Some Problems of Warm Acupuncture in the Treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society and the increment in obesity rate,the incidence of KOA increases sharply,which seriously effects the quality of human life.Before,how to take effective treatment methods is very important.Severe ways to treat the disease include non-steroidal drugs,local injections,surgery,and cell and gene therapies.However,each therapy has certain defections,such as gastrotestinal tract irritation,cardiovascular safety,or high medical costs for patients.Traditional Chinese medicine has a long history in treating KOA,reported by acupuncture,massage,internal administration of traditional Chinese medicine,and external use of traditional Chinese medicine.In clinical practice,patients can be treated from the root agreement to different etiology,and patients can be treated agreement to different syndrome types by syndrome difference to achieve effect.Studies have shown that warm acupuncture is effect in treating KOA.It has two kinds of treatment methods:acupuncture and moxibustion at the same time.It has fewer side effects and is more acceptable to patients.However,there are still some problems in the basic research and clinical application of warm acupuncture and moxibustion in treating KOA.This paper discussed the existing problems from the followingfive aspects:lack of unified synthesis difference and treatment system,problems in clinical research,weak basic research,problems in the study of moxibustion,and lack of the best treatment program recognized by the academic community.Meanwhile,the selection of acupoints,the relationship between acupuncture depth and anatomy should be further studied in order to offer research ideas for the healthy development of the treatment of KOA with warming acupuncture and moxibustion in the future.

Therapeutic effect of San Bi Tang combined with glucosamine sulfate capsules in cold-dampness-type knee osteoarthritis

BACKGROUND Cold-dampness-type knee osteoarthritis is a common middle-aged and elderly disease,but its pathogenesis is not fully understood,and its clinical treatment has limitations.Glucosamine sulfate capsules are commonly used for treating arthritis,and San Bi Tang is a classic formula of traditional Chinese medicine(TCM)that has the effects of warming yang,dispelling dampness,relaxing muscles,and activating collaterals.This research hypothesized that the combination of modified San Bi Tang and glucosamine sulfate capsules could enhance the clinical efficacy of treating cold-dampness-type knee osteoarthritis through complementary effects.AIM To analyze the clinical efficacy of San Bi Tang combined with glucosamine sulfate capsules when treating cold-dampness-type knee osteoarthritis.METHODS A total of 110 patients with cold-dampness-type knee osteoarthritis were selected as research subjects and randomly divided into a control group and an experimental group of 55 cases each.The control group received only treatment with glucosamine sulfate capsules,while the experimental group received additional treatment with modified San Bi Tang for a duration of 5 wk.The patients’knee joint functions,liver and kidney function indicators,adverse reactions,and vital signs were evaluated and analyzed using SPSS 26.0 software.RESULTS Before treatment,the two groups’genders,ages,and scores were not significantly different,indicating comparability.Both groups’scores improved after treatment,which could indicate pain and knee joint function improvement,but the test group had better scores.The TCM-specific symptoms and the clinical efficacy of the treatment in the test group were higher.Before and after treatment,there were no abnormalities in the patients’liver and kidney function indicators.CONCLUSION The combination of modified San Bi Tang and glucosamine sulfate capsules is superior to treatment with sulfated glucosamine alone and has high safety.

Systematic evaluation and Meta-analysis of acupuncture and collaterals cupping therapy for Knee Osteoarthritis

Objective:In order to obtain the best treatment program for Knee Osteoarthritis(KOA),to alleviate the pain of patients with KOA,and to systematically evaluate the efficacy of acupuncture cupping therapy for KOA.Methods:we used computer to search the databases of CNKI(1989-2018.10),Wanfang(1989-2018.10),VIP(1989-2018.10),PubMed(1966-2018.10),EMbase(1986-2018.10)and Cochrane Library(the 3rd issue of 2018).And the literature quality was evaluated by Jadad scale.Results:A total of 19 eligible RCT studies were included,and a total of 2,088 patients participated in the eligible clinical study.Meta-analysis results showed that the total effective rate OR combination=2.85[OR=3.98,95%CI(2.98,5.32),P<0.00001].The results showed that the curative effect of acupuncture and collaterals cupping in the treatment of KOA was superior to other therapies.Conclusion:Acupuncture and cupping therapy of traditional Chinese medicine is effective and safe in treating KOA.Due to the impact of the original study on Meta-analysis results,more large samples and high-quality clinical trials are still needed to verify.

