Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis.

OBJECTIVES: This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time. DESIGN: Systematic review and pairwise and exploratory network meta-analysis. SETTING: PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023. PARTICIPANTS: Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA. INTERVENTIONS: Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA). MAIN OUTCOMES MEASURES: The primary outcome was pain intensity at the end of treatment. RESULTS: 80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 to -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture. CONCLUSIONS: The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors. PROSPERO REGISTRATION NUMBER: CRD42021232177.

Mechanisms and protective measures for radiation-induced brachial plexus nerve injury.

Radiation therapy is a common treatment modality for patients with malignant tumors of the head and neck, chest and axilla. However, radiotherapy inevitably causes damage to normal tissues at the irradiated site, among which damage to the brachial plexus nerve(BP) is a serious adverse effect in patients receiving radiation therapy in the scapular or axillary regions, with clinical manifestations including abnormal sensation, neuropathic pain, and dyskinesia, etc. These adverse effects seriously reduce the living quality of patients and pose obstacles to their prognosis. Therefore, it is important to elucidate the mechanism of radiation induced brachial plexus injury (RIBP) which remains unclear. Current studies have shown that the pathways of radiation-induced BP injury can be divided into two categories: direct injury and indirect injury, and the indirect injury is closely related to the inflammatory response, microvascular damage, cytokine production and other factors causing radiation-induced fibrosis. In this review, we summarize the underlying mechanisms of RIBP occurrence and possible effective methods to prevent and treat RIBP.

Advances in electrical impedance tomography-based brain imaging.

Novel advances in the field of brain imaging have enabled the unprecedented clinical application of various imaging modalities to facilitate disease diagnosis and treatment. Electrical impedance tomography (EIT) is a functional imaging technique that measures the transfer impedances between electrodes on the body surface to estimate the spatial distribution of electrical properties of tissues. EIT offers many advantages over other neuroimaging technologies, which has led to its potential clinical use. This qualitative review provides an overview of the basic principles, algorithms, and system composition of EIT. Recent advances in the field of EIT are discussed in the context of epilepsy, stroke, brain injuries and edema, and other brain diseases. Further, we summarize factors limiting the development of brain EIT and highlight prospects for the field. In epilepsy imaging, there have been advances in EIT imaging depth, from cortical to subcortical regions. In stroke research, a bedside EIT stroke monitoring system has been developed for clinical practice, and data support the role of EIT in multi-modal imaging for diagnosing stroke. Additionally, EIT has been applied to monitor the changes in brain water content associated with cerebral edema, enabling the early identification of brain edema and the evaluation of mannitol dehydration. However, anatomically realistic geometry, inhomogeneity, cranium completeness, anisotropy and skull type, etc., must be considered to improve the accuracy of EIT modeling. Thus, the further establishment of EIT as a mature and routine diagnostic technique will necessitate the accumulation of more supporting evidence.

[Establishment and Application of Performance Evaluation and Obstacle Diagnosis Model for Regional Water Ecological Civilization Construction].

A scientific performance evaluation of the regional water ecological civilization construction and clarifying the obstacle factor are key points to improve the performance of regional water ecological civilization construction theory. This study analyzes the coupling relationship between humans and regional water ecology by applying the thinking logic of "driving force-pressure-state-influence-response-management." The regional water ecological civilization construction performance evaluation index system based on the DPSIRM model was established. Combining the unascertained measurement model and obstacle diagnosis model, the water ecological civilization construction performance of Shizuishan City during the past 10 years was empirically evaluated, and the obstacle factors affecting local construction performance were diagnosed and analyzed. The analytical results reveal the following points:First, the performance of the water ecological civilization construction in Shizuishan City gradually increased annually and revealed three development stages:the site visit and slow improvement (2010-2014), intermediate but fast improvement (2015-2017) and good and fast improvement (2018-2019). Second, each subsystem performance index trend varied, but generally, the fluctuations rose. Third, from 2010 to 2014, the average obstacle degree of the subsystem state, subsystem response, and subsystem pressure reached 58.81%, which became the main obstacles restricting the performance of the local water ecological civilization construction. From 2015 to 2017, the average pressure barrier degree reached 21.73%, which was the most significant obstacle to the construction performance. From 2018 to 2019, the average pressure barrier degree remained the largest obstacle by reaching 24.49%. Lastly, the index barrier of the obstacle degree among the top five factors are primarily distributed in the pressure subsystem. A comprehensive frequency ranking of the obstacles, the irrigation water use coefficient, and the pressure of the water consumption per ten thousand yuan of value-added by industry as a representative subsystem are the key directions to future construction. In this paper, the concepts and methods of the research can provide a theoretical reference for the performance evaluation of regional water ecological civilization construction and its obstacle factor diagnosis analysis.