Analysis of maintaining human maximal voluntary contraction control strategies through the power grip task in isometric contraction.

Power grip force is used as a representative indicator of the ability of the human neuromuscular system. However, people maintain the power grip force via different control strategies depending on the visual feedback that shows the magnitude of the force, the magnitude of the target grip force, and external disturbance. In this study, we investigated the control strategy of maintaining the power grip force in an isometric contraction depending on these conditions by expressing the power grip force as a person's Maximal Voluntary Contraction (MVC). The participants were asked to maintain the MVC for each condition. Experimental results showed that humans typically control their MVC constant abilities based on proprioception, and maintaining the target MVC becomes relatively difficult as the magnitude of the target MVC increases. In addition, through interactions between the external disturbance and the target MVC, the MVC error increases when the target MVC increases and an external disturbance is applied. When the MVC error reaches a certain level, the offset effect is expressed through visual feedback, helping to reduce the MVC error and maintain it smoothly, revealing a person's MVC maintenance control strategy for each condition.

Differentiation between hepatic angiomyolipoma and hepatocellular carcinoma in individuals who are not at-risk for hepatocellular carcinoma.

PURPOSE: To develop a practical methodfor differentiating hepatocellular carcinoma (HCC) from angiomyolipoma (AML) in individuals who are not at-risk for HCC. METHOD: We retrospectively enrolled consecutive patients who underwent gadoxetic acid-enhanced liver magnetic resonance imaging (MRI) and pathological confirmation between January 2008 and April 2022. Patients who underwent prior treatment, those with multiple lesions, or those at-risk for HCC were excluded. The training cohort included patients with pathological confirmation between 2008 and 2019, whereas the validation cohort included the remaining cases. Independent reviews of the MRI were performed by two reviewers. Using the clinical and MRI findings, we developed AML-HCC score using Firth's logistic regression in the training cohort, and the diagnostic performance was validated in the validation cohort. RESULTS: Of the 206 patients, 156 were assigned to the training cohort (25 and 131 patients with AML and HCC, respectively) and 50 were assigned to the validation cohort (4 and 46 patients with AML and HCC, respectively). The AML-HCC score was defined as the sum of female (score 1), early draining vein (score 2), T2 homogeneity (score 1), necrosis or severe ischaemia (score -2), and HBP hyperintensity to spleen (score -1). When the AML-HCC score was ≥1, the sensitivity and specificity were 80% and 95% for the training cohort and 100% and 80% for the validation cohort, respectively. CONCLUSIONS: We developed and validated an AML-HCC score to differentiate between AML and HCC in individuals who are not at-risk for HCC, and our model demonstrated good diagnostic performance.

Effectiveness and Safety of Acupotomy Treatment on Shoulder Pain: 25 Multicenter Retrospective Study.

Objective: Shoulder pain is a common complaint in outpatient clinics and can result in an inability to work or perform household activities, leading to significant socioeconomic burden. Acupotomy, as one kind acupuncture that has flat knife-shaped tip, has been widely used for treating shoulder pain. However, despite the widespread use of acupotomy in primary medical institutions, large sample size clinical trials have not sufficiently been performed. In this respect, this multi-center retrospective study aimed to investigate the effectiveness and safety of acupotomy in reducing shoulder pain and disability using data from multi-center primary care clinics. Methods: This study was conducted in 25 Korean medicine clinics affiliated with the Korean Medical Society of Acupotomology, Republic of Korea, from August 2021 to December 2021. The medical records of patients who visited the clinics complaining of shoulder pain were gathered, and among them were those of patients who underwent acupotomy treatment and those who received acupuncture combined therapy. The Numeric Rating Scale (NRS), SPADI (Shoulder Pain and Disability Index), Range of Motion (ROM) and adverse event were evaluated at each visit. A linear mixed-effects models and paired t-test were used to identify the effectiveness of the treatment. Results: Overall analysis showed that the NRS score of patients decreased from 4.95 ± 1.97 before treatment to 3.78 ± 2.03 after treatment (n = 332, difference in NRS score, 1.17; 95% CI: 0.96-1.38, t = 10.89 p < 0.001). SPADI score decreased from 19.05 ± 20.44 at baseline before treatment to 12.12 ± 17.26 after the last visit, which was statistically significant (n = 332, mean difference in SPADI score, 6.93; 95% CI: 4.71-9.15, t = 6.150, p < 0.001). No serious adverse event was reported in both groups. Conclusion: This study showed the effectiveness of acupotomy therapy for shoulder pain, and as the treatment sessions increased, the effect of pain reduction and shoulder function improvement were also increased.