Therapeutic Effect of Chinese Massage Combined with Warm Acupuncture on Knee Osteoarthritis

Objective:To investigate the effect of Chinese massage combined with warm acupuncture on knee osteoarthritis.Methods:60 patients with knee osteoarthritis who were treated in our hospital from January 2017 to October 2019 were selected as the research subjects,and they were randomly divided into 2 groups of 30 patients each.The control group was treated with oral western medicine,and the observation group was treated with massage combined with warm acupuncture.The clinical efficacy and WOMAC index were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group,and the WOMAC score was lower than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Chinese massage combined with warm acupuncture is effective in treating knee osteoarthritis It can effectively alleviate the symptoms of pain and joint stiffness in patients,and improve joint mobility,which is worth for clinical promotion.

Clinical Effect of Acupuncture Treatment in 109 Cases of Knee Osteoarthritis

Knee Osteoarthritis, a retrograde disease, is mainly characterized by pain in the knee joints and limitation of the movement. It is a common and frequently occurring disease affecting the health and life quality of old people. In recent years, acupuncture treatment of knee osteoarthritis with satisfactory therapeutic results has been repeatedly reported,2-3, 5-6 but there has been few report on the observation of long-term therapeutic effects after treatment. With acupuncture as the main therapy, 109 cases of knee osteoarthritis were treated in this series. 91 cases with good therapeutic results were followed up for 6 months. A report is presented in the following.

Deqi effect for treating knee osteoarthritis using manual acupuncture:A network meta-analysis

Objective: To explore whether the deqi effect affects the effectiveness of manual acupuncture for treating knee osteoarthritis by a network meta-analysis(NMA).Methods: Eight databases were searched for relevant published studies since inception through January 2021. Randomized control trials that compared manual acupuncture with deqi, manual acupuncture without deqi, and conventional treatment of western medicine were included. Languages were limited to English and Chinese. Two authors independently selected eligible studies, assessed methodological quality and the effects of deqi, and extracted outcome data. The mean difference(MD) and standardized mean differences(SMDs) with 95% confidence intervals(CIs) were calculated by Stata 15.0 to conduct an NMA based on a frequentist framework.Results: Fourteen trials with a total of 1868 subjects were included. The direct and indirect comparisons were authentic, according to inconsistency tests. The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) pooled results indicated that there was no significant effect of deqi(SMD=-0.23, 95% CI [-0.81, 0.35]). The pooled results of visual analogue scale(VAS) were similar to those of WOMAC(MD=-0.53, 95% CI [-1.03, 0.02]).Conclusion: As a summary of the currently available research, the NMA results indicated that deqi effect might not be the crucial factor for the effectiveness of manual acupuncture.

Clinical observation of kidney tonifying and collateral tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and its effect on TRACP and CTX-I

Objective:To observe the clinical effect of kidney-tonifying and colllateral-tonifying acupuncture combined with thermosensitive moxibustion in the treatment of knee osteoarthritis and cold congealing syndrome and the effect on Tartrate-resistant Acid Phosphatase(TRACP)andⅠcollagen C-terminal foreign body peptide(CTX-I).Methods:Totally 90 patients with knee osteoarthritis were divided into three groups:acupuncture group,thermosensitive moxibustion group and routine group with 30 cases in each group.In the conventional group,sodium hyaluronate was injected into the joint cavity and diclofenac sustained release tablets were taken orally.Thermosensitive moxibustion group was given thermosensitive moxibustion on the basis of conventional treatment.Acupuncture and moxibustion group in the heat sensitive moxibustion group treatment was given kidney tonifying acupuncture.VAS score,JKOM score and Ly-Sholm knee score were observed before and after treatment and followed up for 2 weeks.The levels of TRACP and CTX-I in serum before and after treatment.Results:Before treatment,there were statistically significant differences in VAS score,JKOM score and Ly-Sholm knee score among all groups(P>0.05).After treatment,the VAS score and JKOM score decreased,and the decrease degree was the greatest in the acupuncture group(P<0.05).Ly-Sholm knee score increased,and the change degree was the greatest in acupuncture group(P<0.05).Before treatment,the levels of TRACP and CTX-I in serum of all groups were significantly different(P>0.05).After treatment,serum TRACP and CTX-I levels were decreased,and the decrease degree was the greatest in acupuncture group(P<0.05).The total effective rates of the acupuncture group,the thermal sensitive moxibustion group and the conventional group were 96.7%,80%and 66.7%,respectively,and the difference between each group was statistically significant(P<0.05).Conclusion:Kidney-tonifying and collature-tonifying acupuncture combined with thermosensitive moxibustion can significantly relieve knee pain and other symptoms of knee osteoarthritis in patients and cold congealing syndrome,which is worthy of clinical promotion.

