CO Laser Moxibustion for Knee Osteoarthritis: Study Protocol for A Multicenter, Double-blind, Randomized Controlled Trial / 中国结合医学杂志

BACKGROUND@#Knee osteoarthritis (OA) is a major cause of disability among the older adults. Few treatments are safe and effective. Moxibustion is commonly used in treating knee OA in Chinese medicine (CM). CO Laser moxibustion device is a substitute for traditional moxibustion, which mimics the effects of traditional moxibustion. More data are needed to support its application in knee OA.@*OBJECTIVE@#ObjectiveThe trial aims to assess the effect and safety of CO laser moxibustion in patients with knee osteoarthritis compared with a sham control.@*METHODS@#This is a protocol for a multicenter, randomized, double-blind, placebo-controlled trial. A total of 392 participants were recruited and assigned to the CO laser moxibustion group and sham laser moxibustion group with a 1:1 ratio at 6 outpatient clinics in Shanghai, China. Participants in both groups received treatment at the affected knee(s) at the acupuncture point Dubi (ST 35) and an Ashi point. There were 3 sessions per week for 4 weeks, and an additional 20-week follow-up. Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores at week 4. Secondary outcomes were WOMAC function score, stiffness score and overall score, VAS pain, Short-Form heath survey (SF-36), and patients' global assessment. The serum levels of cytokines involved in progress of knee OA were explored. Safety was assessed during the whole trial. Masking effectiveness was assessed by both participants and treatment providers.This is a protocol for a multicenter, randomized, double-blind, placebo-controlled trial. A total of 392 participants were recruited and assigned to the CO laser moxibustion group and sham laser moxibustion group with a 1:1 ratio at 6 outpatient clinics in Shanghai, China. Participants in both groups received treatment at the affected knee(s) at the acupuncture point Dubi (ST 35) and an Ashi point. There were 3 sessions per week for 4 weeks, and an additional 20-week follow-up. Primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores at week 4. Secondary outcomes were WOMAC function score, stiffness score and overall score, VAS pain, Short-Form heath survey (SF-36), and patients' global assessment. The serum levels of cytokines involved in progress of knee OA were explored. Safety was assessed during the whole trial. Masking effectiveness was assessed by both participants and treatment providers.@*DISCUSSION@#CO laser moxibustion device, designed as a substitute for CM moxibustion, is easy to use and control with no choking smoke and smell, and is a plausible method for double-blind research. This study would provide rigorous evidence for the effect and safety of CO laser moxibustion in treating knee OA (Trial registration No.: ISRCTN15030019).

minimally invasive management for abdominal compartment syndrome in severe acute pancreatitis

Three patients with severe acute pancreatitis [SAP] developed into overt abdominal compartment syndrome [ACS] and confirmed or suspected infection of necrotic tissue. We successfully treated these patients by minimally invasive decompression with the assist of laparoscope after the failures of intensive care treatments. This technique we report here may be another safe and effective management for ACS in SAP

Hazards during the preoperative diagnosis of Hepatic Angiomyolipoma

In practice, the diagnosis of Hepatic Angiomyolipoma [HAML] is often difficult to make preoperatively, because of the highly variable histological composition. We describe a HAML in a 54 years old female who presented with right upper quadrant pain for one month and moderate fever for five days. Antibiotic treatment is effective. Abdominal ultrasonography revealed a well-defined hypoechoic mass without flow signals in it. Computed tomography showed a inhomogeneous mass, enhanced reticulately, without fat and vascular components. These were diagnosed to be either HAML or Inflammatory pseudotumor [IPT] of the liver. An Intraoperative ultrasound also found the anechoic lesions of the mass and suggested hemangioma. The cut surface of the specimen showed an encapsulated yellowish tumor consisting scattered intratumoral hemorrhagic focus. Pathological examination and HMB45 marker confirmed the diagnosis of Hepatic AML. The present case indicates that intratumoral hemorrhage led to the imaging diversity and IPT should be added to the list of differential diagnoses for HAML