Correlation and reliability of cervical sagittal alignment parameters between plain radiographs and multipositional MRI images.

STUDY DESIGN: A retrospective study. OBJECTIVES: To assess the validity and reliability of cervical sagittal alignment parameters from multipositional magnetic resonance imaging (MRI) and dynamic cervical radiography. SETTING: Hospital in Suzhou, China. METHODS: Patients who underwent both multipositional MRI and dynamic plain radiography of the cervical spine within a 2-week interval between January 2013 and October 2021 were retrospectively enrolled in this study. The C2-7 angle, C2-7 cervical sagittal vertical axis (C2-7 SVA), T1 slope (T1S), cervical tilt, cranial tilt, and K-line tilt were measured in three different positions (neutral, flexion, and extension) with multipositional MRI and dynamic radiography. Inter- and intraobserver reliabilities were assessed by intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used for statistical analyses. RESULTS: A total of 65 (30 males and 35 females) patients with a mean age of 53.4 years (range 23-69 years) were retrospectively enrolled in this study. Significant positive correlations were noted regarding all parameters between the plain radiographs and multipositional MRI images. Inter- and intraobserver reliabilities were excellent for all cervical sagittal alignment parameters measured in the two imaging modalities. All cervical sagittal parameters had significant positive correlations with those from multipositional MRI in all three positions (p < 0.05). Pearson correlation coefficients demonstrated moderate and strong correlations between the two examinations. CONCLUSIONS: Cervical sagittal alignment parameters measured on multipositional MRI could reliably substitute for those measured on plain radiographs. Multipositional MRI is a valuable, radiation-free alternative for diagnostic evaluation in degenerative cervical diseases.

Mid-term study on the effects of arthroscopic discoid lateral meniscus plasty on patellofemoral joint: An observational study.

In the present study, we aimed to investigate the clinical outcomes of arthroscopic discoid lateral meniscus (DLM) plasty and the adaptive changes in the patellofemoral joint after surgery. From September 2010 to March 2012, 25 patients with DLM injuries who underwent arthroscopic meniscus plasty were enrolled in the prospective study. All patients underwent clinical evaluation before the operation and at the last follow-up, and imaging evaluation was performed by upright magnetic resonance imaging before and 1 month after the operation as well as at the last follow-up. Clinical evaluation included Lysholm score, Kujala score, McMurray's sign, patellar mobility, patella grind test, and quadriceps atrophy. Imaging evaluation included bisect offset index, patella tilt angle (PTA), and cartilage damage. Lysholm score, Kujala score, McMurray's sign, and quadriceps atrophy at the last follow-up were significantly improved compared with the preoperative levels (P < .05). At the last follow-up, there were no statistical differences in patella mobility and patella grind test compared with the preoperative levels. In addition, bisect offset index and PTA showed a dynamic trend of rising and then falling over time (P < .05). At 1 month after the operation, bisect offset index and PTA were significantly increased compared with the preoperative levels or the values at the last follow-up (P < .05), while there were no differences between the preoperation and the last follow-up. Cartilage damage became worse with time (P < 0.05), and the 2 were positively correlated (Spearman = 0.368). At the last follow-up, the degree of cartilage damage was significantly increased compared with the preoperative level (P < .017), while there was no significant difference between the 1-month postoperative grade and the preoperational grade or the last follow-up grade. The effect of arthroscopic DLM plasty on the patellofemoral joint was dynamic, with the position of the patella deviating in the early stages and recovering in the mid-term, especially when the knee was in the biomechanical standing position. In addition, the patellofemoral joint cartilage might undergo accelerated degeneration after the operation, while the mid-term effect of the operation was positive, and the patellofemoral joint function was acceptable.

Capsular Healing in Interportal and Periportal Capsulotomy Methods of Hip Arthroscopy.

