Application of needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography

BACKGROUND: Getting directly into the common bile duct (CBD) is the most important step for successful therapeutic biliary endoscopy. In 5%-10% of cases, the CBD remains inaccessible, necessitating pre-cut papillotomy or fistulotomy with a needle-knife. The aim of this study was to assess the value of early application of the needle-knife in difficult biliary cannulation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Patients with failed biliary cannulation after 10 minutes or guide wire entering the pancreatic tube 3 times were randomly divided into group of needle-knife cut and group of persistent cannulation by standard techniques. The cannulation times, success rates and complication rates were compared between the two groups. RESULTS: A total of 948 therapeutic biliary ERCP procedures were performed between October 2004 and February 2006. Of 91 patients with difficult biliary cannulation, 43 patients underwent needle-knife cut: the cannulation success rate was 90.7%, the mean cannulation time was 5.6 minutes, and the complication rate was 9.3%. The other 48 patients underwent persistent cannulation by standard techniques: the cannulation success rate was 75%, the mean cannulation time was 10.2 minutes, and the complication rate was 14.6%. Significant differences were observed in cannulation success rate and cannulation time but in complication rate between the two groups.CONCLUSION: The early application of the needle-knife in difficult biliary cannulation is time-saving, safe and effective, with no increase in complication rate.

Comparison of efficacy and safety of transpancreatic septotomy, needle-knife fistulotomy or both based on biliary cannulation unintentional pancreatic access and papillary morphology

Background: Precut sphincterotomy has been widely performed to facilitate selective biliary access when standard cannulation attempts failed during endoscopic retrograde cholangiopancreatography(ERCP). However, scarce data are available on different precut techniques for difficult biliary cannulation. This study aimed to evaluate the efficacy and safety of transpancreatic septotomy(TPS), needle-knife fistulotomy(NKF) or both based on the presence of unintentional pancreatic access and papillary morphology. Methods: Between March 2008 and December 2016, 157 consecutive patients undergoing precutting for an inaccessible bile duct during ERCP were identified. Precut techniques were chosen depending on repetitive inadvertent pancreatic cannulation and the papillary morphology. We retrospectively assessed the rates of cannulation success and procedure-related complications among three groups, namely TPS, NKF, and TPS followed by NKF. Results: The baseline characteristics of the three groups were comparable. The overall success rate of biliary cannulation reached 98.1%, including 111 of 113(98.2%) with TPS, 35 of 36(97.2%) with NKF and 8 of 8(100%) with NKF following TPS, without significant difference among groups. The incidences of total complications and post-ERCP pancreatitis were 9.6% and 7.6%, respectively. There was a trend towards less frequent post-ERCP pancreatitis after NKF(0%) compared with 11 cases(9.7%) after TPS and one case(12.5%) after NKF following TPS, but not significantly different( P = 0.07). No severe adverse event occurred during this study period. Conclusions: The choice of precut techniques by the presence of unintended pancreatic access and the papillary morphology brought about a high success rate without increasing risk in difficult biliary cannulation.

Needle-knife fistulotomy vs double-guidewire technique in patients with repetitive unintentional pancreatic cannulations

AIM: To compare the success rates and adverse events of early needle-knife fistulotomy(NKF) and double-guidewire technique(DGT) in patients with repetitive unintentional pancreatic cannulations.METHODS: From a total of 1650 patients admitted for diagnostic or therapeutic endoscopic retrograde cholangiopancreatography(ERCP) at a single tertiary care hospital(Pusan National University Yangsan Hospital, Yangsan, South Korea) between January2009 and December 2012, 134(8.1%) patients with unsuccessful biliary cannulation after 5 min trial of conventional methods, together with 5 or more repetitive unintentional pancreatic cannulations, were enrolled in the study. Early NKF and DGT groups were assigned 67 patients each. In the DGT group, NKF was performed for an additional 7 min if successful cannulation was not achieved.RESULTS: The success rates with early NKF andthe DGT were 79.1%(53/67) and 44.8%(30/67)(P< 0.001), respectively. The incidence of post-ERCP pancreatitis(PEP) was lower in the early NKF group than in the DGT group [4.5%(3/67) vs 14.9%(10/67),P = 0.041]. The mean cannulation times in the early NKF and DGT groups after assignment were 257 s and312 s(P = 0.013), respectively.CONCLUSION: Our data suggest that early NKF should be considered as the first approach to selective biliary cannulation in patients with repetitive unintentional pancreatic cannulations.

