Traditional Chinese medicine for foot pain in a patient with complex regional pain syndrome: A case report

BACKGROUND Complex regional pain syndrome(CRPS)is characterized by pain as well as sensory,motor,and sudomotor disorders.Generally,it is classified into two types CRPS-I and CRPS-II.There is no single diagnostic test or treatment approach for CRPS,and a multidisciplinary approach is gaining attention to improve patients’symptoms and their quality of life.CASE SUMMARY A 35-year-old woman with an unremarkable medical history sought treatment for CRPS at a hospital of Korean medicine.During her first visit,she was wheelchairbound due to severe pain in her left lower extremity.She had edema and discoloration of the left foot.She was treated with a combination of traditional Chinese medicine(TCM)approaches,including acupuncture,moxibustion,pharmacopuncture,and herbal decoction,for approximately 20 sessions.The foot and ankle outcome score(FAOS)and visual analog scale(VAS)score for pain were evaluated,along with general signs and functions.Her symptoms,signs,FAOS,and VAS scores improved after treatment,with a significant 7-degree decrease in the VAS score and a 62-point increase in the FAOS score.Additionally,the foot swelling and discoloration gradually resolved.During the phone follow-up,5 mo after the last visit,additional improvements in outcomes were observed.CONCLUSION Combined TCM treatment may be a reasonable and safe option for alleviating symptoms and improving function in patients with CRPS.

The effectiveness and safety of acupuncture for poor semen quality in infertile males： a systematic review and meta-analysis

The aim of this review is to evaluate the effectiveness and safety of acupuncture for poor semen quality in infertile men. We searched for relevant trials registered up to May 2013 in 14 databases. We selected randomized controlled trials （RCTs） that compared acupuncture, with or without additional treatment, against placebo, sham, no treatment, or the same additional treatment. Two reviewers independently performed the study selection, data extraction, risk of bias and reporting quality appraisal. Risk of bias and reporting quality were appraised by the Cochrane risk of bias tool, the consolidated standards of reporting trials and Standards for Reporting Interventions in Clinical Trials of Acupuncture. The outcomes were sperm motility, sperm concentration, pregnancy rate, and adverse events. Pregnancy was defined as a positive pregnancy test. Four RCTs met the eligibility criteria. Acupuncture increased the percentage of sperm with rapid progression （mean difference - 6.35, 95% confidence interval （CI）. 4.38-8.32, P〈 0.00001） and sperm concentration （mean difference - 6.42, 95% CI. 4.91-7.92, P〈 0.00001）, but these two outcomes were substantially heterogeneous among the studies （F = 72% and 58%, respectively）. No differences in pregnancy rate were found between acupuncture and control groups （odds ratio 1.60, 95% CI. 0.70-3.69, P= 0.27, F = 0%）. No participants experienced adverse events. The current evidence showing that acupuncture might improve poor semen quality is insufficient because of the small number of studies, inadequacy of procedures and/or insufficient information for semen analysis, high levels of heterogeneity, high risk of bias, and poor quality of reporting. Further large, well-designed RCTs are required.

A review of rat models of periodontitis treated with natural extracts

Objective:To review treatment methods using natural extracts applied in rat models of periodontitis to establish a direction for the design of future experiments.Methods:An electronic search of PubMed was carried out using the keywords“periodontitis,”“natural”,“extracts”,“herb*”,“plants”and“rats.”Articles were screened against inclusion and exclusion criteria by two independent researchers.Data describing the characteristics of rats,method of periodontitis inducement,extract administration,and outcome measures were extracted and analyzed by more than two authors manually.Results:Of the 864 articles identified,33 studies were included.The use of SpragueeDawley rats(51.2%)and male rats(90.9%)was preferred.The most common experimental methods were ligature placement(72.7%)and oral administration(66.7%).Alveolar bone loss was evaluated mainly by photography(51.5%)and micro-computed tomography(39.4%).Factors related to bone remodeling and inflammatory processes,such as interleukin-1b,tumor necrosis factor-a,receptor activator of nuclear factor-kB,and osteoprotegerin,were also measured.Conclusion:Many diverse experimental periodontitis models have been used.However,few articles observed bone formation,immune responses,antibacterial effects,and toxicity.Future studies to assess natural extracts for the treatment of periodontitis should be robust and well-designed.