CLINICAL OBSERVATION ON THE TREATMENT OF KNEE OSTEOARTHRITIS BY ACUPUNCTURE IN BA-HE TECHNIQUE

Objective: To observe the clinical therapeutic effect of Ba-He techniqu e of acupuncture in the treatment of knee osteoarthritis. Methods: A total of 90 cases of knee osteoarthritis were evenly randomized into Ba-He technique group (observation group) and common technique group (control group), with 45 cases in each group. Zusanli (足三里 ST 36), Heding (鹤顶 EX-LE 2) and Dubi (犊鼻 ST 35 ) were punctured respectively in Ba-He technique and common technique in the two gr oups. The therapeutic effects of the two groups were compared after one course o f treatment (10 sessions) in accordance with Japanese assessment criteria for kn ee-joint functions. Results: After treatment, among the 74 and 7 1 affected knees in the observation and control groups, the therapeutic effect was excellent in 42 (56.8%) and 26 (36.6%) knees, fine in 14 (18.9%) and 20 (28.2%), OK in 10 (13 .5%) and 11 (15.5%), and poor in 8 (10.8%) and 14 (19.7%) respectively. The ther apeutic effect of the observation group was significantly better than that of co ntrol group (P<0.01). Conclusion: The Ba- He technique of acupuncture applied to the above-mentioned three acupoints exerted remarkable therapeutic effect for k n ee osteoarthritis, which is obviously better than that of the common needling te chnique.

Clinical effect of scraping therapy in the treatment of knee osteoarthritis

Objective:The objective of this study is to investigate the effect of scraping therapy in the treatment of knee osteoarthritis.Materials and Methods:A total of eighty patients with knee osteoarthritis were assigned to the moxibustion group and the scraping therapy group according to the random numerical table method,with forty cases in each group.Patients in both two groups received functional exercise and moxibustion therapy,and those in the scraping therapy group were supplemented with scraping therapy.The serum indexes of interleukin‑1(IL‑1),IL‑6,tumor necrosis factor‑alpha(TNF‑α),and superoxide dismutase(SOD)were detected before and after the treatment.The clinical syndrome integral and Visual Analog Scale(VAS)on pain of patients were assessed.The clinical therapeutic efficacy was evaluated and compared between the two groups.Results:Patients in the scraping therapy group received better outcomes of serum IL‑1,IL‑6,TNF‑α,and SOD compared with those in the moxibustion group at 2 months after treatment(P<0.05).The scores of clinical syndrome integral and VAS on pain were decreased in two groups at 2 months after the treatment and were lower in the scraping therapy group than those in the moxibustion group(P<0.05).The overall effective rate in the scraping therapy group was higher than that in the control group(87.50%vs.67.50%,P<0.05).Conclusion:The scraping therapy is potentially effective to ameliorate the clinical symptom and pain degree of patients with knee osteoarthritis.