Estimation of One-Repetition Maximum, Type, and Repetition of Resistance Band Exercise Using RGB Camera and Inertial Measurement Unit Sensors.

Resistance bands are widely used nowadays to enhance muscle strength due to their high portability, but the relationship between resistance band workouts and conventional dumbbell weight training is still unclear. Thus, this study suggests a convolutional neural network model that identifies the type of band workout and counts the number of repetitions and a regression model that deduces the band force that corresponds to the one-repetition maximum. Thirty subjects performed five different exercises using resistance bands and dumbbells. Joint movements during each exercise were collected using a camera and an inertial measurement unit. By using different types of input data, several models were created and compared. As a result, the accuracy of the convolutional neural network model using inertial measurement units and joint position is 98.83%. The mean absolute error of the repetition counting algorithm ranges from 0.88 (seated row) to 3.21 (overhead triceps extension). Lastly, the values of adjusted r-square for the 5 exercises are 0.8415 (chest press), 0.9202 (shoulder press), 0.8429 (seated row), 0.8778 (biceps curl), and 0.9232 (overhead triceps extension). In conclusion, the model using 10-channel inertial measurement unit data and joint position data has the best accuracy. However, the model needs to improve the inaccuracies resulting from non-linear movements and one-time performance.

Elastic Resistance and Shoulder Movement Patterns: An Analysis of Reaching Tasks Based on Proprioception.

This study departs from the conventional research on horizontal plane reach movements by examining human motor control strategies in vertical plane elastic load reach movements conducted without visual feedback. Here, participants performed shoulder presses with elastic resistances at low, moderate, and high intensities without access to visual information about their hand position, relying exclusively on proprioceptive feedback and synchronizing their movements with a metronome set at a 3 s interval. The results revealed consistent performance symmetry across different intensities in terms of the reach speed (p = 0.254-0.736), return speed (p = 0.205-0.882), and movement distance (p = 0.480-0.919). This discovery underscores the human capacity to uphold bilateral symmetry in movement execution when relying solely on proprioception. Furthermore, this study observed an asymmetric velocity profile where the reach duration remained consistent irrespective of the load (1.15 s), whereas the return duration increased with higher loads (1.39 s-1.45 s). These findings suggest that, in the absence of visual feedback, the asymmetric velocity profile does not result from the execution of the action but rather represents a deliberate deceleration post-reach aimed at achieving the target position as generated by the brain's internal model. These findings hold significant implications for interpreting rehabilitation approaches under settings devoid of visual feedback.

An Observational Study Using Ultrasound to Assess Allowable Needle Insertion Range of Acupoint CV12.

BACKGROUND: Abdominal organ injuries are a rarely reported complication when deep acupuncture needling is applied to the abdomen. In order to ascertain the allowable needle insertion range (ANIR) of the abdomen region, we selected acupoint CV12, which is commonly used for treating gastric disease, and ANIR was measured with an ultrasound device. METHOD: Eighty-five healthy volunteers were recruited, of which 83 cases of ultrasound images were obtained. To investigate the prediction factor of ANIR, we also measured several anthropometric factors. RESULTS: The average ANIR was 25.3 ± 10.2; generally, the ANIRs of females were thicker than those of males; and the liver was observed in 62.7% subjects' ultrasound images. The non-observed group showed thicker ANIR and higher BMI than the liver-observed group. CONCLUSION: There are reliable variables that make it possible to predict the ANIR. It is advised to refer to anthropometric factors in needling acupoint CV12 to avoid complications with the acupuncture treatment. However, individual differences are not negligible when applying deep needling. Thus, if the risk is not judged before or during the procedure, practitioners could consider the patient's ANIR on CV12 when applying acupuncture by examining the individual anatomical structures using ultrasound and considering internal organ positions to prevent adverse events due to acupuncture.