Clinical Efficacy and Safety of Miniscalpel-Needle Treatment for Tension-Type Headache:A Systematic Review and Meta-Analysis

Objective:To investigate the clinical efficacy and safety of miniscalpel-needle(MSN)treatment for tension-type headache(TTH).Method:Seven medical databases were searched to identify randomized controlled trials(RCTs)evaluating the effect and safety of MSN treatment.All articles published up to November 15,2018 were retrieved.A meta-analysis was conducted for the included studies,and the risk of bias was assessed.Primary outcomes were visual analogue scale(VAS)or numeric rating scale(NRS)score.Secondary outcomes were clinical effective rates including total effective rate(TER),markedly effective rate(MER),and totally cured rate(TCR)determined by improvement in clinical symptoms or VAS scores,the frequency of adverse events(AEs)that occurred during the study,and participant quality of life(QOL).Results:Seven RCTs involving 724 participants were included.MSN treatment showed significantly higher MER and TCR[relative risk(RR)1.27,95%confidence interval(Cl)1.01 to 1.61;RR 1.31,95%Cl 1.09 to 1.57,respectively],but not TER(RR 1.03,95%Cl 0.96 to 1.10)compared to acupuncture.MSN treatment plus conventional treatment showed significant lower VAS and higher TER,MER,and TCR(mean difference-3.54,95%Cl-3.80 to-3.28;RR 1.14,95%Cl 1.06 to 1.23;RR 2.31,95%Cl 1.50 to 3.58;RR 3.01,95%Cl 2.25 to 4.02,respectively)compared to conventional treatment.Conclusions:According to current evidence,MSN treatment as a monotherapy or as an adjunctive treatment to other existing treatments might have benefits on treating TTH.However,since the number and the sample size of studies included were both small and the methodological quality was poor,the findings of this review should be interpreted with great caution,and our confidence in the results is low.A high quality RCT using objective outcomes should be performed on this topic.

Current Usage of Terminologies Related to Acupotomy: A Literature Research and Standardization Suggestion

Objective: To investigate the current usage of terminologies related to acupotomy through systematic search and analyze the pros and cons of each for proposing a standard terminology. Methods: Seven medical journal databases were searched including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Oriental Medicine Advanced Searching Integrated System, KoreaMed, and Korean studies Information Service System using 10 candidate terminologies as searching terms. All studies published from their inception to July 26, 2017 were collected. Articles were included if the title stated one of the 10 candidate terminologies consistent with the definition of acupotomy. Priorly established frequency and consistency of each candidate terminology from medical databases were calculated and evaluated. Moreover, the pros and cons of each were analyzed to propose a standard terminology. Results: A total of 112 studies in English databases, 1,129 studies in Chinese database, and 44 studies in Korean databases were included. The most frequently used terminologies were needle knife(35.71%), acupotomy(48.54%) and acupotomy(90.90%) in English, Chinese and Korean database, respectively. Overall, acupotomy and needle knife were the most frequently used. Others like acupotomology, needle scalpel, miniscalpel acupuncture and miniscalpel needle were used within 10% of the total searched literature. Acupotome, stiletto needle, sword like needle, and Xiaozhendao were rarely used. Acupotomy had the advantages of high frequency and consistency but lacked representativeness. Needle knife also showed a high frequency, but the consistency was poor. Though miniscalpel acupuncture and miniscule needle were used less frequently, they had advantages of inclusiveness and clarity. Conclusions: A debate for standardization of the terminology is necessary. This preliminary research can provide a basic outline for the standardization consensus process, and we believe it is noteworthy to discuss miniscalpel needle and miniscalpel acupuncture along with acupotomy and needle knife on the subject.

