Acupuncture for the treatment of trigger finger in adults: a prospective case series.

OBJECTIVE: To determine the effect of acupuncture performed at the synovial and ligamentous tendon sheath (A1 pulley site) on pain during snapping and the severity of the snapping phenomenon in patients with trigger finger. METHODS: In this observational study, changes in the patients' condition were compared before and after acupuncture treatment. Acupuncture was performed on 19 fingers of 15 patients. Acupuncture needles were inserted into the radial and ulnar sides of the flexor tendon at the A1 pulley of the affected finger. Treatment was performed daily up to a maximum of five times. Before and after each treatment, pain during snapping and the severity of snapping were evaluated using a visual analogue scale (VAS). RESULTS: VAS scores for pain and snapping severity were significantly improved immediately after the first treatment (p<0.001). Pain during snapping, assessed before each treatment, improved over time, reaching statistical significance from the second treatment onwards (p<0.001); similarly, a significant improvement in the severity of snapping was observed, also from the second treatment (p<0.001). Patients with clinically significant improvements (≥50%) in pain and snapping severity had a significantly shorter duration of the disorder than those with <50% improvement (p<0.05). CONCLUSIONS: Acupuncture at the impaired A1 pulley site may be an effective treatment for trigger finger. We postulate that acupuncture may reduce inflammation/swelling of the synovial membrane of the tendon sheath, which predominates when the disorder is of short duration. Further research is required to confirm the efficacy/effectiveness of acupuncture for trigger finger and its mechanisms of action.

The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.

OBJECTIVE: To examine the effect of electroacupuncture (EA) on early post-rupture tendon repair in a rat model of Achilles tendon rupture using histological and mechanical evaluation. METHODS: An Achilles tendon rupture model was prepared in 90 Wistar rats, which were randomly assigned to EA, manual acupuncture or control groups. Rats in the EA group received EA (pulse width 5 ms; stimulation frequency 50 Hz; stimulation strength 20 µA; stimulation time 20 min) daily from 1 day following model preparation until the day of assessment (either 7 or 10 days after model preparation), when the region of interest was sampled to assess tendon repair using in vitro methods. Total cell count and the number of cells staining positive for transforming growth factor-ß1 (TGF-ß1) and basic fibroblast growth factor (b-FGF) were measured. Tension tests were performed 10 days after model preparation to measure the maximum breaking strength of the repaired tendon. RESULTS: Both the total cell count and the number of cells positive for b-FGF were significantly higher in the EA group (p<0.05). In the EA group only, immunostaining showed strong expression of TGF-ß1 7 days after model preparation (p<0.05). Maximum breaking strength of the repaired tendon 10 days after model preparation was significantly higher in the EA group (p<0.01). CONCLUSIONS: The marked increase in cell count and growth factor expression as well as increased tendon strength in the EA group suggest that EA may be a useful method for promoting tendon repair.

Clinical effect of acupuncture on cervical spondylotic radiculopathy: results of a case series.

OBJECTIVE: To observe the effectiveness of acupuncture applied to the cervical region of patients with upper extremity radicular symptoms due to cervical spondylotic radiculopathy (CSR). METHODS: 15 subjects diagnosed with CSR and with upper extremity pain and/or paraesthesiae for 13.1±18.0 months were selected. The 15 patients had 16 affected limbs and scored a total of 17 symptom scores of pain and/or paraesthesiae. All patients were treated with acupuncture once a week for 4 weeks at up to 10 sites in the cervical paraspinal region centred on the affected area. The severity of the symptoms was recorded using a visual analogue scale (VAS) and functional evaluation was conducted using a Neck Disability Index (NDI). RESULTS: A significant reduction over time was seen for both mean VAS (p<0.0001) and NDI (p<0.0001). Changes were still significant at 4-week follow-up. A 50% reduction in symptoms was scored for 15 of the 17 symptoms scored. CONCLUSIONS: Favourable results were seen in nearly 90% of cases. These results show that acupuncture treatment to the cervical region may be effective as a conservative therapy for treating CSR.