Implementation of Objective Structured Clinical Examination on Diagnostic Musculoskeletal Ultrasonography Training in Undergraduate Traditional Korean Medicine Education: An Action Research.

This study aimed to report the specific methods and investigate the educational effects of diagnostic musculoskeletal ultrasound training and the Objective Structured Clinical Examination (OSCE) for traditional medicine students. Scanning volar wrist and diagnosing carpal tunnel syndrome were selected for musculoskeletal ultrasound to train students to use the basic functions of the ultrasound device and scan various structures including tendons, nerves, and arteries. The students were divided into two groups: one group had 8 weeks of training with mock OSCE experience and received feedback about their scan images, and the other group had 3 weeks of training with flipped learning. The OSCE was implemented on the last day of the training. The subjective learning outcomes were analyzed as students' evaluation with a 5-point scale, and the objective learning outcomes were analyzed using OSCE scores evaluated with a pre-validated checklist. Of the 111 students, 60 (54.1%) responded to the questionnaire. Overall satisfaction with this ultrasound training was high (4.5 ± 0.60). The average OSCE score in the 8-week group was significantly higher than that in the 3-week group. The students' self-assessment showed no significant differences between the two groups. Proficiency in using ultrasound is affected by the practice time and feedback. Ultrasound training should be further expanded as a required curriculum to meet students' needs and achieve learning objectives in the clinical skills education of Korean medicine colleges. Further studies are needed on ultrasound education, especially guided interventions for traditional medicine students.

Estimation of 1-Repetition Maximum Using a Hydraulic Bench Press Machine Based on User's Lifting Speed and Load Weight.

1-repetition maximum (1RM), a representative index for an individual's weightlifting capacity, provides an organized workout guide, but to measure 1RM needs several repetitive exercises up to one's limit and has a risk of injury, thus, not adequate for beginners, elders, or disabled people. This study suggests a simpler and safer 1RM measurement method using a hydraulic fitness machine. We asked twenty-five female subjects with less than a month of experience in weight training to repeat chest exercises using a conventional plate-loaded bench press machine and a hydraulic bench press machine and measured 1RMs. Repeated-measures ANOVA and paired t-test reported the difference between the plate and hydraulic 1RMs insignificant (p-value = 0.082) and confirmed the generality of 1RM across the different types of fitness machines. We then derived several 1RM equations in terms of load weight W and lifting speed v during non-1RM exercise and reduced it to a first-order polynomial expression 1RM=-0.3908+0.8251W+0.1054v with adjusted R-square of 0.8849. Goodness-of-fit test and comparison with 1RM equations from reference studies (v=-1.46×W1RM+1.7035, W1RM×100=7.5786v2-75.865v+113.02) verified our formula valid. We finally simplified the 1RM measurement process up to a maximum of three repetitions.

Visuomotor control of intermittent circular tracking movements with visually guided orbits in 3D VR environment.

The analysis of visually guided tracking movements is important to the understanding of imitation exercises and movements carried out using the human visuomotor control system. In this study, we analyzed the characteristics of visuomotor control in the intermittent performance of circular tracking movements by applying a system that can differentiate between the conditions of invisible and visible orbits and visible and invisible target phases implemented in a 3D VR space. By applying visuomotor control based on velocity control, our study participants were able to track objects with visible orbits with a precision of approximately 1.25 times greater than they could track objects with invisible orbits. We confirmed that position information is an important parameter related to intermittent motion at low speeds (below 0.5 Hz) and that tracked target velocity information could be obtained more precisely than position information at speeds above 0.5 Hz. Our results revealed that the feedforward (FF) control corresponding to velocity was delayed under the visible-orbit condition at speeds over 0.5 Hz, suggesting that, in carrying out imitation exercises and movements, the use of visually presented 3D guides can interfere with exercise learning and, therefore, that the effects of their use should be carefully considered.