Effect of dexamethasone injection into Zusanli(ST 36) acupoint on ovalbumin-induced allergic rhinitis

OBJECTIVE:To investigate the effects of acupunc ture with dexamethasone(A.Dex)on allergic rhini tis(AR)by injecting dexamethasone into the Zusan li(ST 36)acupoint.METHODS:Thirty 6-week-old female BALB/c mice were sensitized on days 1,5,and 14 by intraperitoneal injection of 100 pg of ovalbumin(OVA).The mice were then randomly divided into six groups(n =5 in each group).Five groups were sensitized intranasally with 2μL of 1.5 mg of OVA for 10 consecutive days,while one group was sensitized intranasally with PBS in a similar manner as a negative control group.One hour before each administration of intranasal OVA,two groups were orally administered either a control vehicle(distilled water;AR control group)or 200 pg/kg Dex(O.Dex group),while three groups received A.Dex at Zusanli(ST36)with Dex concentrations of 2,20,and 200μg/kg for each group,respectively.AR symptoms were evaluated by measuring the rubbing score,which comprised the number of nose,ear,and eye rubs that occurred in the initial 10 min after OVA intranasal provocation on the 10 th day.We isolated spleen,serum,and nasal mucosal tissue after measuring the rubbing score.Spleen weight was measured using an electronic microbalance.The levels of IgE,thymic stromal lymphopoietin,tumor necrosis factor-a,intercellular adhesion molecule-1,and macrophage-inflammatory protein-2 in serum or nasal mucosal tissue were measured using enzyme-linked immunosorbent assays.The serum histamine levels of OVA-sensitized AR mice were measured using O-phthaldialdehyde spectrofluorometry.Western blot analysis was performed on nasal mucosal tissue extracts.RESULTS:A.Dex significantly reduced the rubbing score,spleen weight,serum IgE,and serum histamine in OVA-sensitized mice.A.Dex significantly decreased the serum levels of inflammatory cytokines(thymic stromal lymphopoietin and tumor necrosis factor-a)in OVA-sensitized mice.A.Dex significantly reduced the nasal mucosal levels of inflammatory markers(intercellular adhesion molecule-land macrophage-inflammatory protein-2)in AR mice.A.Dex effectively attenuated the expression of caspase-1 and receptorinteractingprotein-2 in nasal mucosal tissue.CONCLUSION:A.Dex may be a new and useful therapy for AR.

Effectiveness and safety of auriculotherapy for breastfeeding: a systematic review

OBJECTIVE:To summarize and critically evaluate the evidence pertaining to the effectiveness and safety of auriculotherapy for breastfeeding.METHODS:We performed a systematic search of10 databases from their inception dates to May 15,2017.Randomized controlled trials evaluating the effectiveness and safety of auriculotherapy for breastfeeding were included.Risk of bias was assessed using the Cochrane risk of bias tool.RESULTS:This review included 31 randomized controlled trials with 5389 participants.Owing to the obvious clinical or statistical heterogeneity,a Meta-analysis was not conducted.Twenty-nine studies compared auriculotherapy plus routine care with routine care alone.No consistent adjunctive effect of auriculotherapy was observed in increasing the volume of milk production(9 studies showed significant results in favor of auriculotherapy and 5 did not)and serum prolactin level(7 studies showed significant results in favor of auriculotherapy and 2 did not),and in facilitating the initiation of milk secretion(10 studies showed significant results in favor of auriculotherapy and 7 did not).Two studies compared auriculotherapy with no treatment.Auriculotherapy as a monotherapy showed significant effects in increasing serum prolactin level and facilitating the onset of milk secretion;however,it was limited and inconclusive because only two studies were included in this comparison.The subgroup analysis of women who underwent cesarean delivery showed inconsistent results with respect to all outcomes.No serious adverse events were reported with the use of auriculotherapy.The methodological quality of the included studies was generally poor.CONCLUSION:Although some studies showed positive results,no definite conclusion about the effectiveness and safety of auriculotherapy for breastfeeding could be drawn,owing to the low methodological quality of the included studies and the heterogeneity among trials.Large-scale,well-designed studies are warranted on this topic.

Combination of anti-PD-L1 antibody with peptide MEL-dKLA targeting M2 tumor-associated macrophages suppresses breast cancer metastasis

Dear editors,Breast cancer is a leading cause of cancer-related deaths worldwide and is the most common cancer among women[1].The cause of death in patients with breast cancer is not the primary tumor itself but mainly metastasis.The most common sites of breast cancer metastasis include the bones,lungs,brain,lymph nodes,and liver.Importantly,lung metastasis has been a particular concern as it results in high patient morbidity and mortality rates[2].