The effect of electroacupuncture on osteotomy gap healing in a rat fibula model.

OBJECTIVE: To examine the effect of electroacupuncture (EA) on osteotomy gap healing in a rat fibula model. METHODS: A total of 40 12-week-old male Wistar rats underwent unilateral open osteotomy of the fibula to create a 2 mm gap. The rats were randomly assigned to an EA group (n=20) and a control group (n=20). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously at the surgery site, while another acupuncture needle inserted 15 mm proximal to the surgery site was used as an anodal electrode. EA was performed 5 days a week for 6 weeks. The control group received no treatment. Some rats were killed at 3 days and 1 week after surgery and the cut end of the distal part of the fibula was surgically removed and histologically assessed. Haematoxylin and eosin (H&E) staining was used to measure total cell count and immunohistochemical staining to assess the increase in the bone morphogenetic protein 2 (BMP-2)-positive cells. The healing process was also assessed weekly after surgery via x-ray examinations. RESULTS: At each time point, total cell count showed a marked increase in the EA group (p<0.05), while BMP-2 expression showed a tendency to increase in the EA group. Radiological examination showed a marked reduction in the distance between the cut ends of the fibula in the EA group. CONCLUSIONS: There was a marked increase in cell count and expression of growth factor in the EA group. These results indicate direct current EA could be useful for promoting bone healing.

Spinal nerve root electroacupuncture for symptomatic treatment of lumbar spinal canal stenosis unresponsive to standard acupuncture: a prospective case series.

OBJECTIVE: To study the effectiveness of electroacupuncture of the spinal nerve root using a selective spinal nerve block technique for the treatment of lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis. METHODS: Subjects were 17 patients with spinal canal stenosis who did not respond to 2 months of general conservative treatment and conventional acupuncture. Under x-ray fluoroscopy, two acupuncture needles were inserted as close as possible to the relevant nerve root, as determined by subjective symptoms and x-ray and MRI findings, and low-frequency electroacupuncture stimulation was performed (10 Hz, 10 min). Patients received 3-5 once-weekly treatments, and were evaluated immediately before and after each treatment and 3 months after completion of treatment. RESULTS: After the first nerve root electroacupuncture stimulation, scores for lumbar and lower limb symptoms improved significantly (low back pain, p<0.05; lower limb pain, p<0.05; lower limb dysaesthesia, p<0.01) with some improvement in continuous walking distance. Symptom scores and continuous walking distance showed further improvement before the final treatment (p<0.01), and a significant sustained improvement was observed 3 months after completion of treatment (p<0.01). CONCLUSION: Lumbar and lower limb symptoms, for which conventional acupuncture and general conservative treatment had been ineffective, improved significantly during a course of electroacupuncture to the spinal nerve root, showing sustained improvement even 3 months after completion of treatment. The mechanisms of these effects may involve activation of the pain inhibition system and improvement of nerve blood flow.

Muscarinic receptor subtypes involved in regulation of colonic motility in mice: functional studies using muscarinic receptor-deficient mice.

Although muscarinic M(2) and M(3) receptors are known to be important for regulation of gastric and small intestinal motility, muscarinic receptor subtypes regulating colonic function remain to be investigated. The aim of this study was to characterize muscarinic receptors involved in regulation of colonic contractility. M(2) and/or M(3) receptor knockout (KO) and wild-type mice were used in in vivo (defecation, colonic propulsion) and in vitro (contraction) experiments. Amount of feces was significantly decreased in M(3)R-KO and M(2)/M(3)R-KO mice but not in M(2)R-KO mice. Ranking of colonic propulsion was wild-type=M(2)R-KO>M(3)R-KO>M(2)/M(3)R-KO. In vitro, the amplitude of migrating motor complexes in M(2)R-KO, M(3)R-KO and M(2)/M(3)R-KO mice was significantly lower than that in wild-type mice. Carbachol caused concentration-dependent contraction of the proximal colon and distal colon from wild-type mice. In M(2)R-KO mice, the concentration-contraction curves shifted to the right and downward. In contrast, carbachol caused non-sustained contraction and relaxation in M(3)R-KO mice depending on its concentration. Carbachol did not cause contraction but instead caused relaxation of colonic strips from M(2)/M(3)R-KO mice. 4-[[[(3-chlorophenyl)amino]carbonyl]oxy]-N,N,N-trimethyl-2-butyn-1-aminium chloride (McN-A-343) caused a non-sustained contraction of colonic strips from wild-type mice, and this contraction was changed to a sustained contraction by tetrodotoxin, pirenzepine and L-nitroarginine methylester (L-NAME). In the colon of M(2)/M(3)R-KO mice, McN-A-343 caused only relaxation, which was decreased by tetrodotoxin, pirenzepine and L-NAME. In conclusion, M(1), M(2) and M(3) receptors regulate colonic motility of the mouse. M(2) and M(3) receptors mediate cholinergic contraction, but M(1) receptors on inhibitory nitrergic nerves counteract muscarinic contraction.