Application of five-element music therapy in pain coping skills training in patients with knee osteoarthritis

Objective:The objective of this study is to assess the application effect of five elements music therapy introduced in the pain coping skills training of knee osteoarthritis(KOA).Materials and Methods:Totally,80 patients with KOA were selected and randomly divided into the experimental group(39 cases)and the control group(41 cases).The control group was only given routine nursing measures,and the experimental group was additionally treated with five-element music therapy on the basis of the control group,twice a day,28 days in total.The Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC)was used to evaluate the functional status of the knee joint of the two groups.The clinical efficacy of the two groups was evaluated by Guiding Principles for Clinical Research of New Chinese Medicine in the Treatment of Osteoarthritis.Results:WOMAC score statistically significantly decreased in the experimental group(35.92±9.48 vs.16.17±5.43,P<0.01)and the control group(36.73±6.42 vs.22.53±7.51,P<0.01)after 28 days of intervention when compared with that before intervention;WOMAC score in the experimental group was lower than that of the control group after 28 days of intervention(16.17±5.43 vs.22.53±7.51,P<0.01).The total effective rate of the experimental group was statistically higher than that of the control group(82.0%vs.51.2%,χ2=11.97,P=0.003).Conclusion:The combination of five-element music therapy and routine nursing measures has better effect in relieving pain and bad emotions of patients with KOA when compared with routine nursing measures alone.

Clinical effect of extracorporeal shockwave therapy for knee osteoarthritis: A meta analysis

Objective:To provide evidence-based evidence for the clinical use of shockwave therapy in KOA.Methods: Two researchers independently searched the randomized controlled study of shockwave therapy for KOA in the databases of CNKI、VIP、WanFang Data、 Sinomed and PubMed. Jadad rating scale was used for literature quality evaluation, and the extracted data was meta-analyzed by RevMan5.3 software.Results: A total of 15 randomized controlled trials involving 1248 patients were included. The results of meta-analysis showed: The clinical effective rate of shock wave therapy for knee osteoarthritis was reliable[RR=1.12, 95%CI(1.03, 1.20), p=0.005], and the efficacy was reliable in reducing the visual analogue scale [MD=-1.73, 95%CI(-2.31, -1.14), p<0.00001] , Lequesne osteoarthritis severity index[MD=-1.60, 95%CI(-2.55, -0.64), p<0.00001] and WOMAC[MD=-6.03, 95%CI(-9.49,-2.57) p=0.0006] of KOA patients, without serious adverse reactions.Conclusion:At present, the evidence shows that shock wave can effectively improve the pain and other related symptoms in KOA patients, and the curative effect is reliable.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

Efficacy of Slow Reversal Hold and Isometrics in Improving Muscle Strength, Increasing Range of Motion, and Reducing Pain in Patients with Osteoarthritis of Knee

Osteoarthritis of knee is a common problem in the elderly population worldwide. Physical therapy has been shown to be useful in decreasing pain and increasing mobility in this population. The aim of this study was to study the effectiveness of slow reversal hold and isometric exercise techniques in reducing pain, increasing muscle strength, and increasing range of motion for knee flexion in patients with osteoarthritis of knee. The other aim of this study was to compare the relative effectiveness of these two interventions. 60 subjects participated in this study and were randomly assigned either to the slow reversal hold group (n = 30) or, to the isometrics exercise group (n = 30). All subjects performed their respective exercises for 3 weeks. Pain scores using the visual analog scale, muscle strength using manual muscle testing of quadriceps and hamstrings, and range of motion (ROM) for knee flexion using a goniometer were recorded both pre-treatment and post-treatment for both left and right knees. Both the interventions showed a significant decrease in pain scores, an increase in muscle strength, as well as an increase in the ROM. However, ROM was significantly increased in the slow reversal hold group as compared to the isometrics group in both knees. It was concluded that both exercise techniques could be useful in patients with osteoarthritis of knee for decreasing pain and increasing muscle strength. Slow reversal hold technique might be a better technique than isometrics for increasing ROM for knee flexion.