OBJECTIVE: To evaluate the midterm outcomes and the capsular healing in patients who had interportal capsulotomy versus periportal capsulotomy of hip arthroscopy. METHODS: Retrospectively reviewed 33 patients with labral tear received hip arthroscopy, with an average age of 41 (27-67) years, including 13 cases of Cam deformity and three cases of Pincer deformity. All patients had positive sign of flexion adduction internal rotation or flexion abduction external rotation. With MRI and radiographic (CT, X plain) imageological examination. MRI showed that all patients had labral tear. Radiographic finding (CT, X plain) showed the pathological changes of acetabular and femoral neck osteophyte. One group with 23 patients were treated with periportal capsulotomy. Another group with 10 patients were treated with interportal capsulotomy. All patients did not close the capsule. Clinical outcomes were measured with the Hip Outcome Score Activities of Daily Living (HOS-ADL) and the modified Harris Hip Score (mHHS), patient satisfaction measured with visual analogue scale (VAS). The healing of the capsule was evaluated by MRI. MRI showed continuous capsular indicated healing, discontinuous capsular indicated unhealing. Postoperatively 6 months, mHHS and HOS-ADL were obtained. Randomized controlled trials were used in this study for analysis. RESULTS: All patients were followed up with average time of 9.3 months(3-29 months). The postoperative symptoms were obviously relieved, the VAS decreased from (4.9 ± 0.6) to (1.2 ± 0.2) after 3 months postoperative. Follow up 6 months post-operation, patients in the interportal group, the mHHS and HOS-ADL scores improvement were respectively 69.4 ± 9.3 & 70 ± 8.8 pre-operation, and 92.5 ± 5.0 & 86.6 ± 5.4 post-operation (P < 0.05); Patients in the periportal group, the mHHS and HOS-ADL scores improvement were respectively 69.9 ± 15.8, 68.1 ± 15.0 pre-operation, and 90.1 ± 9.3 & 86.7 ± 7.9 post-operation (P < 0.05).The differences were statistically significant. Six months after operation, MRI showed that 23 patients with periportal capsulotomy, the capsule have healed, without other complications. Three of the ten patients with interportal capsulotomy were healed and seven were not. CONCLUSION: Interportal and periportal capsulotomy had good outcomes. The technique of periportal capsulotomy had little damage to the joint capsule. Although the capsule did not close, the capsule healed well in postoperative follow-up. The nonunion rate of the joint capsule was high in the interportal capsulotomy without close the capsule.

Medium-Term (Least 5 Years) Comparative Outcomes in Anterior Cruciate Ligament Reconstruction Using 4SHG, Allograft, and LARS Ligament.

OBJECTIVE: To compare the clinical efficacy of anterior cruciate ligament (ACL) reconstruction with 4-strand hamstring tendon autograft (4SHG), allograft and the Ligament Advanced Reinforcement System (LARS) ligament, and to find the causes of cumulative failure or nonreturn to sport. DESIGN: Retrospective case series. SETTING: Department of Orthopedic Surgery, the second affiliated hospital of Soochow University, Suzhou, Jiangsu, China. PATIENTS: Three hundred six patients with isolated ACL deficiency were included. Two hundred twenty-nine patients met the inclusion/exclusion criteria, and finally, 185 of these patients participated in this study. INTERVENTIONS: Anterior cruciate ligament reconstruction using 4SHG, allograft, and LARS. MAIN OUTCOME MEASURES: Objective knee function, subjective knee function, and information regarding return to sport, cumulative failure, and complications. Secondary: distribution of tunnel position and tunnel enlargement. RESULTS: There were no statistically significant differences between the 3 groups regarding all the clinical objective and subjective results, return to sport, complications, or cumulative failures (P > 0.05). One hundred twenty-eight patients (69.2%, 128/185) returned to sport. Preoperative (after injury) Tegner scores were inferior to postoperative Tegner scores, and postoperative Tegner scores were inferior to preinjury Tegner scores (P < 0.01). The femoral tunnel malposition was significantly associated with cumulative failure (P < 0.05). CONCLUSIONS: There were no statistically significant differences among the 4SHG, allograft, and LARS ligament in terms of the clinical outcomes after ACL reconstruction (ACLR) at 5-years follow-up. Interestingly, ACLR could improve the functional and motorial level of the knee, but patients had great difficulty in regaining the level of preinjury movement. In addition, the malposition of the femoral tunnel was an important cause of cumulative failure.

Correlation Between Dural Sac Size in Dynamic Magnetic Resonance Imaging and Clinical Symptoms in Patients with Lumbar Spinal Stenosis.

OBJECTIVE: To assess the dynamic change of the dural sac size in patients with lumbar spinal stenosis (LSS) from supine to standing position and their correlation with clinical symptoms. METHODS: A total of 110 patients with LSS were prospectively enrolled to undergo both supine (0°) and standing (78°) magnetic resonance imaging (MRI). Dural sac cross-sectional area (DCSA) and dural sac anteroposterior diameter (DAPD) at the most constricted spinal level in supine and standing MRI were measured and compared. Clinical symptoms were assessed by duration of disease, claudication distance, visual analog scale (VAS) score of leg pain, and Chinese Oswestry Disability Index score of low back pain. The correlation between the parameters and clinical symptoms was analyzed by Pearson correlation coefficient (r). RESULTS: Mean minimum DCSA and DAPD in the standing position were significantly smaller (both P < 0.01) than in the supine position. DCSA and DAPD in standing MRI and their changes had better correlation with the intermittent claudication distance and VAS score of leg pain than in the supine position. A more than 15 mm2 reduction of DSCA was observed in patients with shorter claudication distance and more severe VAS score of leg pain (both P < 0.01). CONCLUSIONS: Dural sac size on MRI was reduced significantly from supine to standing position. Standing MRI and the changes of DCSA significantly correlated with claudication distance and VAS score of leg pain in patients with LSS. Therefore, standing MRI provides more radiologic information correlating with clinical symptoms in patients with LSS than supine MRI.

