Effects of Warm Needle Acupuncture on Temporomandibular Joint Disorders: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background. Temporomandibular joint disorders (TMDs) are a common and prevalent disease with main symptoms of pain, joint sounds, and mandibular movement disorders, which seriously affects the mental health and quality of life of the sufferers. In recent years, there have been an increasing number of studies utilizing warm needle acupuncture (WNA) for the treatment of TMD, and the quality of the studies has gradually improved. However, evidence from evidence-based medicine is lacking. This study aims to use a systematic review and meta-analysis method to understand the efficacy of WNA for the treatment of TMD. Methods and Analysis. We searched randomized controlled trials (RCTs) of WNA for the treatment of TMD from 9 electronic databases, including 5 English databases (PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database (CBM)) from their inception to May 2021. The included RCTs compared WNA with acupuncture, electroacupuncture, pharmacological therapy, or other therapies. And outcome indicators such as total effective rate and cure rate were assessed. All analyses were conducted using RevMan software V5.3 and Stata16. Measurement count data used the relative risk (RR) as the efficacy statistic, and each effect size was given its point estimate value and 95% confidence interval (CI). Results. The meta-analysis included 10 studies with a total of 670 patients, which included 340 patients in the experimental group and 330 patients in the control group. The data in this review showed that WNA is superior to treatments such as acupuncture alone, acupuncture therapy combined with TDP, drug therapy, and ultrasonic therapy in terms of effective rate (RR = 1.20; 95% CI, 1.06 to 1.35; and P = 0.003) and cure rate (RR = 1.82; 95% CI, 1.46 to 2.28; and P < 0.00001) for the treatment of TMD. Conclusions. This systematic review and meta-analysis provides new evidence for the effectiveness of WNA for the treatment of TMD. However, the above conclusions need to be further verified by multicenter prospective studies of larger samples and higher-quality RCTs. Protocol registration number: INPLASY202160030.

Acupuncture for Symptomatic Rotator Cuff Disease: A Systematic Review and Meta-Analysis

The objective was to evaluate the effectiveness and safety of acupuncture for patients with rotator cuff diseases.<br/>There were 12 electronic databases and 3 trial registries searched up to November 30^th, 2019. All randomized trials were eligible, regardless of language, date of publication, or settings. The primary outcomes were pain, shoulder function, and proportion of improved participants assessed within 12 weeks of randomization of the trial. The Cochrane risk of bias for the studies was assessed. Effects sizes were presented as a risk ratio, mean difference, or standardized mean difference with a 95% confidence intervals. Grading of Recommendations Assessment, Development and Evaluation approach was adopted to rate certainty of evidence.<br/>Of the 3,686 records screened, 28 randomized trials (2,216 participants) were included in this review. The types of acupuncture included manual acupuncture, dry needling, electroacupuncture, acupotomy, warm needle acupuncture, and fire needle acupuncture. All of the studies had an unclear or high risk of bias related to more than 1 domain. Significant benefits of acupuncture in terms of pain and shoulder function were observed in all comparisons, however, the proportion of improved participants was not described in 2 comparisons. There was substantial heterogeneity among meta-analyzed trials. No serious harm was observed. For primary outcomes, the overall certainty of evidence was very low.<br/>There was very low certainty of evidence for the benefits of acupuncture for patients with rotator cuff diseases. The safety of acupuncture remains unclear due to the incompleteness of reporting. Future welldesigned randomized trials with transparent reporting are required.

Stimulated oxygen transport in tissue by magnetic needle acupuncture

AimTo understand physiology of magnetic needle acupuncture by investigating O2 transport in tissue during needle intervention.MethodsO2 transport in tissue is modeled by utilizing COMSOL with magnetic needle inserted into muscle tissue in a 2D porous media. The damaged tissue has been mimicked by an extracted tissue block with 1st order O2 consumption rate. The convection-diffusion O2 transport in the damaged tissue has been further evaluated by varying magnetic flux density B0 of the needle (0-1 T), myoglobin concentration (0-1 mM), O2 tension (5-100 Torr), O2 consumption rates, tissue permeability (10−12-10−6 m2) and porosity (0.1-0.9).Results1) Active O2 transport carried by interstitial flow is enhanced with the intervention of a magnetic needle by generating a high gradient magnetic field around the tip, which exerts a strong force (104 N/m3) on the diamagnetic interstitial fluid to accelerate the flow. 2) This interstitial flow can reach 30 μm/s at B0 = 1T and strongly correlates to the needle B0 and tissue permeability. 3) The needle stirs the interstitial flow can pump O2 flux by 1-2 orders of magnitude compared to that without magnetic field. 4) The enhancement of active O2 transport by magnetic needle is site-specific to the tissue in the vicinity of the tip. This enhancement is more effective in edema condition with a high tissue permeability (>10−9 m2).ConclusionsThe dramatic enhancement of O2 transport to restore the O2 mitochondria metabolism for dysfunctional muscle tissues is the fundamental physiological mechanism of magnetic needle acupuncture.