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Background/Aims: Combi-elastography is a B-mode ultrasound-based method in which two elastography modalities are utilized simultaneously to assess metabolic dysfunction-associated steatotic liver disease (MASLD). However, the performance of combi-elastography for diagnosing metabolic dysfunction-associated steatohepatitis (MASH) and determining fibrosis severity is unclear. This study compared the diagnostic performances of combi-elastography and vibration-controlled transient elastography (VCTE) for identifying hepatic steatosis, fibrosis, and high-risk MASH.Methods: Participants who underwent combi-elastography, VCTE, and liver biopsy were selected from a prospective cohort of patients with clinically suspected MASLD. Combi-elastography-related parameters were acquired, and their performances were evaluated using area under the receiver-operating characteristic curve (AUROC) analysis.Results: A total of 212 participants were included. The diagnostic performance for hepatic steatosis of the attenuation coefficient adjusted by covariates from combi-elastography was comparable to that of the controlled attenuation parameter measured by VCTE (AUROC, 0.85 vs 0.85; p=0.925). The performance of the combi-elastography-derived fibrosis index adjusted by covariates for diagnosing significant fibrosis was comparable to that of liver stiffness measured by VCTE (AUROC, 0.77 vs 0.80; p=0.573). The activity index from combi-elastography adjusted by covariates was equivalent to the FibroScan-aspartate aminotransferase score in diagnosing high-risk MASH among participants with MASLD (AUROC, 0.72 vs 0.74; p=0.792).Conclusions: The performance of combi-elastography is similar to that of VCTE when evaluating histology of MASLD.

This review aims to analyze the efficacy of acupotomy in treating superior cluneal nerve entrapment syndrome (SCNES) by summarizing the findings of randomized controlled trials (RCTs). The RCTs were retrieved from seven databases (i.e., the Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Korean Studies Information Service System, Research Information Service System, and Oriental Medicine Advanced Searching Integrated System). Seven RCTs were selected for this review. The results indicate that acupotomy is promising for providing significant pain relief and improving function in patients with SCNES. However, more high-quality RCTs are required to establish the long-term effectiveness and safety of acupotomy. This review provides valuable insights for clinicians and researchers in the management of SCNES.

This study aimed to provide the basis of treatment effects by analyzing randomized control trials (RCTs) on the use of thread embedding acupuncture (TEA) for low back pain that were published between February 2018 and July 2023. In total, 2,865 articles were retrieved from international and Korean databases. Nine of these articles were selected and evaluated based on the following categories: (1) year of publication, (2) type of disease, (3) sample size, (4) treatment interventions, (5) treatment frequency and duration, (6) insertion point and depth of thread embedding, (7) types and sizes of threads and needles, (8) evaluation indexes, (9) treatment outcomes, and (10) side effects. The risk of bias in RCTs was also assessed. This study also emphasizes the importance of further research on TEA for clinical treatment and the use of objective approaches. Furthermore, detailed method descriptions and results are important in determining the efficacy of TEA.

Between May 2014 and April 2022, a total of 926 articles were retrieved from the international database, and a total of 233 articles were retrieved from the Korean database. From there, 14 studies were selected, and evaluated by the published year, terminology of the acupotomy, sample size, disease type, retention time, treatment sites, insertion depth and size of the acupotomy, treatment frequency, and duration, type of acupotomy manipulation method, evaluation index, therapeutic effects, adverse effects, and assessment of the risk of bias in randomized controlled trials. This study examined the need for additional acupotomy studies to secure an objective basis for the application of clinical treatment. Furthermore, the detailed description of the study methods and results and unified terminology can provide evidence for the efficacy of acupotomy.