Analysis of Visuo Motor Control between Dominant Hand and Non-Dominant Hand for Effective Human-Robot Collaboration.

The human-in-the-loop technology requires studies on sensory-motor characteristics of each hand for an effective human-robot collaboration. This study aims to investigate the differences in visuomotor control between the dominant (DH) and non-dominant hands in tracking a target in the three-dimensional space. We compared the circular tracking performances of the hands on the frontal plane of the virtual reality space in terms of radial position error (ΔR), phase error (Δθ), acceleration error (Δa), and dimensionless squared jerk (DSJ) at four different speeds for 30 subjects. ΔR and Δθ significantly differed at relatively high speeds (ΔR: 0.5 Hz; Δθ: 0.5, 0.75 Hz), with maximum values of ≤1% compared to the target trajectory radius. DSJ significantly differed only at low speeds (0.125, 0.25 Hz), whereas Δa significantly differed at all speeds. In summary, the feedback-control mechanism of the DH has a wider range of speed control capability and is efficient according to an energy saving model. The central nervous system (CNS) uses different models for the two hands, which react dissimilarly. Despite the precise control of the DH, both hands exhibited dependences on limb kinematic properties at high speeds (0.75 Hz). Thus, the CNS uses a different strategy according to the model for optimal results.

Analysis of motor control strategy for frontal and sagittal planes of circular tracking movements using visual feedback noise from velocity change and depth information.

We aim to investigate a control strategy for the circular tracking movement in a three-dimensional (3D) space based on the accuracy of the visual information. After setting the circular orbits for the frontal and sagittal planes in the 3D virtual space, the subjects track a target moving at a constant velocity. The analysis is applied to two parameters of the polar coordinates, namely, ΔR (the difference in the distance from the center of a circular orbit) and Δω (the difference in the angular velocity). The movement in the sagittal plane provides different depth information depending on the position of the target in orbit, unlike the task of the frontal plane. Therefore, the circular orbit is divided into four quadrants for a statistical analysis of ΔR. In the sagittal plane, the error was two to three times larger in quadrants 1 and 4 than in quadrants 2 and 3 close to the subject. Here, Δω is estimated using a frequency analysis; the lower the accuracy of the visual information, the greater the periodicity. When comparing two different planes, the periodicity in the sagittal plane was approximately 1.7 to 2 times larger than that of the frontal plane. In addition, the average angular velocity of the target and tracer was within 0.6% during a single cycle. We found that if the amount of visual information is reduced, an optimal feedback control strategy can be used to reduce the positional error within a specific area.

Analysis of Control Characteristics between Dominant and Non-Dominant Hands by Transient Responses of Circular Tracking Movements in 3D Virtual Reality Space.

Human movement is a controlled result of the sensory-motor system, and the motor control mechanism has been studied through diverse movements. The present study examined control characteristics of dominant and non-dominant hands by analyzing the transient responses of circular tracking movements in 3D virtual reality space. A visual target rotated in a circular trajectory at four different speeds, and 29 participants tracked the target with their hands. The position of each subject's hand was measured, and the following three parameters were investigated: normalized initial peak velocity (IPV2), initial peak time (IPT2), and time delay (TD2). The IPV2 of both hands decreased as target speed increased. The results of IPT2 revealed that the dominant hand reached its peak velocity 0.0423 s earlier than the non-dominant hand, regardless of target speed. The TD2 of the hands diminished by 0.0218 s on average as target speed increased, but the dominant hand statistically revealed a 0.0417-s shorter TD2 than the non-dominant hand. Velocity-control performances from the IPV2 and IPT2 suggested that an identical internal model controls movement in both hands, whereas the dominant hand is likely more experienced than the non-dominant hand in reacting to neural commands, resulting in better reactivity in the movement task.

