Objective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis. Design: Pilot randomised, controlled trial. Setting: Rehabilitation hospital. Subjects: In-patients with osteo-arthritis of the knee. Interventions: Either 1 to 3 small needle-knife treatments over seven days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation. Measures: Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at three weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded. Results: 83 patients were randomized: 44 into the control group, of whom 10 were lost by three weeks and 12 at 3 months; 39 into the experimental group of whom eight were lost at three weeks and three months. The mean (SE) OKS scores at baseline were Control 35.86 (1.05), Exp 38.38 (0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0.03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) ( P < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months Conclusions: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.
Objective To explore the therapeutic mechanisms of massage for cervical spondylosis of vertebral artery type (CSA) from the effects of sympathetic neurotransmitter changes on vertebral artery blood flow and apoptosis. Methods Forty rabbits were randomly divided into a normal group, model group, electroacupuncture (EA) group, and massage group, with 10 rabbits in each group. The CSA rabbit model was established by neck injection of sclerosing agent in all groups except the normal group. In the EA group, the left “Fengchi” (GB 20) and the 3rd-5th cervical vertebrae (C3-5) “Jiaji” (EX-B2) were selected for EA treatment. In the massage group, pushing manipulation with one finger was performed at 0.5 cm to the left side of the C3-5 spinous process and the tip of the transverse process. The vertebral artery blood flow was detected by laser Doppler. The levels of serum neuropeptide Y (NPY) and norepinephrine (NE) were determined by ELISA. The pathological morphological changes of vertebral arteries were observed by HE staining. The apoptosis of vertebral arteries and cerebella were detected by Tunel assay. The protein expressions of CHOP, Bcl-2, and Bax in vertebral arteries and cerebella were detected by Western blot. Results Vertebral artery blood flow was significantly decreased in all rabbits after modeling. Massage increased vertebral artery blood flow, decreased serum levels of NPY and NE which secreted by sympathetic nerves, improved vertebral artery lumen narrowing, intimal thinning, and mesenteric smooth muscle cell alignment. Moreover, these effects were superior to that in the EA group. In addition, the massage group significantly reduced the apoptotic index, decreased the CHOP and Bcl-2 associated X protein (Bax) protein expressions, and increased the B-cell lymphoma-2 (Bcl-2) protein expression in vertebral arteries and cerebella relative to the model group. Conclusion The treatment of CSA has a neuro-vascular regulatory mechanism. Massage can decrease the release of sympathetic neurotransmitters that constrict blood vessels and mitigate apoptosis induced by excessive endoplasmic reticulum stress (ERS) due to sympathetic excitation, so as to improve vertebral artery blood flow and serve as a treatment for CSA.
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