In this study, the evidence of thread embedding acupuncture (TEA) in treating cervical radiculopathy in randomized controlled trials was investigated. We searched 16 databases up to August 22, 2022. Of the 2,644 studies retrieved, 22 randomized controlled trials (2,483 participants) were selected. Quality assessments were performed using Cochrane’s risk-of-bias tool and RevMan 5.4 software. Outcome measures in the included studies typically showed TEA had a significant therapeutic effect compared with simple acupuncture and other remedies, and TEA was better than sham TEA. Catgut and polydioxanone had no difference in effectiveness, however, catgut was considered to be less safe. TEA was shown to be more therapeutic when inserted deeper into the skin. Ultrasound guided TEA was more effective and safer than conventional TEA, and using a flat blade needle was better than conventional needles for TEA. No serious adverse events were reported from using TEA, and only a few mild side effects were observed. However, the limited number and heterogeneity of the included studies, together with the unclear methodological quality, indicate that higher-quality studies need to be conducted to determine the effectiveness and safety of TEA for cervical radiculopathy.

Two patients with sequelae of peripheral facial nerve palsy were treated with Facial Chuna Manual Therapy (FCMT) and acupuncture over 6 months. The House-Brackmann (HB) scale, facial nerve grading system 2.0 (FNGS), the scale of Peitersen, the scale of Murata, and the Numeric Rating Scale (NRS) were used to assess the effects of treatment. The HB scale, FNGS and NRS scores showed improvement for both patients (Case 1: HB scale 5 to 3, FNGS 4 to 2, NRS 10 to 5; Case 2: HB scale 5 to 3, FNGS 4 to 3, NRS 10 to 2.5) following 6 months of treatment. The scores for the Peitersen and Murata scales showed improvement over 6 months in Case 1 (Peitersen 2 to 1, Murata 10 to 7), but there was no change in Case 2 over the test period (4 months). FCMT and acupuncture may help patients with sequelae of facial palsy.

Lumbar spinal stenosis (LSS) is a common degenerative spinal condition that can have unpredictable improvement and worsening of symptoms which include low back pain, radiating pain, claudication, and degenerative lumbar scoliosis affecting quality of life. In this study, thread embedding acupuncture (TEA) was used as a conservative treatment for LSS in combination with complex Korean medicine treatments (acupuncture, herbal medicines, and physical therapy). The treatment was evaluated using the numerical rating scale, walking distance and duration, and inclination of radiological lumbar scoliosis according to antalgic posture. TEA was performed 27 times between June 8, 2020, and March 16, 2021. The patient showed improvement in numerical rating scale score from 7 to 2, pain-free walking distance from 10 m to 900 m, and scoliosis inclination following treatment. The findings of this study suggest that TEA may be helpful in the treatment of LSS.

Background Aconitum sinomontanum Nakai (ASN) has been reported to have analgesic effects. In this study an animal model of pharmacopuncture using ASN (100–500 mg/kg) was examined. Methods Sprague-Dawley (SD) rats (n = 40) were randomly assigned to ASN-Low (1 mg/mL, 1.8 mL, ASN-L), ASN-Intermediate (5 mg/mL, 1.8 mL, ASN-M), ASN-High (10 mg/mL, 1.8 mL, ASN-H), negative control (0.2 mL normal saline), and positive control (0.2 mL 0.5% lidocaine) groups. All experiments were administered to the rats’ left hind leg. The analgesic response was assessed by monitoring the physical (hot plate, and von Frey test) and chemical (formalin) responses to pain. Results All ASN pharmacopuncture groups demonstrated significant differences in pain response to the hot plate test, von Frey test, and formalin test, compared to the control group (p < 0.05). The response of the ASN-M group and ASN-H groups to the hot plate, the formalin, and the von Frey tests were significantly different, compared to the lidocaine group (p < 0.05). Conclusion ASN pharmacopuncture had a significant analgesic effect on SD rats in response to physical and chemical models of pain.