Endoscopic treatment for pancreatic diseases:Needle-knife-guided cannulation via the minor papilla

AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife.METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulationsvia the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed.RESULTS: Standard methods were successful in79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17(89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%,(79 +17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further(80.6%, 79/98 vs98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods(4.7% vs 10.5%, P = 0.301).CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

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.

基于PACAP-cAMP-PKA信号通路探讨J型针刀调节神经源性膀胱逼尿肌的效应机制

目的:探讨J型针刀通过PACAP-cAMP-PKA信号通路改善脊髓损伤后神经源性膀胱大鼠逼尿肌的作用机制。方法:36只SD雄性大鼠随机分为6组:空白组、假手术组、模型组、J型针刀治疗组、治疗+Bupivacaine抑制剂组、治疗+H-89抑制剂组,各6只。采用脊髓横断法制作神经源性膀胱模型。空白组为正常SD大鼠;假手术组为切开相关部位组织,无脊髓切断;其余4组予以手术脊髓切断造模。J型针刀治疗组造模后第19天予J型针刀针刺大鼠次髎穴,2 d 1次,共治疗7次。干预结束后各组行HE染色观察膀胱逼尿肌组织形态变化,Elisa检测膀胱逼尿肌组织中c AMP、PKA含量,免疫组化检测膀胱逼尿肌组织中PACAP38蛋白表达,Western blot检测膀胱逼尿肌组织中PKA、p-MLC蛋白表达。结果:HE染色结果显示,与空白组相比,模型组中膀胱逼尿肌组织严重坏死,可见大量炎症细胞浸润;与模型组相比,J型针刀治疗组、治疗+Bupivacaine抑制剂组及治疗+H-89抑制剂组均有不同程度坏死组织修复情况。免疫组化检测PACAP38蛋白表达在模型组中表达量最低,针刀治疗之后,PACAP38表达量均不同程度上调;与J型针刀治疗组相比,治疗+Bupivacaine抑制剂组及治疗+H-89抑制剂组PACAP38蛋白表达均不同程度下调(P<0.05),但高于模型组(P<0.05)。Elisa检测结果显示,cAMP、PKA表达量模型组显著下调(P<0.05),J型针刀治疗组与模型组比显著上调(P<0.05),治疗+Bupivacaine抑制剂组及治疗+H-89抑制剂组比无显著差异(P>0.05)。WB结果显示:与空白组相比,模型组PKA、p-MLC蛋白表达上调;针刀治疗组表达量下调,其中PKA蛋白表达有显著性(P<0.05),p-MLC蛋白表达无显著性(P>0.05)。与J型针刀治疗组比,PKA蛋白表达量在治疗+Bupivacaine抑制剂组及治疗+H-89抑制剂组中无显著差异(P>0.05),p-MLC蛋白表达量显著下降(P<0.05)。结论:J型针刀针刺次髎穴可改善脊髓损伤后神经源性膀胱大鼠膀胱功能,其机制与J型针刀上调膀胱逼尿肌中PACAP38、cAMP、PKA表达,激活PACAP-cAMP-PKA信号通路,从而促进逼尿肌舒张有关。

Role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma

AIM:To study the role of needle knife assisted ampullary biopsy in the diagnosis of periampullary carcinoma.METHODS:In this study the authors retrospectively analyzed clinical records of patients with periampullary tumors diagnosed by ampullary biopsy taken after needle knife papillotomy in whom surface ampullary biopsies were non contributory.RESULTS:Between January 2008 and December 2010,38 patients with periampullary tumors were seen by us and initial side viewing endoscopy with surface biopsy from the papilla was positive for malignancy in 25 patients.Thirteen patients with a negative surface biopsy for malignancy underwent a repeat ampullary biopsy following needle knife papillotomy.There were 8(61.5%)males and 5(38.5%)females.The most common presenting symptom was jaundice(100%),followed by fever(46.2%),melena(38.5%),abdominal pain(30.8%)and weight loss(30.8%).All the patients had hyperbilirubinemia with a mean ± SD serum bilirubin of(11.2 ± 1.9)mg/dL(normal value <1 mg%)and the mean ± SD serum alkaline phosphatase was(288.0 ± 94.3)IU/L(normal value < 129 IU/L).Serum CA 19.9 level estimation was done in 11 patients;it was elevated(cut off value > 70.5 IU/L)in all of them with a median of 1200 IU/L(inter quartile range 274-3500).Side viewing endoscopy showed a bulky papilla in all of them.Adequate tissue was obtained in all of the 13 patients for histological evaluation;12 of the 13 patients were reported to have adenocarcinoma while one patient had adenoma.There were no complications from the needle knife papillotomy in any of the patients.CONCLUSION:Needle knife assisted ampullary biopsy appears to be a safe and effective diagnostic modality for periampullary carcinoma.