[Clinical trials of treatment of woman menopause insomnia due to disharmony between heart and kidney by body and auricular acupuncture].

OBJECTIVE: To observe the therapeutic effect of body acupuncture combined with auricular acupuncture in the treatment of woman menopause insomnia induced by disharmony between the heart and kidney. METHODS: A total of 111 outpatients with menopausal insomnia were randomly divided into treatment group (n＝55, body acupoints plus auricular points) and control group (n＝56, body acupoints). For control group, Shenmen (HT7), Sanyinjiao (SP6), Anmian, Zhaohai (KI6), Shenmai (BL62), Sishencong (EX-HN1), Xinshu (BL15) and Shenshu (BL21) were needled with filiform needles, and HT7, SP6, Anmian, BL15 and BL21 were also stimulated with electroacupuncture (EA) for 30 min, once every other day, 3 times a week for 3 weeks. For the treatment group, auricular points as Kidney, Shenmen, Sympathetic and Endocrine around the ear canal and the ear cavity were punctured with filiform needles in combination with the same intervention methods mentioned above in the control group. The quality and efficiency of sleep were assessed by using Pittsburgh Sleep Quality Index (PSQI) scale before and after the treatment. The symptom scores of traditional Chinese medicine (TCM) and the therapeutic effect were determined according to the "Guide Principles for Clinical Research of New Drugs of TCM" (formulated by Chinese Ministry of Health, 1997). RESULTS: After the treatment, the scores of sleep quantity and effective rate of PSQI scale, and those of insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, paplpitation and irritability, fatigue and forgetfulness of TCM were reduced significantly in both groups compared with their own pre-treatment (P<0.05). Of the 56 and 55 cases in the control and treatment groups, 18 (32.1%) and 30 (54.5%) experienced a marked improvement in their symptoms, 28 (50.0%) and 22 (40.0%) were effective, and 10 (17.9%) and 3 (5.5%) failed, with the effective rate being 82.1% and 94.5%, respectively. The therapeutic effect of stimulation of the body acupoints plus auricular acupoints was significantly superior to that of stimulation of simple body acupoints in lowering scores of PSQI scale, insomnia and dreaminess, dysphoria with feverish sensation in chest, palms and soles, dizziness and tinninus, paplpitation and irritability, and tital fever and night sweating of TCM, as well as the effective rate (P<0.05). CONCLUSION: Both body acupuncture and body acupuncture combined with auricular acupuncture are effective in the treatment of woman menopause insomnia due to disharmony between the heart and kidney, and the two combined treatment was evidently better.

Anatomical Risk Factors of Anterior Cruciate Ligament Injury.

BACKGROUND: Nowadays, the anterior cruciate ligament (ACL) injury has been one of the most common diseases of the knee joint. The relationships between the ACL injury and the anatomical structures are still controversial. This study aimed to identify the anatomical risk factors of ACL injury by magnetic resonance imaging (MRI) of the knee. METHODS: This was a retrospective study of 125 patients undergoing primary ACL reconstruction between July 2013 and May 2017. Another 125 patients without any organic knee joint injury were served as controls. The shape of intercondylar notch, the intercondylar notch width index, the intercondylar notch height index, the α angle, the ß angle, and the medial and lateral tibial plateau slope were measured with MRI and compared. The data were compared by binary logistic regression to find the risk factors. RESULTS: The two groups differed in the proportion of male patients (70.4% vs. 52.0%, χ2 = 8.911, P = 0.003), but gender was excluded as a risk factor for ACL injury with regression analysis (odds ratio = 1.476, 95% confidence interval [CI]: 0.689-3.160, P = 0.317). The injured group was found to have a smaller notch width index (95% CI = 7.960E-23-2.154E-9, P < 0.001), a larger ß angle (95% CI = 1.311-1.785, P < 0.001), and a larger lateral tibial plateau slope (95% CI = 1.201-1.683, P < 0.001). The cutoff values of notch width index, ß angle, and the lateral tibial plateau slope were 0.252, 38.5°, and 7.5°, respectively. CONCLUSIONS: In this study, a narrow intercondylar notch (intercondylar notch width index <0.252), a larger lateral tibial slope (>7.5°), and larger ß angle (>38.5°) might be the factors associated with ACL injury. TRIAL REGISTRATION: ChiCTR-RRC-17014116; http://www.chictr.org.cn/showproj.aspx?proj=24119.

