[Research Progress on the Application of Goel Technique in Craniovertebral Junction Anomalies].

Craniovertebral junction anomalies are a group of diseases characterized by the pathological changes of occipital bone,atlantoaxial bone,cerebellar tonsil,surrounding soft tissue,and nervous system,which are caused by a variety of factors.Chiari malformation is a common type of craniovertebral junction anomalies,the conventional surgical therapy of which is posterior fossa decompression.Currently,scholars represented by Goel have proposed a new theory on the classification,pathogenesis,and treatment of Chiari malformation based on posterior atlantoaxial fixation (Goel technique).This article introduces the progress in Goel technique,aiming to provide reference for the clinical work.

Molecular Mechanism of Electroacupuncture Regulating Cerebral Arterial Contractile Protein in Rats with Cerebral Infarction Based on MLCK Pathway.

OBJECTIVE: To explore the effect of electroacupuncture (EA) intervention on the vasoconstriction of cerebral artery smooth muscle cells after cerebral infarction. METHODS: Male Wistar rats were randomly divided into 3 groups by a random number table: the model group (n=24), the EA group (n=24), and the normal group (n=6). The model and the EA groups were divided into different time subgroups at 0.5, 1, 3, and 6 h after middle cerebral artery occlusion (MCAO), with 6 rats in each subgroup. MCAO model was established using intraluminal suture occlusion method. The EA group was given EA treatment at acupoint Shuigou (GV 26) instantly after MCAO for 20 min. The contents of cerebrovascular smooth muscle MLCK, the 3 subunits of myosin light chain phosphatase (MLCP) MYPT1, PP1c-δ and M20, as well as myosin-ATPase activity were detected using immunohistochemistry and Western blotting. RESULTS: The overall expression level of the MYPT1 and PP1c-δ in the model group was significantly higher (P<0.01). After EA intervention, the 0.5 h group expression level was close to that of the normal group (P>0.05), and the other subgroups were still significantly higher than the normal group (P<0.01). After EA intervention, the expression level of each subgroup was significantly lower than the corresponding model group. There was a significant difference between the 0.5 and 1 h subgroups (P<0.01), while a difference was also observed between the 3 and 6 h subgroups (P<0.05). The dynamic change rule gradually increased with the prolongation of infarction time within 6 h after infarction. CONCLUSION: EA intervention can inhibit contraction of cerebral vascular smooth muscle cells and regulate smooth muscle relaxation by regulating MLCK pathway.

[Recurrence Rate and Risk Factors of Atypical Meningioma:a Meta-analysis].

Objective To systematically review the overall status of postoperative recurrence in patients with atypical meningiomas. Methods China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Literature Database,VIP Database,PubMed,Embase,Web of Science,and Cochrane Library were searched for collection of the relevant literature on the recurrence of atypical meningioma from database establishment to July 2021.Two investigators independently screened the literature,extracted data,and assessed the risk of bias of the included studies,and then performed a meta-analysis by using R 5.0. Results A total of 29 studies involving 3122 patients were included in this study.The meta-analysis showed that the overall postoperative recurrence rate of atypical meningioma was 38%.The subgroup analysis showed that the tumor recurrence rate of patients ≥60 years old and<60 years old was 51% and 40%,respectively,with no significant difference.The tumor recurrence rates in male and female patients were 42% and 44%,respectively,which showed no significant difference.The recurrence rates of the patients with parasagittal meningiomas,brain tissue infiltration,Ki-67>8%,mitotic count ≥6/10 high-power fields,and tissue necrosis were 52%,47%,63%,53%,and 69%,respectively.The recurrence rate after subtotal tumor resection was as high as 58%,and the patients who received radiotherapy had higher tumor recurrence rate than that those who did not receive radiotherapy (38% vs.29%,P=0.007). Conclusions The current evidence demonstrates that atypical meningioma has a high recurrence rate after surgery.It is essential to pay more attention and take corresponding measures to improve the tumor-free survival rate of the patients.

[Clinical effects of matrix acupuncture on cervical spondylotic radiculopathy with nuchal ligament calcification].