Endoscopic sphincterotomy with needleshaped knife: report of 476 cases

Objectives: To evaluate endoscopic duodenal sphinc- terotomy and improve its success rate. Methods: Needle-shaped knife was used for endoscop- ic sphincterotomy (EST) in 476 patients with biliary or pancreatic diseases from March 1995 to October 2000. Results: Direct incision was made in 243 patients, papillary fenestration in 89, and opposite incision in 144. The papilla located beside and in the diverticu- lum in 56 and 12 patients, respectively. EST emer- gency was made in 147 patients. ERCP after EST be- cause of the difficulty in intubation was made suc- cessfully in 62 patients. Mild complications occurred in 14 patients (2.94%), all of whom were cured af- ter symptomatic treatment. Conclusions: EST with needle-shaped knife has such advantages as safety in operation and convenience in incision. It is suitable for the papilla with different shape, with a higher success rate.

针刀干预对LDH模型大鼠TGF-β/BMP信号通路水平的影响

目的探讨针刀干预对腰椎间盘突出症(LDH)模型大鼠椎间盘退变及转化生长因子β/骨形态发生蛋白(TGF-β/BMP)信号通路水平的影响。方法建立LDH大鼠模型,大鼠分为空白组、假手术组、模型组、塞来昔布组(0.34g·kg^(-1)·d^(-1)塞来昔布溶剂)、针刀组、TGF-β/BMP抑制剂组(针刀+SB-431542,针刀+100μL/鼠/2d的SB431542)、TGF-β/BMP激动剂组(针刀+SRI-011381 hydrochloride,针刀+10 mg·kg^(-1)·2 d^(-1)的SRI-011381 hydrochloride),每组20只。观察7组大鼠一般行为状态;HE染色观察椎间盘软骨组织形态学变化;RT-qPCR检测TGF-β1 mRNA、BMP-7 mRNA、Smad2/3 mRNA、Smad1/5/8 mRNA、Smad4 mRNA及TIMP-3 mRNA的表达;ELISA法检测肿瘤坏死因子(TNF-α)、白介素-6(IL-6)、基质金属蛋白酶-3(MMP-3)水平;免疫组化检测椎间盘软骨组织TIMP-3表达;Western blot检测TGF-β1、BMP-7、Smad2/3、Smad1/5/8、BMPR-1A、ALK5、Sox9、COL2A1蛋白水平。结果与空白组及假手术组比较,模型组大鼠行为异常,椎间盘出现破裂,基质丢失,软骨细胞减少,软骨终板与髓核边界结构紊乱,Smad4 mRNA、TIMP-3 mRNA表达与TGF-β1、BMP-7、Smad2/3、Smad1/5/8 mRNA及蛋白、BMPR-1A、ALK5、Sox9、COL2A1蛋白表达、TIMP-3平均光密度值显著降低(P<0.05),TNF-α、IL-6、MMP-3水平显著升高(P<0.05)。与模型组比较,针刀组、塞来昔布组大鼠异常行为减少,椎间盘软骨组织损伤减轻,Smad4 mRNA、TIMP-3 mRNA表达与TGF-β1、BMP-7、Smad2/3、Smad1/5/8 mRNA及蛋白、BMPR-1A、ALK5、Sox9、COL2A1蛋白表达、TIMP-3平均光密度值显著升高(P<0.05),TNF-α、IL-6、MMP-3水平显著降低(P<0.05)。与针刀组比较,TGF-β/BMP抑制剂组大鼠异常行为及椎间软骨组织损伤加重;Smad4 mRNA、TIMP-3 mRNA表达与TGF-β1、BMP-7、Smad2/3、Smad1/5/8 mRNA及蛋白、BMPR-1A、ALK5、Sox9、COL2A1蛋白表达、TIMP-3平均光密度值显著降低(P<0.05),TNF-α、IL-6、MMP-3水平显著升高(P<0.05)。TGF-β/BMP激动剂组大鼠异常行为减少,椎间盘软骨组织损伤减轻;Smad4 mRNA、TIMP-3 mRNA表达与TGF-β1、BMP-7、Smad2/3、Smad1/5/8 mRNA及蛋白、BMPR-1A、ALK5、Sox9、COL2A1蛋白表达、TIMP-3平均光密度值显著升高(P<0.05),TNF-α、IL-6、MMP-3水平显著降低(P<0.05)。结论针刀干预可能通过激活TGF-β/BMP信号通路,抑制细胞外基质降解、抑制椎间盘组织内炎症,起到延缓椎间盘退变发展、达到治疗LDH的目的。