[Detection of pain thresholds of acupoints for irritable bowel syndrome].

OBJECTIVE: To compare the pain thresholds of acupoints in the meridians related to irritable bowel syndrome(IBS) between IBS patients and healthy people. METHODS: Thirty-four healthy adults were collected into a normal group,and 60 patients with IBS were arranged into an IBS group. Pain thresholds were detected on the acupoints of large intestinal,small intestinal,stomach,spleen,gallbladder meridians and some commone use acupoints for IBS by pain measuring apparatus three times. Bilateral jing-well,xing-spring,shu-stream,jing-river,he-sea,front mu-alarm,lower he-sea,yuan-primary,luo-connecting and back shu-transport points of each meridian were selected as the main acupoints. And pain thresholds of acupoints common used in clinic were compared between the two groups. RESULTS: The thresholds of five shu-transport points and luo-connecting point of the large intestinal meridian in the IBS group were apparently lower than those in the normal group(all P<0.05),with Hegu(LI 4),Tianshu(ST 25),Shangjuxu(ST 37) and Dachangshu(BL 25) more decreasing(all P<0.01). The thresholds of five shu-transport points,front mu-alarm point and yuan-primary point of the small intestinal meridian in the IBS group were obviously lower than those in the normal group(all P<0.05),with Zhizheng(SI 7),Xiajuxu(ST 39) and Xiaochangshu(BL 27) more decreasing(all P<0.01). The thresholds of Zusanli(ST 36),Weishu(BL 21),Yanglingquan(GB 34),Danshu(BL 19),Pishu(BL 20),Neiguan(PC 6),Taichong(LR 3),Taixi(KI 3),Sanyinjiao(SP 6) and Qihai(CV 6) in the IBS group were markedly lower than those in the normal group(all P<0.05). CONCLUSIONS: The pathological changes of IBS often appeared in the stomach,large intestinal,small intestinal,bladder meridians,and some acupoints in the liver,spleen and kidney meridians. When the functions of viscera are abnormal,the pain thresholds of related acupoints tend to decrease,and meridians and acupoints become sensitized from quiet state.

[Influence of electroacupuncture plus jasminoidia intervention on expression of OX-42 and nuclear factor-kappa B in hippocampus and amygdale in cerebral ischemia plus diabetes rats].

OBJECTIVE: To observe the changes of expression of OX-42 and nuclear factor-kappa B (NF-kappaB) transporter factor in the hippocampus and amygdale in diabetes and cerebral ischemia (CI) rats with learning and memory impairment after combined treatment with electroacupuncture (EA) plus Jasminaidia, so as to explore their mechanism underlying cerebral protection. METHODS: Sixty male Wistar rats were randomly divided into control, model, medication, EA, and EA + medication groups (12 rats/group). The diabetes mellitus model was established by intraperitoneal injection of Streptozotocin (60 mg/kg, for 3 days) and the CI model made by repeated occlusion and reperfusion of the bilateral carotid arteries. The rats' lear-ning-memory ability was measured via Morris water maze tasks. Rats of the medication group were fed with Jasminaidia (25 mg/kg), once a day for one week, and those of the EA group administrated with EA stimulation of "Baihui"(GV 20) and "Dazhui"(GV 14), once every other day for 20 days. For rats of the EA+medication group, both EA and Jasminaidia were given the same to those mentioned above. Three weeks later, changes in the number and optical density of OX-42 (microglial cell markers)-positive and NF-kappaB-positive cells in the hippocampus and amygdale were examined by immunohistochemistry. RESULTS: After the treatment, the diabetes + CI induced decrease of percentages of swimming distance and swimming time in the target quadrant were obviously increased in the EA, medication and EA+medication groups (P < 0.05), suggesting an improvement of the rats' memory ability. The number of OX-42 positive microglial cells and NF-kappaB-positive cells and their immu noactivity in the hippocampus and amygdale were significantly higher in the diabetes plus CI model rats than in the control rats (P < 0.01, P < 0.05). After the treatment, the number and expression levels of OX-42 marked microgliacytes and NF-kappaB-positive cells were significantly decreased in the EA, medication and EA + medication groups compared with the model group (P < 0.05). No significant differences were found among the 3 treatment groups in the number of OX-42 and NF-kappaB-positive cells and their expression levels (P > 0.05). CONCLUSION: EA combined with Jasminoidia intervention can improve the learning-memory ability and inhibit the microglial cell activity in diabetes+CI rats probably via down-regulation of NF-kappaB signaling pathway.

