Needle knife in the treatment of primary dysmenorrhea: a systematic review and meta-analysis

Objective: The aim of this meta-analysis was to examine the effectiveness and safety ofneedle knives for primary dysmenorrhea. Methods: We searched the electronicdatabases from their inception to May 25, 2022, comprising Cochrane Library, PubMed,Embase, SinoMed, CNKI, VIP and Wanfang databases. Randomized controlled trials(RCTs) investigating the effectiveness of needle knives for people with primarydysmenorrhea were eligible. The risk of bias and the quality of the included literaturewere evaluated. RevMan5.3 software was used for this study. Results: Five articles with313 participants were involved in the review. The cure rate (2.82 (2.01, 3.95), I^(2) = 25%)and total effective rate (1.32 (1.10, 1.57), I^(2) = 65%) of the experimental group werehigher than those of the control group. The dysmenorrhea symptom scores (–1.81(–2.61, –1.01), I^(2) = 69%), TCM symptom scores (–4.19 (–6.06, –2.31), I2 = 0%) andadverse reactions (0.16 (0.05, 0.51), I^(2) = 0%) of the experimental group were lowerthan those of the control group. Conclusions: Needle knives may provide advantages inthe treatment of primary dysmenorrhea. RCTs, including the larger sample, multi-center,high-quality and double-blind research, were required to further verify the efficacy ofneedle knives for primary dysmenorrhea.

Observation on the Clinical Effect of Needle Knife Release Combined with Microporous Decompression in Subchondral Bone Marrow Edema Area for Treatment of Knee Osteoarthritis

Objective:To observe the curative effect of release with needle knife combined with microporous decompression in bone marrow edema area of subchndral bone for treatment of knee osteoarthritis.Method:From March 2019 to March 2020,66 patients with knee osteoarthritis were selected as the research objects,and divided into treatment group and control group according to random nuber table.The treatment group was treated with release with needle knife combined with microporous decompression in bone marrow edema area,while the control group was treated with release with needle knife.Visual analogue scale(VAS),the Western Ontario and Mc Master University composite index(WOMCA)and inflammatory factors were used to evaluate the curative effect of patients before treatment and after treatment.Results:The VAS scores of knee pain in both groups decreased after treatment.The treatment group was lower than the control group.The WOMAC scores of both groups were decreased significantly after treatment,and then gradually decreased with time.The WOMAC scroes of the treatment group were lower than those of the control group after treatment,and there was an interactive effect on time factor.Conclusion:Release with needle knife combined with microporous decompression in bone marrow edema area of subchondral bone has good curative effect in the treatment of knee osteoarthritis;it can relieve the pain of patients,improve the function of joint,reduce inlfammatory reaction,and then delay the pathological progress of KOA,which is worthy of clinical promotion.

TREATMENT OF VERTEBRAL－ARTERY TYPE CERVICAL SPONDYLOPATHY WITH NEEDLE－KNIFE THERAPY

In the present paper, 62 cases of vertebral artery type cervical spondylopathy were treated with needle knife therapy (acupotomy). After 2-6 sessions of treatment, 23 cases (37.1%) were cured, 19 (30.7%) showed marked improvement, 15 (24.2%) had some improvement and 5 (8.1%) failed in the treatment. The total effective rate was 91.9%. It indicates that acupotomy therapy is a highly effective remedy for treating vertebral artery type cervical spndylopathy.

Effect of Small Needle Knife on Autophagy and TGF-β in Synovial Fluid of KOA Rats

Objective:To explore the effects of small needle knife on the autophagy function of synovium and the expression of TGF-βin synovial fluid of KOA rats,so as to provide a new theoretical basis for the treatment of KOA.Methods:48 SD rats were randomly divided into blank control group,model group,drug group and acupotomy group.The blank control group maintained the original feeding without any intervention,the model group adopted the sodium monoiodoacetate injection method to prepare the KOA rat model without any intervention,the drug group prepared the KOA rat model and then treated with tripterine by gavage,and the needle knife group treated the KOA rat model with small needle knife.The expression levels of autophagy-related proteins in synovial tissues were detected by immunohistochemistry and Western blotting,and the content of TGF-βin synovial fluid was measured by ELISA.Results:Compared with the blank control group,Beclin-1,Caspase-3 and Bax were up-regulated and m TOR was down-regulated in the model group.Beclin-1,m TOR,Caspase-3 and Bax were up-regulated in the drug group.There was no significant difference in the expression of autophagy-related proteins Beclin-1(0.28±0.09)and m TOR(0.45±0.12)between the acupotomy group and the blank control group,while Caspase-3(0.17±0.03)and Bax(0.30±0.01)were up-regulated.The expression level of TGF-βin synovial fluid in the small needle knife group was(0.29±0.09),which was similar to that in the blank control group,and was significantly higher than that in the model group.Conclusion:Small needle knife treatment can promote the recovery of synovial autophagy in KOA rats,and reduce the level of TGF-βin synovial fluid,and can play a clinical role in the treatment of KOA by regulating the expression of synovial autophagy and TGF-β.