OBJECTIVE: To observe the effects of matrix acupuncture on the neck disability index (NDI) score, clinical efficacy, and the calcification size of the nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification. METHODS: A total of 120 cases were randomly divided into a matrix acupuncture group and a routine acupuncture group, with 60 cases in each group. In the matrix acupuncture group, Ashi-point, bilateral Tianzhu (BL10), bilateral Fengchi (GB20), bilateral Dazhu (BL11), bilateral Jianzhongshu (SI15), and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), and Hegu (LI4) at the affected side were selected. In the routine acupuncture group, C3-C7 Jiaji points at the neck and Jianjing (GB21), Tianzong (SI11), Quchi (LI11), Shousanli (LI10), Waiguan (TE5), Hegu (LI4), and Ashi-point at the affected side were selected. The patients in the two groups were treated 30 min once, six days a week, for a total of four weeks. The NDI scores, clinical efficacies, and calcification sizes of nuchal ligament were compared between the two groups every wee-kend. RESULTS: After four weeks of treatment, the NDI scores and calcification volumes of nuchal ligament decreased in both groups (P<0.05). Compared with the routine acupuncture group, the matrix acupuncture group showed decreased NDI scores and reduced calcification volumes of nuchal ligament at the 1st, 2nd, 3rd, and 4th weeks of treatment (P<0.05). The cure and marked effective rate in the matrix acupuncture group at the 2nd, 3rd, and 4th weeks of treatment were superior to those of the routine acupuncture group (P<0.05). CONCLUSION: The matrix acupuncture group and the routine acupuncture group are effective in reducing the NDI score and calcification size of nuchal ligament in patients of cervical spondylotic radiculopathy with nuchal ligament calcification. However, matrix acupuncture has obvious advantages over routine acupuncture.

[Effects of electroacupuncture "Shuigou" on expression of soluble guanylate cyclase(sGC) and protein kinase G (PKG)in vascular smooth muscle of cerebral artery in rats with cerebral infarction].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the expression of soluble guanylate cyclase (sGC), cyclic guanosine phosphate (cGMP) and protein kinase G (PKG) of cerebral vascular smooth muscle in cerebral infarction (CI) rats, so as to study its dynamic regulation mechanism. METHODS: Male Wistar rats were randomly divided into normal control (n=10), sham operation (n=40), model (n=40), and EA (n=40) groups, and the latter three groups were further di-vided into 3, 6, 12 and 24 h subgroups (n=10 in each subgroup). The CI model was established by occlusion of the middle cerebral artery (MCAO). EA(15 Hz, 2 mA)was applied to "Shuigou" (GV26) for 20 min. The cGMP, sGC and PKG activity and expression levels in the vascular smooth muscle of cerebral artery were detected using ELISA and Western blot, respectively. RESULTS: After modeling, the immunoactivity and activities of sGC at 3 h, PKG at 3 and 6 h and cGMP from 3 h to 24 h were ob-viously decreased in the model group relevant to the normal control and sham-operation groups (P<0.05, P<0.01). After the intervention, the expression levels and activities of sGC at 3 h, PKG at 3 and 6 h and cGMP at 3 and 6 h were apparently up-regulated in the EA group relevant to the model group (P<0.05). CONCLUSION: EA intervention can significantly inhibit the down-regulation of sGC, PKG and cGMP expression of cerebral artery smooth muscle in MCAO model rats, which plays an important role in inhibiting cerebral artery smooth muscle spasm after ischemia, maintaining normal vascular function and state, and thus increasing blood perfusion around cerebral infarction area. However, acupuncture effect has a certain time-effectiveness.

[Effect of Electroacupuncture at "Shuigou" (GV 26) on Immunoactivity and Content of Protein Kinase C in the Middle Cerebral Artery in Acute Cerebral Infarction Rats].

OBJECTIVE: To observe the effect of electroacupuncture (EA) intervention on expression and content of protein kinase C (PKC) in the middle cerebral artery in acute cerebral infarction (ACI) rats so as to explore its mechanism underlying improvement of ACI. METHODS: Wistar rats were randomly divided into normal control (n = 6), sham operation (n = 30), ACI model (n = 30), and EA (n = 30) groups, and the latter three groups were further divided into 0. 5 h, 1 h, 3 h, 6 h and 12 h subgroups (n = 6 in each subgroup). The ACI model was established by occlusion of the middle cerebral artery (MCAO). EA (15 Hz, 1 mA) was applied to "Shuigou" (GV 26) for 20 min. The PKC expression levels and activity in the vascular smooth muscle of the middle cerebral artery were detected using immunohistochemistry and ELISA, respectively. RESULTS: In comparison with the control group, the immunoactivity and activities of PKC in the middle cerebral artery tissue at 0. 5 h, 1 h, 3 h, 6 h and 12 h were significantly increased in the model group (P<0. 05). After EA intervention, the expression levels and activities of PKC at the 5 time-points were markedly down-regulated in comparison with the model group at the same corresponding time-point (P<0. 05). No significant changes of PKC expression and activity were found in the sham operation group (P>0. 05). CONCLUSION: EA intervention can up-regulate the immunoactivity and activity of PKC in the vascular smooth muscle of the middle cerebral artery in ACI rats, which may contribute to its effect in improving ACI by relieving arterial spasm.

[Observation on the clinical efficacy of spasmodic torticollis treated with matrix needling technique and acupuncture at "Wuxin points" mainly].

