicated that acupotomy showed a significant improvement for short-term effect[cure rate: odds ratio(OR) = 2.04, 95% confidence interval(CI)(1.46, 2.85), P < 0.01;total effective rate:OR = 2.25, 95% CI(1.55, 3.28), P < 0.01;pain score:standard mean difference(SMD) =-1.02;95% CI(-1.72,-0.31);P = 0.005;Western Ontario and McMaster Universities Questionnaire(WOMAC) score:SMD =-0.74;95% CI(-1.11,-0.37);P < 0.01];and also for long-term effect [total effective rate:OR = 2.99, 95%CI(1.88, 4.76), Z = 4.64, P < 0.01;pain score: SMD =-1.68;95% CI(-2.14,-1.22);P <0.001;WOMAC score: SMD =-0.91;95% CI(-1.40,-0.41);P < 0.001]. In addition, there was no obvious difference between acupotomy group and control group in adverse events [OR = 2.13, 95% CI(0.14, 32.28), P = 0.58].CONCLUSION: Acupotomy is a safe and effective treatment for KOA. However, due to the methodological deficiency of the included studies, well-designed randomized controlled trials are required to further confirm the findings.

Effect of Herb-Partitioned Moxibustion on Structure and Functional Prediction of Gut Microbiota in Rats with Irritable Bowel Syndrome with Diarrhea

Objective:The objective of this study was to observe the effect of herb-partitioned moxibustion(HPM)on the gut microbiota of rats with diarrhea-predominant irritable bowel syndrome(IBS-D).Materials and Methods:A total of 48 male rats were randomly divided into a normal control group and an irritable bowel syndrome(IBS)model group.Using acetic acid irrigation and constraint stress,an IBS-D rat model was developed.After the model was made,the IBS rats were divided into IBS,HPM group,and pinaverium bromide(PB)group.The HPM received HPM for 20 min every day,while the PB was given gastric perfusion once a day for 14 days.After modeling and treatment,the abdominal withdrawal reflex,fecal character score,and fecal water content of rats were scored,and a 16S rRNA sequencing analysis was performed on the gut microbiota.Results:After treatment,the fecal character score and fecal water content in the HPM increased significantly,while visceral sensitivity decreased.Investigation of 16S rDNA sequencing revealed that α-diversity was reduced in the IBS,and HPM could increase the diversity of flora.The flora structure of IBS-D rats changed.HPM can increase the abundance of probiotics such as Akkermansia and reduce the abundance of opportunistic pathogens such as Bacteroides and Prevotella.Functional prediction analysis showed that the HPM was mainly related to the bacillary secret system,tricarboxylic acid cycle,and other pathways.Conclusion:HPM can regulate the gut microbiota of rats with IBS-D.