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth Ⅱ gastrectomy

AIM:To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in BillrothⅡ(B-Ⅱ)gastrectomy patients.METHODS:Endoscopic sphincterotomy in patients with B-Ⅱgastrectomy is challenging.We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy.This technique was performed in nine patients between August 2010 and June 2012.Sphincterotomy as described above was performed.Adequate sphincterotomy,successful stone removal,and complications were investigated prospectively.RESULTS:Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients.Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof.Complete stone removal in one session was achieved in all patients.There were no procedure related complications,such as bleeding,pancreatitis,or perforation.CONCLUSION:In patients with B-Ⅱgastrectomy,guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones.

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.

小针刀联合热敏灸治疗腰大肌损伤性腰腿痛患者的疗效及对其JOA评分、血清白细胞介素-17、白细胞介素-18水平的影响

目的探讨小针刀联合热敏灸治疗腰大肌损伤性腰腿痛患者的疗效及对其日本骨科学会(JOA)评分、血清白细胞介素17(Interleukin-17,IL-17)、白细胞介素-18(Interleukin-18,IL-18)水平的影响。方法选取2020年10月—2022年10月期间赣州市人民医院中医科门诊收治的100例腰大肌损伤性腰腿痛患者,根据患者入院单双号分为小针刀组和联合组,每组各50例。分别给予小针刀治疗和小针刀联合热敏灸治疗,连续治疗1周,共治疗两周。观察比较两组患者临床疗效、腰腿功能评价[JOA量表和Oswestry功能障碍指数问卷表(ODI)]、血清炎性指标[白细胞介素-17(interleukin-17,IL-17)、白细胞介素-18(Interleukin-18,IL-18)、白细胞介素-1β(Interleukin-1β,IL-1β)]、疼痛递质[血清神经肽Y(Neuropeptide Y,NPY)、5-羟色胺(5-Hydroxytryptamine,5-HT)及P物质(Substance P,SP)]水平。结果治疗后联合组临床总有效率94.00%(47/50)明显高于小针刀组78.00%(39/50),差异有统计学意义(P<0.05)。治疗后两组患者JOA量表评分均较治疗前升高,ODI量表评分均较治疗前降低,差异有统计学意义(P<0.05);且联合组JOA量表评分明显高于小针刀组,ODI量表评分明显低于小针刀组,差异有统计学意义(P<0.05)。治疗后两组患者IL-17、IL-18、IL-1β水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组炎性因子水平明显低于小针刀组,差异有统计学意义(P<0.05)。治疗后两组患者NPY、5-HT、SP水平均较治疗前降低,差异有统计学意义(P<0.05);且联合组疼痛递质水平明显低于小针刀组,差异有统计学意义(P<0.05)。结论小针刀联合热敏灸不仅能够促进腰大肌损伤性腰腿痛患者的功能恢复,对于减轻炎症反应,抑制神经疼痛递质也效果显著。

生物-心理-社会一体化护理在膝骨关节炎针刀治疗患者中的应用效果

目的:观察生物-心理-社会一体化护理在膝骨关节炎(KOA)针刀治疗患者中的应用效果。方法:选取2021年1月至2023年1月该院采取针刀治疗的88例KOA患者进行前瞻性研究,采用随机数字表法将其分为对照组和观察组各44例。对照组采取常规护理,观察组采取生物-心理-社会一体化护理,比较两组护理前后不良情绪[正性负性情绪量表(PANAS)]、膝关节病情严重程度[膝骨关节炎严重性指数(ISOA)]、生命质量[健康调查简表(SF-36)],以及护理满意度评分。结果:护理后,观察组积极情感层面PANAS评分高于对照组,消极情感层面PANAS评分低于对照组,差异均有统计学意义(P<0.05);护理后,观察组ISOA评分均低于对照组,差异有统计学意义(P<0.05);护理后,观察组躯体功能、情感职能、心理健康、活力、躯体疼痛、社会功能、总体健康和生理职能等SF-36评分均高于对照组,差异有统计学意义(P<0.05);观察组护理方式、心理干预、沟通态度和护理效果评分均高于对照组,差异有统计学意义(P<0.05)。结论:生物-心理-社会一体化护理应用于KOA针刀治疗患者可提高SF-36和护理满意度评分,改善PANAS评分,降低ISOA评分,效果优于常规护理。