[Clinical observation on common peroneal nerve palsy treated with comprehensive therapy].

OBJECTIVE: To compare the difference of the clinical efficacy on common peroneal palsy between the comprehensive therapy of electroacupuncture, moxibustion and moving cupping method and western medication. METHODS: Ninety cases of common peroneal nerve palsy were randomized into a comprehensive therapy group and a western medication group, 45 cases in each one. In the comprehensive therapy group, electroacupuncture was applied to Yanglingquan (GB 34), Zusanli (ST 36), Xuanzhong (GB 39), Jiexi (ST 41), Taichong (LR 3), Zulinqi (GB 41) and the others, combined with warm moxibustion and moving cupping on the lateral side of the affected leg. The comprehensive therapy was used once a day. In the western medication group, vitamin B1 , 10 mg each time, 3 times a day; and mecobalamine, 0. 5 mg each time, three times a day were prescribed for oral administration. In the two groups, 15 days made one session, and the efficacy was observed after 2 sessions treatment. RESULTS: The total effective rate of the improvement of sensory function and motor nerve function was 97. 8% (44/45) in the comprehensive therapy group and was 82. 2% (37/ 45) in the western medication. The efficacy in the comprehensive therapy group was better than that of the western medication (P<0. 01). The electrophysiological examination showed that the amplitude of motor conduction of deep peroneal nerve and that of sensory conduction of surficial peroneal nerve after treatment were improved remarkably as compared with those before treatment in the comprehensive therapy group (both P<0. 05). The amplitude of motor conduction of deep peroneal nerve was improved significantly in the comprehensive therapy group as compared with that in the western medication group (P<0. 05). CONCLUSION: The comprehensive therapy of electroacupuncture, moxibustion and moving cupping method achieves the significant efficacy on common peroneal nerve palsy as compared with western medication.

Lateral patellar translation effects after arthroscopic partial meniscectomy of torn discoid lateral meniscus.

OBJECTIVE: To investigate the effects of arthroscopic partial meniscectomy of torn discoid lateral meniscus on patellar tracking. METHODS: In all, 112 patients (112 knees) who underwent arthroscopic partial meniscectomy participated in the study. All subjects were examined with standing weight-bearing magnetic resonance imaging (MRI) preoperatively and one month postoperation. Axial-plane images through the maximum width of the patella and the maximum dorsal area of the femoral condyles were superimposed and the bisect offset index used to quantify patellar translation. Differences between pre- and postoperation in the bisect offset indexes were calculated and compared by Student's paired t-test. P < 0.05 was considered statistically significant. RESULTS: Before surgery, the mean bisect offset index was 0.574 (0.437-0.692). One month postoperation, the mean bisect offset index was 0.622 (0.510-0.801). The postoperation bisect offset index increased by an average of 0.048 (-0.018 to 0.129) compared with the preoperation value; this difference is statistically significant result (t = 18.33, P < 0.01). CONCLUSION: After arthroscopic partial meniscectomy, the patella translates more lateral to the femoral trochlear groove. These results suggest that arthroscopic partial meniscectomy may result in patellar maltracking.

Observation of Pain-Sensitive Points along the Meridians in Patients with Gastric Ulcer or Gastritis.

This study aims to investigate the sensitization of human skin points along certain meridians related to visceral disease by using the pressure-pain threshold (PPT) as an indicator. We detected and compared the PPTs of people with and without gastric ulcer or gastritis on the related acupoints, abdomen area, and back area with von Frey detector and observed the similarities and differences under their respective physiological and pathological states. The results showed that (1) the PPTs of patients with gastric ulcer on related acupoints decreased significantly compared with the control group; (2) there was no significant difference in PPT between the chosen points of the measured meridian and the adjacent nonacupoints; (3) there was an apparent distribution of tender points on the relevant abdomen and back regions of patients with gastric ulcer or gastritis, but none was found on the control group; (4) the pain-sensitive points of gastric ulcer and gastritis patients were BURONG (ST19), LIANGMEN (ST21), and HUAROUMEN (ST24) of the stomach meridian on the abdominal region and PISHU (BL20), WEISHU (BL21), and WEICANG (BL50) on the back, among others The results suggest that the practical significance of acupoints may lie in its role as a relatively sensitive functional area. In a pathological state, the reflex points on the skin which are related to certain visceral organs become sensitive and functionally intensify.