OBJECTIVE: To compare the difference in the efficacy on spasmodic torticollis between matrix needling technique combined with puncturing "Wuxin points" and the local injection of botox type A. METHODS: Forty-two cases were randomized into an acupuncture group and a botox group, 21 cases in each one. In the acupuncture group, the matrix needling technique was used and acupuncture was adopted at Fengchi (GB 20), "Wuxin points" [Shuigou (GV 26), bilateral Laogong (PC 8) and bilateral Yongquan (KI 1)] and local Ashi points. In the botox group, botox type A was injected at several spots of local region. The treatment course was 1 month in the two groups. The efficacy in each weekend and the results of follow-up visit in half a year after treatment were compared between the two groups. RESULTS: In the 1st weekend, the markedly effective rate was 42.8% (9/21) and the total effective rate was 90.5% (19/21) in the botox group, which were better than those of 4.8% (1/21) and 28.6% (6/21) respectively in the acupuncture group (both P < 0.01). In the 2nd weekend, the markedly effective rate was 71.4% (15/21) and the total effective rate was 95.2% (20/21) in the botox group, which were better than those of 19.1% (4/21) and 61.9% (13/21) respectively in the acupuncture group (both P < 0.01). In the 3rd weekend, the markedly effective rate was 66.7% (14/21) and the total effective rate was 95.2% (20/21) in the botox group, which were better than those of 38.1% (8/21) and 71.4% (15/21) respectively in the acupuncture group (both P < 0.05). The markedly effective rate and the total effective rate were not different significantly between the two groups in the treatment of 1 month and the follow-up visit in half a year (all P > 0.05). There was no adverse reaction in the acupuncture group. There were 14 cases of adverse reactions in the botox group, in which 9 cases of neck muscular weakness and 5 cases of neck muscular pain. CONCLUSION: The treatment of matrix needling technique and combined with acupuncture at "Wuxin points" achieves the significant efficacy on spasmodic torticollis. Although the effect is not obtained as quickly as the local injection of botox, the efficacy of matrix needling technique is similar to that of botox in the treatment of 1 month and the follow-up visit in half a year. Moreover, this therapy has no adverse reaction.

[Effect of electroacupuncture intervention on expression of vascular PKC in the ischemic cerebral tissue in rats with cerebral infarction].

OBJECTIVE: To observe the effect of electroacupunctur (EA) of Shuigou(GV 26)on the expression of vascular protein kinase C (PKC) in the focal ischemia cerebral tissue in rats so as to study its dynamic regulation mechanism. METHODS: A total of 78 Wistar rats were randomly divided into model group (n = 24), EA group (n = 24), sham operation (sham) group (n = 24) and control group (n = 6). The first 3 groups were further divided into 0. 5 h, 1 h, 3 h and 6 h subgroups, with 6 cases in each. Cerebral ischemia (CI) model was established by occlusion of the middle cerebral artery. EA (15 Hz, 1.0 mA) was applied to "Shuigou" (GV 26) for 20 min. The anterior, middle and posterior cerebral arteries on the infarct side of the brain were collected for assaying the expression of PKC protein by using Western blot, and the formalin-fixed artery samples were embedded with paraffin, followed by sectioning and staining with immunohistochemistry. RESULTS: Compared with the control group, the expression levels of cerebral vascular smooth PKC protein shown by both immunohistochemistry and Western blot were upregulated significantly at the time-points of 0.5 h, 1 h, 3 h and 6 h after CI in the model group (P<0.05, P<0.01). In comparison with the model group, the expression levels of PKC protein in the cerebral vascular smooth muscle shown by the aforementioned two methods were down-regulated considerably in the EA group (P<0.01, P<0.05). No statistic differences were found between the control and sham groups in the expression of vascular PKC protein at different time-points (P>0.05). CONCLUSION: EA Intervention can significantly inhibit PKC expression in the cerebral vascular smooth muscle in CI rats, which may be responsible for its efficacy in improving ischemic stroke.

[Indications of acupuncture outpatient based on clinical investigation].

OBJECTIVE: The present situation of clinical indications of acupuncture in China is investigated in this article which provides clinical evidence for the establishment of acupuncture indications. METHODS: Out-patients of acupuncture departments of 31 Chinese provinces in the year 2008 were investigated through the method of cluster random sampling. And the analysis was made on diseases sorting and distribution based on Pareto principle and with EpiMap software. RESULTS: Information of 31 858 out-patients of the first treatment from 36 hospitals were collected which referred to 368 diseases of 16 disease systems. Among them, there were 57 most commonly-encountered diseases, 60 commonly-encountered diseases and 251 rare diseases. CONCLUSION: There are totally 368 acupuncture clinical indications at present according to the investigation with disproportional distribution in administrative districts. It is held that indications of acupuncture have high centralization degree. Thus, the populariza tion and promotion on application of acupuncture indications should be strengthened.