Direct current electrical stimulation of acupuncture needles for peripheral nerve regeneration: an exploratory case series.

OBJECTIVE: To examine the therapeutic effect of a novel therapeutic method based on electroacupuncture with intermittent direct current (DCEA) and associated adverse events in patients with peripheral nerve damage and a poor clinical prognosis. METHODS: In seven older patients with peripheral nerve damage (neurapraxia 2, axonotmesis 4, neuromesis 1), an acupuncture needle connected to an anode electrode was inserted proximal to the site of the injury along the route of the nerve, while the cathode electrode was inserted into the innervated muscle, and DCEA was performed (100 Hz for 20 min, weekly). Muscular paralysis was evaluated weekly with manual muscle testing, the active range of motion of joints related to the muscular paralysis and, when necessary, needle electromyography. Adverse events were also recorded during the course of the treatment. RESULTS: Complete functional recovery was observed in the two cases with neurapraxia and two with axonotmesis, while one axonotmesis case achieved improvement and the other showed reinnervation potential without functional recovery. No improvement was observed in the neurotmesis case. Pigmentation of the skin where the anode needle was inserted occurred in three cases. Although there was no definite causal link, one case showed excessive formation and resorption of bone in the area close to the cathode needle site. DISCUSSION: Accelerated nerve regeneration caused by DCEA may contribute to recovery. The skin pigmentation and callus formation suggest that the shape of the anode electrode, current intensity and other factors should be examined to establish a safer treatment method.

Clinical trial of minimal treatment for clustering seizures in cases of convulsions with mild gastroenteritis.

UNLABELLED: The aim of this study was to identify means of shortening the treatment period for clustering seizures in patients with convulsions with mild gastroenteritis (CwG). METHODS: Sixty-two episodes in 61 patients who presented with CwG managed with carbamazepine (CBZ) or Lidocaine (Lidocaine tape (LDT) or intravenous infusion (Lid-iv)) between November 2005 and October 2008 were studied. The subjects were divided into the following groups: 33 episodes treated with CBZ-1 (5mg/kg/day, 1 day), 7 with CBZ-3 (5mg/kg/day, 3 days), 11 with LDT-1 (LDT 2 sheets in 24h), 4 with LDT-2 (LDT 2 sheets in 48 h), and 7 with Lid-iv (1mg/kg/h, continuous infusion). RESULTS: One to seven seizures were recognized before starting CBZ or Lidocaine therapy, followed by complete cessation in 57 episodes and one or two recurrent seizures in five. Efficacy rates were 97% for CBZ-1, 100% for CBZ-3, 72.7% for LDT-1, 75% for LID-2, and 100% for Lid-iv. Efficacy was significantly higher in the CBZ groups than the Lidocaine groups (p=0.019), while the differences between treatment periods (CBZ-1 vs. CBZ-3, and Lid-1 vs. Lid-2) did not reach statistical significance (p>0.999). CONCLUSIONS: CBZ and Lidocaine were effective for treating clustering seizures of CwG. We confirmed that the treatment period can be shortened without loss of efficacy. Therefore, we consider 1 day therapy with CBZ or Lidocaine to be sufficient.

