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.

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.

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.

CT导向的内镜下针刀治疗回肠储袋窦道

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.