Comparison of clinical efficacy of neddle knife at acupoints selected from recent regions along meridians and according to anatomical structures in treating early and middle stage knee osteoarthritis

Objective:To stimulate tenderness points around knee joint in two metholds-corresponding acupoints selected from recent regions along meridians and anatomical structures,to compare the clinical efficacy of neddle knife of to cure early and middle stage knee osteoarthritis.Method:70 patients were randomly(Random Number Tables)divided into test group(acupoints selected from recent regions along meridians,n=35)and control group(anatomical structures,n=35),who were diagnosed as knee osteoarthritis.Observe the VAS(visual analogue scale),Lysholm,WOMAC(the Western Ontario and McMaster Unive rsities Osteoarthritis Index)and ROM(rang of motion)between two groups in first week,first month,third month after treatment.Recording the degree of improvement of knee joint’s pain,dysfunction and symptoms of osteoarthritis and rang of motion.Results:Within groups,the VAS,Lysholm,WOMAC and ROM were obviously different from pre-therapy scores in the third,sixth and twelfth week post-therapy(P<0.05).Between groups no significant difference were observed in the third week post-therapy about VAS,Lysholm,WOMAC scores(P>0.05).However,there were differences in the sixth,twelfth weeks post-therapy(P<0.05);compared with control group,the ROM of test group were difference in the third,sixth,twelfth weeks post-therapy(P<0.05).Conclusion:The clinical efficacy of stimulating corresponding acupoints tenderness points selected from recent regions along meridians to treat early and middle stage knee osteoarthritis was superior to anatomical structures,which can effectively relieve pain,dysfunction,symptoms of osteoarthritis of knee joint and rang of motion.

Clinical Study on Small Knife Needle in Treating Transverse Process Syndrome of Third Lumbar Vertebra

Small knife needle plus manual reduction method was used to treat the transverse process syndrome of the third lumbar vertebra. The small knife needle was adopted to loosen the third vertebra with little invasion and manual reduction method to remove adhesion by pulling back and forth. Among 859 cases treated, 652 cases were cured and 196 cases improved, with the total effective rate of 98.8%. It is indicated that small knife needle plus manual reduction method has positive effects on the transverse process syndrome of the third lumbar vertebra as well as other soft tissues injury.

Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques

BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same period.AIM To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying factors.METHODS Demographic/clinical variables and records of ERCP patients at the beginning(2008), middle(2013) and end(2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard"(short position) or "non-standard"(e.g., long, semi-long).RESULTS Patients undergoing ERCP were older in 2018 compared to 2008(69.7 ± 15.2 years vs 55.1 ± 14.7, P < 0.05). Increased ampullary distortion and peri-ampullary diverticula were noted in 2018(P < 0.001). ERCPs were increasingly performed with a non-standard duodenoscope position, from 2.2%(2008) to 5.6%(2013) and 16.1%(2018)(P < 0.001). Utilization of more than one advanced cannulation technique for a given ERCP increased from 0.7%(2008) to 0.9%(2013) to 6.6%(2018)(P < 0.001). Primary mass size > 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/d L predicted use of advanced cannulation techniques(P < 0.03 for each).CONCLUSION Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary can- nulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identif iable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 nave pa-pilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or postERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures.

Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum

Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.