The effect of hot intermittent cupping on pain,stiffness and disability of patients with knee osteoarthritis

Objective:The aim of this study was to investigate the effect of hot intermittent cupping on pain,stiffness and inability of patients with knee osteoarthritis(KO).Methods:The present study was a clinical trial,which was performed on 38 patients with KO referring to Gonabad Rheumatology Specialty Clinic.Based on permutation block method,the research units were divided into cupping therapy and control groups.For the cupping therapy group,four sessions of cupping therapy were performed every four days.To collect data,the form of demographic information,Visual Analogue Scale(VAS)and the Western Ontario and McMaster(WOMAC)osteoarthritis scale were used,and the data were analyzed by SPSS software v.16 using descriptive statistics and independent t-test,paired t-test,Chi-square test and Fishers exact test with a significance level of P<0.05.Results:Findings showed that there was no significant difference between the cupping therapy and control groups in terms of demographic characteristics and they were homogeneous.Findings indicated that,based on VAS,the mean pain intensity in the left(P<0.001)and the right knees(P<0.001),as well as based on WOMAC,stiffness(P=0.006),pain intensity(P<0.001)and disability(P<0.001)in the cupping therapy group significantly decreased compared to the control group.Conclusion:Findings showed that hot intermittent cupping therapy reduced the pain intensity,stiffness and disability in patients with KO.

Efficacy and safety of extracorporeal shock wave therapy combined with sodium hyaluronate in treatment of knee osteoarthritis:a systematic review and Meta-analysis

OBJECTIVE:To assess the efficacy and safety of extracorporeal shockwave therapy(ESWT)combined with sodium hyaluronate(HA)for the treatment of knee osteoarthritis(KOA).METHODS:PubM ed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,and SinoMed were searched from inception to July 2020.The quality of the randomized controlled trials was evaluated independently by two reviewers according to the criteria in the Cochrane Collaboration for Systematic Reviews.The identified articles were then screened individually using EndnoteX9 for eligibility in this Meta-analysis.The heterogeneity among the articles was evaluated using I2.RESULTS:A total of 17 studies,comprising 2000 individuals,were included in this Meta-analysis.The results showed that a significant improvement was observed in knee pain and function based on the clinical efficacy of ESWT combined with HA.Statistical analysis of clinical efficacy showed that[relative risk(RR)=1.21,95%confidence interval(CI)(1.12,1.30),P<0.01].Statistical analysis of visual analog scale showed that[standardized mean difference(SMD)=-2.84,95%CI(-4.01,-1.66),P<0.01].Western Ontario and McMaster University osteoarthritis index statistical analysis showed that[SMD=-1.57,95%CI(-2.52,-0.61),P<0.01].Lysholm score statistical analysis showed that[SMD=1.71,95%CI(0.98,2.44),P<0.01].In addition,only minor side effects,such as redness and swelling of the skin,were observed.CONCLUSIONS:Medium to low quality evidence showed that ESWT combined with HA offers an inexpensive,welltolerated,safe,and effective method to improve pain and functionality in patients with KOA.However,tightly controlled,randomized,large multicenter trials are warranted to validate the current findings.

Observation on clinical efficacy of tension-balance acupuncture therapy in treating knee osteoarthritis

Objective By comparison of the clinical efficacy of treating knee osteoarthritis with tension-balance acupuncture therapy and conventional acupuncture therapy, the effectiveness of treatment of knee osteoarthritis with tension- balance acupuncture therapy was evaluated. Methods Sixty-three patients with knee osteoarthritis in conformity with the diagnostic criteria were randomly divided into the tension-balance-acupuncture group （32 cases, balance group for short） and the conventional acupuncture group （31 cases, conventional group for short） according to random number table. In the balance group, patients with the pain in the anterior flexor group were needled at Biguan （髀关 ST 31）, Fengshi （风市 GB 31）, Heding （鹤顶 EX-LE 2）,Dubi （犊鼻 ST 35）, Yanglingquan （阳陵泉 GB 34）, Xuehai （血海 SP 10） and Liangqiu （梁丘 ST 34） .Afterwards the patients were repositioned in prone position. They were given the treatment by needling at Huantiao （环跳 GB 30）, Chengfu （承扶 BL 36）, Weizhong （委中 BL 40）, Weiyang （委阳 BL 39）, Yinlingquan （阴陵泉 SP 9）, Ququan （曲泉 LV 8） and Chengshan（承山 BL 57）.Patients with the pain in the posterior extensor group were needled at ST 31, GB 31, EX-LE2, ST 35, GB 34, SP 10 and ST 34 .Then the patients were repositioned in prone position. They were given the treatment by needling at GB 30, BL 36, BL 40, BL 39, SP 9, LV 8 and BL 57. They were treated once a day with five days as a course of treatment and two days as an interval. After three courses, Lequesne indiceses before and after the treatment and clinical efficacy of the treatment were observed. In the conventional group, patients were treated in a sitting position by needling at ST 35, Xiyang （膝眼 EX-LE 5）,Zusanli（足三里 ST 36）, GB 34, Xuanzhong （悬钟 GB 39）, SP 9, EX-LE2, ST 34, Shenshu （肾俞 BL 23） and Pishu （脾俞 20）. They were treated once a day with five days as a course of treatment and two days as an interval. After three courses, the clinical efficacy of the treatment was observed. Results After three courses, improved Lequesne indices score was （5.55± 1.08） in the balance group while improved Lequesne indices score was （2.14 ± 0.57） in the conventional group, indicating that improved Lequesne indices score in the balance group was superior to that of the conventional group with the significant difference （P〈0.05）; efficacy rate in the balance group was 84.37% while that of the conventional group was 58.06%, and efficacy rate in the balance group was superior to that of the conventional group （P〈0.01）. Conclusion Clinical efficacy of treatment of knee osteoarthritis in the balance group was superior to that of the conventional group, worthy of clinical promotion.