[Study on the efficacy graded-disease-spectrum of acupuncture and moxibustion by the fuzzy comprehensive evaluation techniques: musculoskeletal and connective tissue diseases].

The descriptive cross sectional surveys were carried out among the outstanding clinical physicians in the field of acupuncture and moxibustion by using the survey sampling. The fuzzy comprehensive evaluation techniques was applied to evaluate the opinions of clinical experts in the field of acupuncture and moxibustion in order to classify the spectrum of diseases related to the musculoskeletal and connective tissue. After the statistical analysis on sixty-four diseases with 104 subtypes, the spectrum of diseases were determined as grade I spectrum of diseases with 13 subtypes of diseases, grade II spectrum of diseases with 51 subtypes of diseases, grade III spectrum of diseases with 10 subtypes of diseases, and grade IV spectrum of diseases with 30 subtypes of diseases. The outcomes reveal that acupuncture and moxibustion therapy have been applied widely for musculoskeletal diseases and connective tissue related diseases.

[Classification basis and train of thought of functional dyspepsia in disease menu of acupuncture].

OBJECTIVE: To explore the classification basis of functional dyspepsia in disease menu of acupuncture, and to provide regular analyzing process for classification of other diseases. METHODS: Taking the control group as the classification basis, and the 5-level literature classification of evidence based medicine as the estimation basis, literatures which complied with the inclusion criteria were examined according to the sequence from high level to low. Evidences of low levels were given up if support can be acquired from documents of high level. RESULTS: Acupuncture is approved to be effective for intervention on functional dyspepsia. Compared to the international accepted medicines such as Cisapride and Motilium, regular acupuncture has better therapeutic effects and less side effects in improving the gastro-power and relieving discomfort sensations. CONCLUSION: Functional dyspepsia pertains to grade I of disease menu of acupuncture.

[Observation on therapeutic effect of herb-partitioned spread moxibustion for treatment of chronic nonspecific ulcerative colitis].

OBJECTIVE: To compare therapeutic effects of herb-partitioned spread moxibustion and western medicine on chronic nonspecific ulcerative colitis. METHODS: Sixty cases were randomly divided into a spread moxibustion group (n = 28) and a western medicine group (n = 32). The spread moxibustion group was treated with herb-partitioned spread moxibustion at lower limb around stomach meridian, abdomen region around Guanyuan (CV 4) and lower Jiaji (EX B 2) points; and the western medicine group was treated with oral administration of Sulfasalazine. Their therapeutic effects were observed after treatment. RESULTS: The cured-markedly effective rate was 71.4% (20/ 28) in the spread moxibustion group, and 25.0% (8/32) in the western medicine group, the former was better than the latter (P < 0.05). CONCLUSIONS: The therapeutic effect of herb-partitioned spread moxibustion for treatment of chronic nonspecific ulcerative colitis is better than that of the oral administration of Sulfasalazine with less adverse reaction, and is worth popularizing in clinic.

[Graded-disease-spectrum of the nervous system of acu-moxibustion therapy was determined based on its clinical efficacy and by fuzzy comprehensive estimation technique].

OBJECTIVE: To determine the graded-disease-spectrum of the nervous system of acu-moxibustion treatment based on its clinical efficacy. METHODS: We carried out a cross-sectional academic sample investigation on the graded-disease-spectrum of acu-moxibustion by collecting and analyzing data from the self-administered questionnaires which were completed by professional persons who have high-ranking professional titles (associate chief physicians and chief physicians) and are majoring in acupuncture and moxibustion. Then, the collected experts' opinions were analyzed by fuzzy comprehensive estimation technique and statistical processing. RESULTS: A total of 58 medical conditions involving 4 grades and 126 subtypes were included and analyzed. The Grade I contains 14 subtypes as Bell's palsy (in the acute stage and convalescence stage), primary sciatic neuralgia, migraine (mild type and moderate type), etc. which can be relieved by using acu-moxibustion therapy only. The Grade II contains 53 subtypes, such as transient cerebral ischemic attack, acute cerebrovascular disease (in the convalescence stage and sequelae stage), chronic Bell's palsy (sequelae), Hunt's facial palsy, etc. which can be relieved by using acu-moxibustion as the main therapy. The Grade III contains 22 subtypes, such as acute stage of ischemic cerebrovascular disease (with coma and without coma), acute stage of hemorrhagic ischemic cerebrovascular disease (with coma and without coma), etc. which may be relieved to a certain degree by using acu-moxibustion as the supplementary or main therapy. The Grade IV contains 37 subtypes, such as Wohlfart-Kugelberg-Welander disease, myasthenia gravis (type III and type IV), myasthenia gravis of medicinal herbs resource, chorea major, etc. whose clinical effects are not known if treated with acu-moxibustion. CONCLUSION: Acu-moxibustion therapy has apparent advantages in the treatment of different clinical conditions of the nervous system.