Effect of electroacupuncture on the healing process of tibia fracture in a rat model: a randomised controlled trial.

BACKGROUND: Electrical stimulation is used to promote bone reunion, and is most effective when applied directly to the fracture site. OBJECTIVE: To examine the effects of electroacupuncture (EA) on the healing process of tibia fracture in a rat model. METHODS: Thirty 12-week-old male Wistar rats underwent unilateral open osteotomies of the tibiae. The rats were then assigned randomly to three groups: EA group (n=10), sham group (n=10) and control group (n=10). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously penetrated directly at the surgery site, while an acupuncture needle inserted at 15 mm proximal to the surgery site was used as an anodal electrode. EA (50 Hz, 20 µA, 20 min) was performed daily for 3 weeks. In the sham group the acupuncture needles were inserted at the same sites but no electrical stimulation was given and in the control group, no treatment was given. The response was evaluated at 1, 3, 4 and 6 weeks after surgery by radiographic, macroscopic and mechanical examinations. RESULTS: The EA group showed accelerated bone healing (EA group 29.92+/-4.55 mm², sham group 26.46+/-5.21 mm², control group 26.19+/-2.81 mm², p<0.05 at 3 weeks) and accretion of the callus (radiographic evaluation: EA group 35.66+/-4.37 mm², sham group 32.60+/-5.73 mm², control group 29.72+/-6.39 mm², p<0.05 at 6 weeks) compared with the other groups. Mechanical testing also showed an excellent result (EA group 16.54+/-9.92 N, sham group 7.13+/-3.57 N, control group 6.67+/-3.12 N, p<0.05) at 6 weeks in the EA group compared with the other groups. There was no difference between the sham and control groups in any evaluation. CONCLUSION: The use of EA enhanced callus development and bone mineralisation during the bone healing process.

Oseltamivir treatment for children showing abnormal behavior during influenza virus infection.

UNLABELLED: We investigated the clinical courses of children with influenza infection, who showed abnormal behavior, who were treated with oseltamivir (Tamiflu). SUBJECTS: The subjects were 22 children, 2-15 (mean+/-SD, 6.6+/-3.2) years old, admitted to our hospital during the 2004-2005, 2005-2006, and 2006-2007 influenza seasons. Abnormal behavior appeared before treatment with oseltamivir in 13 children (pre-Tami group), and after administration of the medication in 9 (post-Tami group). All patients continued to receive oseltamivir for 3-5 days after admission. RESULTS: Meaningless speech and movements without a specific purpose were the most frequent abnormal behavior (16 children), while illusions, delusions, and misidentifying awareness were the second most common (14 children). Sensations of marked fear and excitement were recognized in 6 children. One child rushed up and down the stairs unconsciously, raising concern that a serious accident might occur. All patients showed a favorable clinical course, without worsening of neurological symptoms or the development of encephalopathy, and outcomes were good. The clinical course, number of recurrences of abnormal behavior, and outcome were similar in the pre-Tami and post-Tami groups. CONCLUSIONS: Our observations suggest that oseltamivir is not a prerequisite for the development of abnormal behavior and does not worsen the clinical manifestations of abnormal behaviors, although further investigations are needed to determine whether oseltamivir is necessary, or even useful, for patients with influenza virus encephalopathy.

Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial.

OBJECTIVE: To compare the effectiveness of repeated acupuncture stimulation and local anaesthetic injection at the most painful points in patients with low back pain. METHOD: This randomised controlled clinical trial involved 26 patients with low back pain randomly allocated to either an acupuncture group (n = 13) or a local anaesthetic injection group (n = 13). Both acupuncture and anaesthetic injection were performed at two to five of the most painful points on the lower back once weekly for 4 weeks. In the acupuncture group, a 0.18 mm diameter stainless steel needle was inserted to a depth of 10-20 mm and manual stimulation was applied. In the local anaesthetic injection group, a 0.5 mm diameter needle was inserted to a depth of 10-20 mm and a local anaesthetic was injected. Participants evaluated pain using a Visual Analogue Scale immediately before and after the first treatment, before each subsequent treatment, and at 2 weeks and 4 weeks after completion of treatment. RESULTS: There was a significant difference between the two groups in the change in Visual Analogue Scale pain scores (p<0.01), with acupuncture providing more favourable results than local anaesthetic injection. The reduction in pain score from baseline calculated at each time period was significantly different between the two groups after the first (p<0.05) and final (p<0.01) treatments, and during the follow-up period (after 2 weeks (p<0.01) and 4 weeks (p<0.05)). CONCLUSION: Both injection and acupuncture relieved pain, but acupuncture was superior for the immediate and sustained effects, suggesting that it is a useful treatment for low back pain. The difference in the effects may be attributable to differences in the mechanism of pain suppression.