解毒除湿通督汤联合小针刀治疗湿热痹阻型强直性脊柱炎疗效及对血清CRP、IL-1β和TNF-α水平的影响

目的探讨解毒除湿通督汤联合小针刀治疗强直性脊柱炎(ankylosing sporidylitis,AS)的疗效及对血清C反应蛋白(C-reactive protein,CRP)、白介素1-β(interleukin-1β,IL-1β)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)水平的影响。方法将医院收治的AS患者96例随机分为对照组(48例,小针刀疗法)和治疗组(48例,解毒除湿通督汤联合小针刀),对比治疗后疗效、证候评分、巴氏强直性脊柱炎活动性指数(Bath ankylosing spondylitis disease activity inde,BASDAI)评分、巴氏强直性脊柱炎测量指数(Bath ankylosing spondylitis metroloty index,BASMI)评分和巴氏强直性脊柱炎功能指数(Bath ankylosing spondylitis functional index,BASFI)评分、健康调查简表(the MOS item short from health survey,SF-36)评分、血清炎性因子水平、枕墙距、指地距、晨僵时间及胸廓活动度变化。结果治疗组临床疗效明显较高(P<0.05);治疗后两组BASMI评分、BASDAI评分和BASFI评分较治疗前明显降低(P<0.05),且治疗组降低较明显(P<0.05);治疗两组后血清CRP、IL-1β和TNF-α水平较治疗前显著降低(P<0.05),且治疗组降低较明显(P<0.05);治疗前两组中医证候评分差异无统计学意义(P>0.05);治疗后两组四肢关节冷痛、颈项脊背僵紧疼痛、腰骶臀胯僵痛评分较治疗前显著降低(P<0.05),且治疗组降低较明显(P<0.05);治疗前两组SF-36评分差异无统计学意义(P>0.05),治疗后两组SF-36较治疗前显著升高(P<0.05),且治疗组升高较明显(P<0.05);治疗后两组枕墙距、指地距和晨僵时间较治疗前显著降低升高,胸廓活动度较治疗前明显升高(P<0.05),并且治疗组改善程度较大(P<0.05)。结论采用解毒除湿通督汤联合小针刀治疗湿热痹阻型强直性脊柱炎具有较好的临床疗效,能够降低血清CRP、IL-1β和TNF-α水平,值得在临床上推广应用。

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.

弹拨牵引松解三部平衡法联合塞来昔布对膝骨关节炎患者膝关节功能及基质金属蛋白酶3、转化生长因子β_(1)、内皮素-1的影响

目的观察弹拨牵引松解三部平衡法联合塞来昔布治疗膝骨关节炎(KOA)的临床疗效。方法将72例KOA患者按照随机数字表法分为2组。对照组36例予塞来昔布治疗,治疗组36例在对照组治疗基础上加弹拨牵引松解三部平衡法治疗,2组疗程均为4周。比较2组临床疗效及不良反应,比较2组治疗前后疼痛视觉模拟评分(VAS)、西安大略和麦克马斯特大学(WOMAC)骨关节炎指数评分(以下简称为WOMAC评分)、膝关节活动度、Lysholm膝关节评分及基质金属蛋白酶3(MMP-3)、转化生长因子β_(1)(TGF-β_(1))、内皮素-1(ET-1)水平。结果治疗后,2组疼痛VAS、WOMAC评分均较本组治疗前降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组膝关节活动度、Lysholm膝关节评分均较本组治疗前增加(P<0.05),且治疗组均高于对照组(P<0.05)。治疗后,2组MMP-3、ET-1水平均较本组治疗前降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组TGF-β_(1)水平均较本组治疗前升高(P<0.05),且治疗组高于对照组(P<0.05)。治疗组总有效率91.7%(33/36),对照组总有效率75.0%(27/36),治疗组总有效率高于对照组(P<0.05)。2组均未见不良反应。结论弹拨牵引松解三部平衡法联合塞来昔布可提高KOA患者的治疗效果,缓解疼痛,抑制炎症反应,改善血管内皮损伤和膝关节功能,安全性高,值得临床推广。