[Clinical observation of the impacts and safety of electroacupuncture at Sanyinjiao (SP 6) on labor].

OBJECTIVE: To observe the impacts of electroacupuncture (EA) at Sanyinjiao (SP 6) on labor and assess its safety. METHODS: The random and single-blind method was adopted to divide 111 cases of the puerperas of natural delivery into an EA group (38 cases), a sham-acupuncture group (37 cases) and a blank control group (36 cases). In EA group, Sanyinjiao (SP 6) was selected and stimulated with Han's acupoint nerve stimulator (HANS). In the sham-acupuncture group, the puerperas were stimulated only with the needle tube, needle removed in advance and they felt subjectively to be needled. Afterward, the filiform needle was attached to Sanyinjiao (SP 6) with the needle tip wrapped with the adhesive plaster in advance, then HANS which one conducting wire was cut off in was connected. In the blank control group, no any treatment was applied, but the same indices were recorded at corresponding time points. The blood pressure and the heart rate of the puerperas as well as the heart rate of fetus were measured in 20 min of EA and 30 min after needle removal in three groups separately. The bleeding 24 h after labor and 1 min Apger score of the newborns were observed. RESULTS: In EA group, the active phase of the 1st labor stage ((4.38 +/- 1.76)h) was shorter than that ((5.28 +/- 2.41)h) in the blank control group and that ((5.38 +/- 2.36)h) in the sham-acupuncture group, presenting statistically significant differences (all P < 0.05). In the latent phase of the 1st labor stage and the 2nd and 3rd stages, in the comparison of the blood pressure and the heart rate of the puerperas as well as the heart rate of fetus after EA, the bleeding 24 h after labor and 1 min Apger score of the newborns among three groups, there were no statistically significant differences (all P > 0.05). CONCLUSION: EA at Sanyinjiao (SP 6) can shorten the duration of the active phase of the 1st labor stage. It is safe for either the puerpera or the fetus and can assist the parturition quality in clinic.

[Effects of acupuncture on the expression of Cx43 in different acupoints of rats].

OBJECTIVE: To observe the differences of the expression of Cx43 in rats' acupoints and sham-acupoint when needled blocks, and explore the relatively specificity of acupoints. METHOD: Twenty Wistar rats were randomly divided into two groups: an acupuncture group and a control group, ten in each group. The rats in the control group were not treated and sacrificed directly to by air embolism; the rats in the acupuncture group were needled at "Neiguan (PC 6)", "Zusanli (ST 36)", "Dazhui (GV 14)" and "Guanyuan (CV 4)", Sham-acupoints were on 1 cm next to each of the above acupoints and "Yongquan (KI 1)" were needled by hand manipulation, retented needles for 30 min, then all the rats were sacrificed by air embolism. With the rats fixed, the tissue blocks at the acupoints and sham-acupoints were collected, then quick-frozen and cut into sections. The sections were stained by immunohistochemical method (Cx43). RESULTS: The expression of the rats' Cx43 at the acupoints was significantly higher than that at the non-points in both groups (all P < 0.01). The expression of Cx43 at the acupoints in the acupuncture group was significantly higher than that in the control group (all P < 0.01). CONCLUSION: The expression of Cx43 at acupoints and non-points is significantly different, which indicates that the acupoints are actually existed and have relatively specificity.

[Effect of acupuncture of "Zusanli"(ST 36)on sexual hormone levels in spleen-deficiency syndrome rats].

OBJECTIVE: To study the underlying mechanism of acupuncture of "Zusanli" (ST 36) in clinical treatment of spleen deficiency syndrome (SDS). METHODS: Twenty-six adult male Wistar rats were randomized into normal control group (n=6), model group (n=8), saline + model (saline) group (n=6) and acupuncture + model (acupuncture) group (n=6). The spleen deficiency syndrome model was duplicated by intragastric perfusion of 50% alcohol (1 mL/100 g, once) and vinegar (pH 3, 1 mL/100 g, once daily for 10 d). Bilateral "Zusanli" (ST 36) was punctured with filiform needles which were manipulated for 1 min after insertion and retained for 20 min. The treatment was conducted once daily for 10 days. The contents of serum testosterone(T) and estradiol(E2)were detected by radioimmunoassay. The rats' physical strength was detected by exhausted swimming test in cool water. RESULTS: In comparison with the normal group, the duration of exhausted swimming, serum T and E2 contents and T/E, were decreased significantly in the model group (P < 0.05). Compared with the model group, the duration of exhausted swimming, serum T and E2 contents and T/E2 in the acupuncture group were upregulated significantly (P < 0.05). No significant differences were found between the saline and control groups (P > 0.05). CONCLUSION: Acupuncture of "Zusanli" (ST 36) is able to reverse SDS-induced decrease of sexual hormones in spleen deficiency syndrome rats, which may contribute to its effect in improving physical strength.