Background This study aimed to assess the toxicity of Aconitum sinomontanum Nakai (ASN) pharmacopuncture. Methods To investigate the toxicity of ASN pharmacopuncture, single and 4-week repeated dose toxicity experiments were conducted on BALB/c mice. In the single-dose toxicity experiment, mice were assigned 1 of 4 groups (5 males, 5 females per group). Then, 31.25, 62.5, and 125 mg/kg of ASN pharmacopuncture were administered to the mice in the experimental groups at acupoint ST36, while 0.2 mL of normal saline was administered to the control group at ST36. After a 4-week repeated dose regimen, the mice were assigned into 4 groups (5 males, 5 females per group). Then, 15.625, 31.25, and 62.5 mg/kg of ASN pharmacopuncture at ST36 were administered to the mice in the experimental groups, while 0.2 mL of normal saline was administered to the control group at ST36. Mortality, morbidity, general body and organ weight changes (after 4 weeks repeated dose), serum hematological and biochemical values, and histopathological changes in the liver and kidney were observed. Results In both single and 4-week repeated dose toxicity experiments, no deaths or symptoms occurred in any of the groups. There were no significant differences between groups in terms of body and organ weights, serum hematological and biochemical values, and specific organ histopathological changes. Conclusion ASN pharmacopuncture injection did not demonstrate significant toxicity in BALB/c mice compared with the control group, with a no-observed-adverse-effect level for a single dose of >125 mg/kg, and for 4 weeks repeated dose it was more than 62.5 mg/kg/day.

Round Acupuncture having blunt end has developed from acupotomy. This case report is to find out that Round Acupuncture is effective in treating patients with recurrent carpal tunnel syndrome (CTS), which has not improved by steroid injection or acupotomy. Round Acupuncture was inserted into the distal fibers of transverse carpal ligament and released toward the proximal fibers. Treatment was performed three times in total. T ingling, numbn ess, night pain and swelling sensation were assessed, and provocative maneuvers were also used. After treat ment, all symptoms completely disappeared and the patient had no recurrence until 3 months after treatment. Round Acupuncture co uld be an effective treatment for recurrent CTS.

Background This study aimed to investigate the protective effects of Zanthoxylum bungeanum Maxim pharmacopuncture on disuse muscle atrophy in the gastrocnemius muscle of rats. Methods Thirty male 250 g Sprague-Dawley rats were distributed randomly into 3 groups. The left hindlimb immobilization was performed with casting tape for 2 weeks, and no treatment was given to the right hindlimb. Rats received pharmacopuncture and were injected daily on the BL57 with either 2 mL of Zanthoxylum bungeanum Maxim aqueous extract (ZM-W group), 1 mL pharmacopuncture of Zanthoxylum bungeanum Maxim ethanol extract (ZM-E group), or 2 mL normal saline (control group). After 2 weeks of immobilization, the weight of the whole gastrocnemius muscle was measured, and the morphology of both the left and the right gastrocnemius muscles were assessed by Hematoxylin and Eosin staining. To investigate the immobilization-induced muscular apoptosis, the immunohistochemical analysis of BAX and Bcl-2 was carried out. Results ZM-W and ZM-E significantly inhibited the reduction in weight of the left gastrocnemius muscle, the reduction in the left myofibrils, and the cross-sectional area of gastrocnemius, as compared with the control. Moreover, the ZM-W and ZM-E groups showed significantly reduced immunoreactivity for BAX, and increased immunoreactivity of Bcl-2 in left gastrocnemius muscle compared with the control group. Conclusions These results suggest that Zanthoxylum bungeanum Maxim pharmacopuncture has protective effects against immobilization-induced muscle atrophy by regulating the activity of apoptosis-associated BAX / Bcl-2 proteins in the gastrocnemius muscle.

This review analyzed randomized controlled trials and case reports to identify the effectiveness, and level of evidence showing that acupuncture treatment aids the recovery of patients with tennis elbow. A literature search was performed between 1st to 10th September, 2019 which used PubMed, the Cochrane library, the Korean databases Oriental Medicine Advanced Searching Integrated System, Korean Studies Information Service System to retrieve Korean and international studies. Amongst the 243 articles retrieved there were 9 randomized controlled trials and 18 case reports. The level of evidence for the recovery of patients with tennis elbow, for efficacy and safety of acupuncture was low. It was observed that the studies had a high risk of bias, missing acupuncture details, multiple combinations of treatments rather than a single treatment, insufficient indicators of assessment, and lacked robustness. Compliance with international standards such as using consolidated standards of reporting trials, will improve the quality of evidence.