Pudendal nerve electroacupuncture for lumbar spinal canal stenosis - a case series.

OBJECTIVE: To investigate the effectiveness of pudendal nerve electroacupuncture for lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis for whom acupuncture of the lumbar and lower limb muscles had been ineffective. METHODS: Nine patients with lumbar spinal canal stenosis for whom conventional acupuncture at the lumbar and lower limb muscles had no effect. Pudendal nerve electroacupuncture was performed eight times (once per week). VAS scores and continuous walking distance were used to evaluate changes in symptoms. RESULTS: The following changes in symptoms occurred after pudendal nerve electroacupuncture: low back pain was improved from 45.3+/-17.4mm (mean +/- SD) to 39.2+/-14.0mm, lower limb pain was improved from 61.1+/-5.6mm to 35.4+/-11.9mm, lower limb dysaesthesia was improved from 63.9+/-8.4mm to 46.9+/-16.2mm, and continuous walking distance was improved from 100.0+/-35.4m to 250.0+/-136.9m. Conclusion Pudendal nerve electroacupuncture may be an effective treatment for lumbar and lower limb symptoms due to spinal canal stenosis, and is potentially useful in patients who have not responded to conventional acupuncture.

The effect of electrical stimulation of the pudendal nerve on sciatic nerve blood flow in animals.

OBJECTIVE: To investigate the mechanism of the clinical effect of electroacupuncture of the pudendal nerve on the lumbar and lower limb symptoms caused by lumbar spinal canal stenosis, we studied changes in sciatic nerve blood flow during electrical stimulation of the pudendal nerve in the rat. METHODS Using rats (n=5), efferent electrical stimulation to the pudendal nerve was performed and sciatic nerve blood flow was measured with laser Doppler flowmetry. Simultaneously, changes in the blood pressure and cardiac rate were measured. Furthermore, the effect of atropine on these responses to the stimulation was also studied. RESULTS: Electrical stimulation of the pudendal nerve significantly increased blood flow in the sciatic nerve transiently without increasing heart rate and systemic blood pressure. The significant increase in the sciatic nerve blood flow disappeared after administration of atropine. CONCLUSION: Electrical stimulation of the pudendal nerve causes a transient and significant increase in sciatic nerve blood flow. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves.

Phosphorylation of c-Cbl protooncogene product following ethanol administration in rat cerebellum: possible involvement of Fyn kinase.

We have previously shown that ethanol administration results in tyrosine phosphorylation of the 130 kDa protein in rat brain, and identified the protein as Cas, the crk-associated src substrate. In the present study, we demonstrate that Cbl of a 120 kDa protein is also tyrosine-phosphorylated in the cerebellum in response to ethanol administration. We also investigated whether Fyn kinase was involved in ethanol-induced Cbl phosphorylation. Immunoprecipitation experiments showed that the amount of coimmunoprecipitated Fyn kinase with an anti-Cbl antibody increased in extracts from ethanol-administered rats compared to those from saline-administered rats. Exogenous Fyn kinase was shown to phosphorylate on tyrosine residue(s) of Cbl from the cerebellum in vitro. Furthermore, Fyn kinase and Cbl were demonstrated immunohistochemically to be coexpressed in white matter in the cerebellum. These findings indicate that Cbl is tyrosine-phosphorylated in rat cerebellum in response to ethanol administration, and also raise the possibility that Fyn kinase may be involved in the process.