Acupotomy alleviates knee osteoarthritis in rabbit by regulating chondrocyte mitophagy via Pink1-Parkin pathway

OBJECTIVE:To investigate the effect of acupotomy,on mitophagy and the Pink1-Parkin pathway in chondrocytes from rabbits with knee osteoarthritis(KOA).METHODS:A KOA model was established via the modified Videman method.Rabbits were randomly divided into a control group(CON),KOA group and KOA+acupotomy group(Acu).Rabbits in the acupotomy group were subjected to acupotomy for 4 weeks after model establishment.The behavior of the rabbits before and after intervention was recorded.Cartilage degeneration was evaluated by optical microscopy and fluorescence microscopy.The level of mitophagy was evaluated by transmission electron microscopy,immunofluorescence and enzyme-linked immunosorbent assay(ELISA).The expression of phosphatase and tensin homolog(PTEN)-induced kinase 1(Pink1)-Parkin mitophagy pathway components was evaluated by immunofluorescence,Western blotting and real-time polymerase chain reaction.RESULTS:In rabbits with KOA,joint pain,mobility disorders and cartilage degeneration were observed,the Mankin score was increased,collagen typeⅡ(Col-Ⅱ)expression was significantly decreased,mitophagy was inhibited,mitochondrial function was impaired,and factors associated with the Pink1-Parkin pathway were inhibited.Acupotomy regulated the expression of Pink1-Parkin pathway-related proteins,the mitophagy-related protein microtubule-associated protein-1 light chain-3,the translocase of the outer membrane,and the inner mitochondrial membrane 23;increased the colocalization of mitochondria and autophagosomes;promoted the removal of damaged mitochondria;restored mitochondrial adenosine-triphosphate(ATP)production;and alleviated cartilage degeneration in rabbits with KOA.CONCLUSIONS:Acupotomy played a role in alleviating KOA in rabbits by activating mitophagy in chondrocytes via the regulation of proteins that are related to the Pink1-Parkin pathway.

Mechanism of acupoint penetration acupuncture therapy regulating chondrocyte autophagy via the PI3K/Akt-mTOR pathway in KOA rats