[Analysis and strategy report on overseas large-scale systematic evaluation on clinical effectiveness of acupuncture].

In recent years, studies of large-scale systematic evaluation on clinical effectiveness of acupuncture were carried out in overseas. The literatures were conducted in Cochrane Library and overseas journals about systematic review of clinical effectiveness of acupuncture. The Cochrane Library contained a series of systematic reviews for the treatment of 67 kinds of diseases by acupuncture in 2009. Preliminary evaluations of clinical effectiveness of acupuncture on 37 kinds of disease were conducted. The results indicated that acupuncture therapy was effective for 7 kinds of disease, such as idiopathic headache, neck disorders, glaucoma, rheumatoid arthritis, chemotherapy-induced nausea or vomiting, primary dysmenorrhoea with TENS and knee osteoarthritis with TENS. However, these studies still need improved research designs and sufficient research evidence. The results also indicated that acupuncture was indecisive for the other 30 kinds of disease because of insufficient evidence. Through analysis, results of most systematic reviews indicated that there were no significant difference between therapeutic effects of acupuncture treatment and pseudo-acupuncture treatment. Effect of acupuncture treatment was equivalent to therapeutic effect of placebo. The likely reasons may be that some important clinical factors are disregarded in these researches, such as selection of acupoints, treatment with syndrome differentiation, the angel and depth of needle insertion, the proper time for treatment and so on. Therefore, the large-scale systematic evaluation on clinical effectiveness of acupuncture was criticized by acupuncturists. Thus, the pressing problem is to establish a rational evaluation system of clinical acupuncture. The suggestions are strengthening the research on diagnosis and treatment standard, strengthening the quality control of clinical acupuncture and establishing sound acupuncture control group and placebo acupuncture group. The basic researches on the relationship between diseases and acupoints need to be strengthened in order to explore the mechanism of acupoints reaction on diseases.

[Morphological study on commonly-used acupoints for thyroid surgery under acupuncture anesthesia].

OBJECTIVE: To study the morphologic structure, afferent projections of "Neiguan" (PC6), "Hegu" (LI 4) and "Futu" (LI 18) acupoint regions so as to understand their underlying mechanisms in acupuncture anesthesia for thyroid surgery. METHODS: A total of 66 Wistar rats were used in the present study. (1) Horseradish peroxidase (HRP, 10%, 10 microL) was injected into PC 6, LI 4 and LI 18 acupoints and the thyroid area on the right side, respectively (n = 6). (2) Propidium iodide (PI, 10% 10 microL) or Bisbenzimide (Bb, 5%, 10 microL) was injected into above-mentioned 3 acupoints and the thyroid region on the right side, respectively (n = 6). The numbers and percentages of the labeled neurons in the dorsal root ganglia (DRGs, C 1 - C 8 and T 1) were observed under microscope. (3) Cutaneous connexin (Cx) 43 immunoactivity of LI 18, PC 6, LI 4 and "Zusanli" (ST 36) regions and their individual non-acupoint regions (about 0.5 cm lateral to LI 18, PC 6, LI 4, and ST 36, n = 12) was determined by immunohistochemistry. RESULTS: 1) HRP-labeled neurons after injection of HRP into LI 18 were found in DRGs of C 1 - C 5, predominantly C 2 - C 4, those from LI 4 found in DRGs of C 3 - C 8. mainly C 5 - C 7, those from PC 6 found in DRGs of C 3 -T 1, chiefly C 5 - C 8, and those from the thyroid region found in C 1 - C 6, predominantly C 2 - C 5, suggesting an overlap or convergence of afferent projections from the 3 acupoints and the thyroid regions being in C 3 - C 5. 2) After injection of PI into LI 18, LI 4 and PC 6. and Bb into the thyroid region, the percentages of PI- and Bb-labelted neurons in DRGs of C 1 - C 8 and T 1 were from 46.4% to 50.0% and the percentages of the double labeled neurons were 3.8% in the LI 18-thyroid group, 3.1% in the LI 4-thyroid group and 3.6% in the PC 6-thyroid group, respectively, suggesting a bifurcate innervation of DRG neurons between theseacupoints and the thyroid region. 3) In comparison with the individual non-acupuncture and non-acupoint subgroups, the immunoactivity of cutaneous Cx 43 in the LI 18, LI 4, PC 6, and ST 36 subgroups was upregulated considerably after acupuncture stimulation (P < 0.05). CONCLUSION: Neurons of DRGs of C 1-C 8 and T 1 innervating "Futu" (Ll 18), "Hegu" (LI 4) and "Neiguan" (PC 6) and the thyroid gland have an overlap or convergence in DRGs of C 3 - C 5 and a bifurcate innervation. Acupuncture stimulation may upregulate cutaneous Cx 43 expression in the acupoint regions.