What is the source of pressure pain during abdominal examination in Korean medicine?

BACKGROUND: This study aimed to observe which anatomical structures change in the abdominal cavity and are involved in pressure pain during the pressurization of CV12 by using an ultrasonic diagnostic device in healthy subjects. METHODS: We recruited 52 healthy people and performed ultrasound imaging by gradually pressurizing the subject's CV12. We analyzed ultrasound images to observe the changes in abdominal anatomical structures during pressurization. RESULTS: A significant change in thickness appeared at the space above the peritoneum and stomach and at the space between the stomach and the abdominal aorta while pressing on CV12. Pressure pain occurred in the following two cases. One was when from the posterior side of the stomach to the inner surface of the rectus abdominis became approximately 1.8 cm. The other was when the anterior side of the abdominal aorta approached the inner surface of the rectus abdominis by approximately 3 cm. Pressure pain occurred when CV12 was pressed to a depth of approximately 2.4 cm for females, 3.1 cm for males and 2.7 cm on average. CONCLUSION: The stomach and tissues around the stomach undergo the greatest pressure change during the pressurization of CV12, and in particular, pressure pain occurs when the posterior wall of the stomach is under pressure. However, further study should be done for clinical application.

The Efficacy and Safety of Acupuncture for Preventing Radiation Pneumonitis in Patients With Lung Cancer: A Prospective, Single-Blinded, Randomized Pilot Proof-of-Principle Study.

Purpose: We evaluated the efficacy and safety of acupuncture for prevention of radiation pneumonitis in patients with lung cancer. Methods: Twenty-five patients were prospectively enrolled in this study and randomized to either intervention group or control group. The patients assigned to the intervention group received 15 minutes of acupuncture treatment twice a week. The patients assigned to the control group received RT alone without acupuncture treatment. The primary endpoint was incidence of radiation pneumonitis. The secondary endpoints were FEV1 (forced expiratory volume in 1 second), DLCO (diffusing capacity for carbon monoxide), 6-minute walk distance, and modified Borg scale. Results: The intervention group showed lower incidences of grade 3 and grade ≥2 radiation pneumonitis than the control group (10% vs 30% for grade 3 and 50% vs 60% for grade ≥2). In the control group, mean DLCO value was decreased from 62.1% at baseline to 49.1% after RT (P = .004). The DLCO was also decreased after RT in the intervention group, but the decrement was not statistically significant (56.7% at baseline and 50.9% after RT, P = .204). The FEV1 and 6-minute walk distance were decreased after RT in the control group. However, FEV1 and 6-minute walk distance were increased after RT in the intervention group. Conclusions: This study found that patients who received acupuncture treatment showed a lower incidence of radiation pneumonitis and a protective effect against aggravation of pulmonary function after RT in patients with lung cancer. To confirm the results of this study, well-designed randomized studies with large sample sizes will be required.