Gastric antral webs in adults:A case series characterizing their clinical presentation and management in the modern endoscopic era

AIMTo investigate the current management of gastric antral webs (GAWs) among adults and identify optimal endoscopic and/or surgical management for these patients. METHODSWe reviewed our endoscopy database seeking to identify patients in whom a GAW was visualized among 24640 esophagogastroduodenoscopies (EGD) over a seven-year period (2006-2013) at a single tertiary care center. The diagnosis of GAW was suspected during EGD if aperture size of the antrum did not vary with peristalsis or if a &ldquo;double bulb&rdquo; sign was present on upper gastrointestinal series. Confirmation of the diagnosis was made by demonstrating a normal pylorus distal to the GAW. RESULTSWe identified 34 patients who met our inclusion criteria (incidence 0.14%). Of these, five patients presented with gastric outlet obstruction (GOO), four of whom underwent repeated sequential balloon dilations and/or needle-knife incisions with steroid injection for alleviation of GOO. The other 29 patients were incidentally found to have a non-obstructing GAW. Age at diagnosis ranged from 30-87 years. Non-obstructing GAWs are mostly incidental findings. The most frequently observed symptom prompting endoscopic work-up was refractory gastroesophageal reflux (n = 24, 70.6%) followed by abdominal pain (n = 11, 33.4%), nausea and vomiting (n = 9, 26.5%), dysphagia (n = 6, 17.6%), unexplained weight loss, (n = 4, 11.8%), early satiety (n = 4, 11.8%), and melena of unclear etiology (n = 3, 8.82%). Four of five GOO patients were treated with balloon dilation (n = 4), four-quadrant needle-knife incision (n = 3), and triamcinolone injection (n = 2). Three of these patients required repeat intervention. One patient had a significant complication of perforation after needle-knife incision. CONCLUSIONEndoscopic intervention for GAW using balloon dilation or needle-knife incision is generally safe and effective in relieving symptoms, however repeat treatment may be needed and a risk of perforation exists with thermal therapies.

Computed tomography-guided endoscopic needle knife therapy for ileal pouch sinus

Ileal pouch-anal anastomosis surgery can be complicated by anastomotic leaks,leading to the formation of abscess and chronic sinus that have been routinely managed by a surgical approach.We developed the endoscopic needle knife sinusotomy(NKSi)technique,which has become a valid alternative.The basic principle of endoscopic NKSi is dissection and drainage of the sinus through its orifice internally into the lumen of pouch body.The success of NKSi requires an access to the sinus from the pouch side.One of the most challenging situations for NKSi is a closed orifice of the sinus,which leaves an isolated chronic abscess cavity.Here we report a case of complicated presacral sinus with a closed orifice that was not amenable to NKSi,necessitating a CT-guided guide wire placement and subsequent NKSi.

Effect of acupotomy on nitric oxide synthase and beta-endorphin in third lumbar vertebrae transverse process syndrome model rats

OBJECTIVE： To explore the long-term effects and pain relief mechanism of acupotomy by observing changes in nitric oxide synthase （NOS） and beta-en- dorphin （~3-EP） in the hypothalamus, spinal cord, and peripheral blood of rats with third lumbar ver- tebrae （L3） transverse process syndrome. METHODS： Twenty-eight SD rats were randomly as- signed to normal, model, electroacupuncture （EA）, and acupotomy group. The last three groups were put through an operation to emulate L3 transverse process syndrome. Fourteen days after the simulation operation, EA and acupotomy treatments were applied to the respective groups. Fifty-six days afterthe simulation operation, biochemistry tests and enzyme-linked immunosorbent assay were used to measure NOS and 13-EP in the hypothalamus, spinal cord, and peripheral blood. RESULTS： Rats with the simulation operation showed significantly higher levels of NOS and II3-EP in the hypothalamus, spinal cord, and peripheral blood than those in the normal group. The EA and acupotomy groups had significantly lower levels of NOS and β-EP than those in the model group. There was no statistical difference between the EA and acupotomy groups. CONCLUSION： EA and acupotomy treatments significantly lowered NOS and β-EP levels in the hypothalamus, spinal cord, and peripheral blood and alleviated L3 transverse process syndrome.

Observation on Clinical Effects of Acupotomy plus Cupping for Knee Osteoarthritis

Objective: To observe the clinical effect of acupotomy plus cupping for knee osteoarthritis(KOA). Methods: Sixty cases with KOA were randomly divided into a treatment group and a control group, 30 cases in each group. The patients in the treatment group were given acupotomy and cupping, while the patients in the control group were given injection of Sodium Hyaluronate. The index of severity for osteoarthritis(ISOA), the change of the effusion of knee joint and clinical effects were observed after treatment. Results: The total effective rate was respectively 96.7% in the treatment group and 66.7% in the control group. The difference in the clinical effects between the two groups was statistically significant(P<0.05). After treatment, ISOA scores and scores of knee effusion in the two groups were remarkably reduced than those before treatment(P<0.05). The changes of the scores of the two indexes were statistically significant(both P<0.05). Conclusion: Acupotomy plus cupping is better than injection of Sodium Hyaluronate in treatment of KOA.