Functional and biochemical studies of CD9 in fibrosarcoma cell line.

CD9, a member of the tetraspanin family, plays important roles in a variety of cell activities. Fibrosarcoma is a malignant tumor that arises from fibroblasts. Low CD9 expression is found in fibrosarcoma tumor, but function of CD9 in fibrosarcoma has been rarely studied. In this study, stable cell lines for CD9 overexpression and vector were generated in HT1080, a human fibroscarcoma cell line, and cellular functions were widely investigated. In CD9-HT1080 cells, CD9 mainly localized in the membrane and co-localized with F-actin in the filopodia of cell surface. In functional assays, we demonstrated that CD9 could up-regulate total and active caspase-3 expression and induce cell apoptosis, but cell proliferation remained unchanged. CD9 overexpression inhibited HT1080 cell adhesion to FN but promoted cell spreading on FN. We also observed CD9 reduced cell migration using FN a chemoattractant and inhibited cell colony formation in soft agar medium. To explore the biochemical mechanism for functional changes, we investigated the effects of CD9 overexpression on cellular pathways and protein association. CD9 overexpression induced Akt phosphorylation on FN but did not change total Akt expression. Phosphorylation of p38 but not ERK was increased by CD9 overexpression, total p38 and ERK were not affected. CD9 overexpression did not affect the expression of TGFα, EGFR, ß1, and EWI-2, but EWI-F expression was up-regulated. Moreover, CD9 could associate with TGFα, EGFR, ß1, EWI-2, and EWI-F in HT1080 cell line. Take together, CD9 overexpression had promoting effects on cell apoptosis and cell spreading, but had inhibitory effects on cell adhesion, migration, and cell colony formation. These effects might be ascribed to CD9 associations with EWI-2/EWI-F/ß1 complex and EGFR pathway, and the activation of Akt and p38 signalings as well.

Vertical weight-bearing MRI provides an innovative method for standardizing Spurling test.

Although Spurling test, a foraminal compression test, is commonly used in clinical practice in patients with a suspected cervical radiculopathy, its protocol is still obscure. In undergoing this test, patients extend, laterally flex and slightly rotate neck to the symptomatic side, and then a pressure is applied on the top of patient's head by examiner. The test is scored as positive if it causes pain or tingling that starts in the shoulder and radiates distally to the elbow. But the range of neck motion and level of load are not clearly defined. Magnetic resonance imaging (MRI) has proved to be an excellent method of assessing the situation of cervical intervertebral foramen. Unfortunately the conventional MRI system is not able to fully achieve this goal because it can only examine patient in supine position while Spurling test needs to be performed in a sitting position. Here we hypothesize that vertical weight-bearing MRI provides an innovative method for researching and standardizing the protocols of Spurling test. The result will provide better knowledge of the mechanism of Spurling test. Standardization of the test will improve its sensitivity and rate of reproducibility.

[Clinical observation on acupuncture for treatment of reflux esophagitis of heat stagnation of liver and stomach type].

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture for treatment of reflux esophagitis of heat stagnation of liver and stomach type. METHODS: Sixty-one cases were randomly divided into an acupuncture group (31 cases) and a medication group (30 cases). The acupuncture group was treated with needles at Zusanli (ST 36), Zhongwan (CV 12), Weishu (BL 21) and Neiguan (PC 6) mainly, once a day; and the medication group was treated with oral administration of 20 mg Omeprazole, once a day. The scores of clincial symptoms, comprehensive therapeutic effect, results of gastroscopy and pathology as well as recurrence rate etc. were observed before and after treatment. RESULTS: After treatment, the scores of symptoms significantly decreased in the two groups (both P < 0.01). The total effective rate of the acupuncture group was 90.3% (28/31), and 90.0% (27/30 )in the medication group, there was no statistical difference between two groups (P > 0.05); results of gastroscopy and esophageal mucosa pathology showed no statistical difference between two groups (both P > 0.05), the recurrence rate 12 weeks after treatment of 9.1% in the acupuncture group was lower than that of 42.9% in the medication grou p (P < 0.05). CONCLUSION: Acupuncture has preferable short and long-term therapeutic effects for treatment of reflux esophagitis of heat stagnation of liver and stomach type.