Efficacy and safety of Ojeok-san plus Saengmaek-san for gastroesophageal reflux-induced chronic cough: protocol for a pilot, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Gastroesophageal reflux disease (GERD) is a major cause of chronic cough. GERD-induced chronic cough is difficult to diagnose because some patients do not complain of any gastrointestinal (GI) reflux symptoms. Although chronic cough due to GERD is highly prevalent, no effective treatment is currently available, especially for GERD-related cough without GI symptoms. Because the herbal medicines Ojeok-san and Saengmaek-san can effectively treat GERD and cough, we aim to evaluate the efficacy and safety of a combination of these components for relieving chronic cough due to GERD. METHODS/DESIGN: This is a study protocol of a randomized, double-blind, placebo-controlled, single-center pilot trial. After a 1-week run-in period, a total of 30 patients with GERD-induced chronic cough will be randomly allocated to an intervention group (n = 15) or a placebo group (n = 15). Participants will receive 5.76 g of Ojeok-san plus Saengmaek-san or a placebo three times per day for 6 weeks. The primary outcome measures, which are the frequency and severity of cough, will be recorded using a cough diary. The secondary outcome measures will include a cough visual analogue scale, the Leicester Cough Questionnaire (Korean version), the Gastrointestinal Symptom Rating Scale, the Hull Airway Reflux (hypersensitivity) Questionnaire, the Pattern Identification for Chronic Cough Questionnaire, the Pattern Identification for Gastroesophageal Reflux Disease, and safety testing. Adverse events will also be reported. DISCUSSION: This will be the first clinical trial to explore the use of herbal medicines for GERD-related chronic cough, including patients without GI reflux symptoms. This study will provide useful evidence regarding the efficacy and safety of Ojeok-san plus Saengmaek-san treatment. In addition, this trial will offer a scientific basis for the combination of herbal medicines. This study will also provide important data for conducting a larger-scale clinical trial on GERD-induced chronic cough. TRIAL REGISTRATION: This trial has been registered with Clinical Research Information Service (CRIS) of South Korea (http://cris.nih.go.kr; registration number KCT0003115). Registered August 28, 2018.

Validation of the Core Seven-Emotions Inventory - short form.

BACKGROUND: This study aimed to evaluate the reliability and validity of short form of the Core Seven Emotions Inventory (CSEI-s) scale. METHODS: The participants were third-grade Korean Medicine University students As with the original CSEI, the scales in the short form (CSEI-s) were composed of seven factors and consisted of 28 items in total. The internal consistency coefficient was calculated, and a confirmatory factor analysis was conducted to verify the reliability of the short form scale. Finally, to verify the validity of the abbreviated scale, a correlation analysis with the abbreviated scale and the CSEI-s scale was conducted. RESULTS: A 178 among 200 initial participants were included in the analysis (mean age: 24.5 years). The results of the exploratory factor analysis made from the 28 items of the seven factors of the CSEI-s showed that the factor loadings were as high as 0.64-0.89, excluding the tenth item of fear (0.52), and the model fit also had a good confirmatory factor with the analysis result. The results of the reliability verification showed that the Cronbach α values of all seven subscales of the short-form CSEI scale were 0.7 or higher, and the overall reliability was 0.83. A factor analysis revealed that the factor loadings were adequate, and their reliability and validity were confirmed for the CSEI-s scale, making it applicable to measuring the core seven emotions of patients in clinical practice. CONCLUSION: CSEI-s scale may apply to measure core emotions of the patient in a clinical setting.

Clinical effects of mindfulness meditation and cognitive behavioral therapy standardized for insomnia: A protocol for a systematic review and meta-analysis.

INTRODUCTION: This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of mindfulness meditation and cognitive behavioral therapy programs as a psychological intervention for insomnia disorders. METHODS AND ANALYSIS: We will search the following 11 electronic databases without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and PsycARTICLES. Furthermore, we will also search 5 Korean-language databases (Oriental Medicine Advanced Searching Integrated System, Korean studies Information Service System, Research Information Service System, Korean Medical Database, and Korea Citation Index). The study selection and data extraction will be performed independently by 2 authors. The study quality assessment and evaluation of the quality of evidence for the main findings will be performed independently by 2 authors using the Cochrane tool for assessing risk of bias and predefined criteria (the Grading of Recommendations Assessment, Development, and Evaluation approach). Data synthesis and analysis will be performed using RevMan Version 5.3. Data will be synthesized by either a fixed effects or random effects model according to a heterogeneity test or the number of studies included in the meta-analysis. If any plan for documenting important protocol amendments changes, the researchers will have a revision agreement and then register the modification in the International Prospective Register of Systematic Reviews (PROSPERO). ETHICS AND DISSEMINATION: Ethical approval will not be required because individual patient data are not included and because this protocol is for a systematic review. The findings of this systematic review will be disseminated through conference presentations.PROSPERO registration number: CRD42018111217.

Development of a quantitative evaluation system for visuo-motor control in three-dimensional virtual reality space.