Objective To investigate whether acupoint penetration acupuncture(APA)could regulate chondrocyte autophagy and apoptosis via the PI3K/Akt-mTOR signaling pathway to reduce cartilage degeneration in knee osteoarthritis(KOA)rats.Methods KOA was induced in rats via intra-articular injection of sodium iodoacetate resolution.Forty male Sprague-Dawley rats were randomly assigned to blank control,model,APA,electro-acupuncture(EA),and sham model groups(n=8)and those in the APA and EA groups received their respective therapies.Following completion of the treatment course,histological examinations of cartilage and muscle were conducted.Levels of apoptosis-and autophagy-related factors,including Bax,Bcl-2,mTOR,ULK-1,and Beclin-1 protein,and mRNAs were assessed.Additionally,β-endorphin(β-EP)concentrations in the brain and serum were measured.Results Histological analysis revealed that APA alleviated cartilage and muscle damage compared with the model group.APA inhibited cartilage degeneration by modulating the expression of apoptosis-and autophagy-related proteins and mRNA,thus preventing chondrocyte apoptosis.In the APA group,Bax and mTOR protein levels were significantly lower than those in the model group(both P=.024).Conversely,the Bcl-2 expression level was significantly higher than that in the EA group(P=.035).Additionally,ULK-1 expression was significantly lower than that in the EA group(P=.045).The mRNA level of Bax was significantly higher than that in the blank control group(P<.001).However,Beclin-1 levels were significantly higher than those in both the model and EA groups(both P<.001).ELISA results showed a significant decrease in the concentration ofβ-EP in the brains of the rats in the APA group compared with those in the model group(P=.032).Conclusions APA reduced osteoarthritis-related pain and alleviated cartilage damage by upregulating chondrocyte autophagy and down-regulating apoptosis via signaling pathways involving PI3K/Akt-mTOR in KOA rats.

Clinical Observation on Treatment of Knee Osteoarthritis by Acupuncture and Tuina Therapy

Objective： To observe the effect of acupuncture and Chinese tuina manipulation therapy in treating knee osteoarthritis, and analyze the alteration of musculus quadriceps femoris strength. Methods： A total of 80 patients were randomly assigned to a treatment group receiving acupuncture combined Chinese tuina manipulation therapy （n=40） and a control group receiving Fenbid treatment （n=40）, curative effective score, Lequene ＆ Mery assessment tests, and isokinetic evaluation were recorded before and after the treatment course. Results： The total effective rate was 90.0 % in the treatment group and 87.5% in the control group, without a significant difference between the two groups. Lequene ＆ Mery assessment tests had no significant change. Musculus quadriceps femoris isokinetic evaluation improved significantly after the treatment course in the two groups （/9〈0.05）, and there was a significant difference between the two groups （P〈0.05）. Conclusion： Acupuncture combined with tuina manipulation therapy and Fenbid treatment both can reduce knee pain and joint disability in the short term, though no improvement was shown in the severity of the disease. Acupuncture combined with tuina manipulation therapy is better than Fenbid in improving the strength, total work and explosive force of the musculus quadriceps femoris.

Effect of acupuncture therapies combined with usual medical care on knee osteoarthritis

OBJECTIVE: To observe the effect of acupuncture or electroacupuncture(EA) combined with usual medical care for treating knee osteoarthritis(KOA).METHODS: A total of 90 patients with KOA were randomly allocated to 3 groups: usual care group(UC group, n = 30) was treated by pharmacological treatment of non-steroidal anti-inflammatory drugs(NSAIDs) and drugs for activating blood circulation(Ds-ABC), acupuncture(AP) combined with usual care group(UC group)(AP + UC group, n =30) and EA combined with UC group(EA + UC group, n = 30). The primary outcome measurements included pain visual analogue scale/score(VAS), Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC Index) and its subscales. Secondary outcome measurement was Assessment of Quality of Life instrument version of the 36-item Short Form Health Survey(AQoL-SF36).RESULTS: By the end of the 1 st week, AP + UC group and EA + UC group exhibited statistically significant improvements in primary outcome measures, except for WOMAC stiffness, compared with the UC group(P < 0.05). Moreover, the energy/fatigue domain of AQoL-SF36 in the AP + UC group showed better results than UC group(P < 0.05). By the end of the 2 nd week, all the primary outcome measures revealed that either the AP + UC or EA +UC group demonstrating remarkable advantages compared with the UC group(P < 0.05). The social functioning and general health domains of AQoLSF36 in the two acupuncture-intervention groups were improved significantly than UC group(P <0.05). We also found the energy/fatigue and emotional wellbeing domains of AQoL-SF36 in the EA +UC group demonstrated better results than UC group(P < 0.05).CONCLUSION: AP or EA combined with usual care is more effective than usual care alone for the treatment of KOA, the intervention of electric current in the process of acupuncture may improve more domains of AQoL-SF36 in KOA patients.