Management of needle blight (Lophodermium pinastri) disease in Blue pine trees in Kashmir,India

Evaluation of various fungicides against needle blight disease of pine was carried out at Shed Kashmir University of Agriculture Sciences and Technology of Kashmir （India） during the year 2008 and 2009. Applica- tion of various fungicides were evaluated in vivo at dif- ferent concentrations. However in both, mist-chamber and poly-chamber, the Blue pine （Pinus wallichiana Jackson） seedlings treated with hexaconazole 5EC （@ 0.03 %） or carbendazim 50WP （@ 0.1%） depicted significantly less disease incidence and intensity. The seedlings treated with mancozeb 75WP （@ 0.3 %） and chlorothalonil 75WP （@ 0.3 %） exhibited less disease incidence and intensity. Increase in relative humidity from 60 to 100 % signifi- cantly enhanced needle blight disease incidence and intensity. In field trial the fungitoxicants used either as single spray or protectant followed by systemic fungitoxi- cant spray significantly reduced disease incidence in Blue pine compared to check. The mean disease incidence in fungitoxicant treated plants varied from 11.82 to 25.51% as compared to 36.03 % in control.

Wide-awake结合肌骨超声下腕管综合征针刀手术治疗的临床观察

目的:观察局麻无止血带技术(wide-awake)结合肌骨超声在腕管综合征(CTS)针刀手术中的应用效果。方法:选取江西中医药大学附属医院2019年7月—2021年5月收治的CTS患者52例,随机数字表法分为观察组(n=26)和对照组(n=26),观察组使用wide-awake结合肌骨超声CTS针刀手术治疗,对照组采用传统针刀手术治疗。比较2组视觉模拟评分(VAS)、出血量、Levine腕管综合征问卷评分、肌电图指标和疗效,记录不良事件。结果:术前、术中和术后观察组患者VAS评分和术中出血量均显著低于对照组(P<0.05);术后2组Levine腕管综合征问卷功能和症状评分均明显降低(P<0.05),且观察组显著低于对照组(P<0.05);2组术后肌电图指标有显著改善(P<0.05),且观察组明显优于对照组(P<0.05);观察组疗效优于对照组(P<0.05);观察组未见不良事件,对照组不良事件1例。结论:wide-awake结合肌骨超声疗法疗效显著,可有效降低CTS针刀手术时患者的疼痛感和出血量,改善临床症状且安全性可靠。

基于经筋理论的膝骨关节炎患者“筋结点”超声解剖学特征分析与针刀治疗的疗效评价研究

目的:借助可视化肌骨超声深入剖析膝骨关节炎患者膝关节局部经筋病灶点的病理特征,并综合评价弓弦平衡针刀法与常规针刺法治疗膝骨关节炎的疗效差异,为今后针刀精准辨位定点及安全入路研究提供客观参考依据。方法:将120例膝骨关节炎患者随机分为针刀治疗组和针刺对照组,每组60例。针刀治疗组进行弓弦平衡针刀法治疗,每周2次;针刺对照组选取犊鼻、内膝眼、阳陵泉、梁丘、鹤顶,及局部阿是穴进行针刺,同时根据不同的证型进行配穴加减,每周3次。2组均以3周为1个疗程,治疗3个疗程。根据肌骨超声下“筋结点”的精确定位、层次解剖、回声特点深入剖析经筋病灶点的超声影像学特征,采用股直肌羽状角、肌纤维横断面积、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)综合评价2组疗效差异。结果:治疗后,2组患者WOMAC评分、股直肌羽状角、平均肌纤维厚度、弹性应变率、IL-1β、TNF-α水平,及膝关节疼痛程度、僵硬、日常活动能力方面较治疗前均显著改善(P <0.05);其中,针刀治疗组在提升股直肌羽状角、增加肌纤维厚度、降低弹性应变率、降低致炎致痛因子水平方面优于针刺对照组,差异有统计学意义(P <0.05);与正常膝关节超声解剖结构相比,患者膝关节各针刀松解点(筋结点)处呈现出不同程度回声增强,同时伴有滑膜增厚、增生、关节腔积液、滑囊积液等典型超声影像学特征。结论:肌骨超声能够精准呈现膝骨关节炎患者膝关节经筋病灶点的解剖位置、解剖层次等超声病变特征,证实弓弦平衡针刀法的安全性和有效性,为针刀医学的标准化、规范化研究提供重要参考依据。