The process of learning a human's movement and motor control mechanisms by watching and mimicking human motions was based on visuo-motor control in three dimensional space. However, previous studies regarding the visuo-motor control in three dimensional space have focused on analyzing the tracking tasks along one-dimensional lines or two-dimensional planes using single or multi-joint movements. Therefore, in this study, we developed a new system to quantitatively evaluate visuo-motor control in three-dimensional space based on virtual reality (VR) environment. Our proposed system is designed to analyze circular tracking movements on frontal and sagittal planes in VR space with millimeter level accuracy. In particular, we compared the circular tracking movements under monocular and binocular vision conditions. The results showed that the accuracy of circular tracking movements drops approximately 4.5 times in monocular vision than that in binocular vision on both frontal and sagittal planes. We also found that significant difference can be observed between frontal and sagittal planes for only the accuracy of X-axis in both monocular and binocular visions.

Oral administration of herbal medicines for radiation pneumonitis in lung cancer patients: A systematic review and meta-analysis.

BACKGROUND: Radiation pneumonitis is a common and serious complication of radiotherapy. Many published randomized controlled studies (RCTs) reveal a growing trend of using herbal medicines as adjuvant therapy to prevent radiation pneumonitis; however, their efficacy and safety remain unexplored. OBJECTIVE: The aim of this systematic review is to evaluate the efficacy and safety of herbal medicines as adjunctive therapy for the prevention of radiation pneumonitis in patients with lung cancer who undergo radiotherapy. METHODS: We searched the following 11 databases: three English medical databases [MEDLINE (PubMed), EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL)], five Korean medical databases (Korean Studies Information, Research information Service System, KoreaMed, DBPIA, National Digital Science Library), and three Chinese medical databases [the China National Knowledge Database (CNKI), Journal Integration Platform (VIP), and WanFang Database]. The primary outcome was the incidence of radiation pneumonitis. The risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS: Twenty-two RCTs involving 1819 participants were included. The methodological quality was poor for most of the studies. Meta-analysis showed that herbal medicines combined with radiotherapy significantly reduced the incidence of radiation pneumonitis (n = 1819; RR 0.53, 95% CI 0.45-0.63, I2 = 8%) and the incidence of severe radiation pneumonitis (n = 903; RR 0.22, 95% CI 0.11-0.41, I2 = 0%). Combined therapy also improved the Karnofsky performance score (n = 420; WMD 4.62, 95% CI 1.05-8.18, I2 = 82%). CONCLUSION: There is some encouraging evidence that oral administration of herbal medicines combined with radiotherapy may benefit patients with lung cancer by preventing or minimizing radiation pneumonitis. However, due to the poor methodological quality of the identified studies, definitive conclusion could not be drawn. To confirm the merits of this approach, further rigorously designed large scale trials are warranted.

Change of Safe Needling Depth at Acupoint GB21 according to Posture and Breathing.

Acupoint GB21 (Jianjing) is used for treating back and shoulder pain but is associated with a risk of pneumothorax. We aimed to determine the SND (safe needling depth) at GB21 according to posture and breathing in real time. Ultrasonographic images of GB21 during normal breathing, inspiration, and expiration in a SP (sitting position) were acquired for 52 healthy volunteers. Images were also acquired during normal respiration in the PP (prone position) with arms raised and lowered. The average SND was greater for men than for women (p < 0.05). Analysis of variance revealed that the SND was greater for the PP than for the SP (p = 0.01 and p < 0.05, resp.). Although the SND tended to change according to posture, the average depth tended to deviate widely in some subjects. During breathing, the differences between inspiration and expiration were less than 1 mm in most subjects, but some showed differences more than 4.5 mm. The SND at GB21 was greater in overweight subjects and significantly greater in the PP and during maximal expiration. However, intragroup differences were greater than the intergroup differences. Therefore, it is dangerous to simply apply needling depth on a gender or BMI basis. The practitioner would adjust the SND by examining the individual anatomical structures.