Background The aim of this study was to investigate the safety and analgesic effects of Datura Flos; pharmacopuncture (DFP). Methods The analgesic effects of DFP were assessed using mechanical (hot plate), chemical (formalin test), and thermal (von Frey filament test) pain tests. Forty male Sprague Dawley rats were assigned randomly into DFP (75 mg/kg, 150 mg/kg), lidocaine 0.5%, or normal saline group for treatment on Kl3. Gross pathology, histopathology, biochemistry and hematology were performed. Results In the hot plate test, DFP at a high dose (HDDFP; 150 mg/kg) produced a significant analgesic effect, at 10 and 20-minutes post injection (p < 0.01). Low dose DFP (LDDFP; 75 mg/kg) also showed an analgesic effect at 10 minutes post injection (p < 0.01). In the formalin test, HDDFP produced an analgesic effect, for 0-10 and 10-20 minutes (p < 0.01) post treatment, whereas LDDFP showed analgesic effects between 10-20 minutes (p < 0.05). In the von Frey filament test, DF-H produced an analgesic effect, 10 (p < 0.01) and 20 minutes post treatment (p < 0.05). LDDFP showed analgesic effect at 10 minutes (p < 0.05). In the acupuncture response test, HDDFP produced an analgesic effect at 10 minutes post treatment (p < 0.05). DF-H did not cause any anatomical changes to the liver or kidney and there were no abnormalities in biochemistry or hematology. Conclusions DF-H was not toxic and provided short term analgesia, suggesting it may be useful in the management of pain.

Background This study was conducted to evaluate the effects of pharmacopuncture and dermal application of Sebalgukhwa-san extracts on hair growth in an alopecia mouse model. Methods Twenty-one C57BL/6 mice were divided into 3 groups; control group-normal saline injection or vehicle solution application, positive control group-minoxidil (MNXD), experimental group-pharmacopuncture and applied Sebalgukhwa-san (SGS) extract. The effects of the treatment on hair growth, were determined through photographs, and phototrichogram analysis by folliscope. Hair follicle morphometry by hematoxylin-eosin staining was performed, and hair growth-related protein expression of vascular endothelial growth factor, insulin like growth factor-1, and transforming growth factor-beta 1 were monitored by Western blotting. Serum levels of aspartate aminotransferase and alanine aminotransferase were measured for liver function test. Results Body weight increased consistently in all groups. Hair growth was improved in the MNXD and SGS groups compared with the control. Hair density and thickness improved statistically significantly in the MNXD and SGS groups compared with the control p < 0.05. The number of hair follicles improved in the MNXD and SGS groups compared with the control but the size did not. The expression of vascular endothelial growth factor and insulin like growth factor-1 increased, and there was a decrease in the expression of transforming growth factor-beta 1 in the MNXD and SGS groups compared with the control, however, there was no significant difference. Sebalgukhwa-san treatment had no toxicity in liver function tests. Conclusions Pharmacopuncture and dermal application of Sebalgukhwa-san extract may be therapeutically beneficial for the treatment of alopecia.

Background The purpose of this study was to examine the effect of Dokhwalgisaeng-tang on immobilization-induced muscle atrophy. Methods Twenty young male Sprague-Dawley rats were divided into 2 groups. The rats in Dokhwalgisaeng-tang group were orally administered Dokhwalgisaeng-tang water extract, and the rats in the control group were given saline only. Hind limb immobilization was performed with casting tape to keep the left ankle joint in a fully extended position. No intervention was performed on the right leg which was used as an intact region. After 2 weeks of immobilization, all animals were sacrificed, and the gastrocnemius muscle was dissected from both legs and weighed. The morphology of the right and the left gastrocnemius muscle in both the Dokhwalgisaeng-tang and the control group was assessed by hematoxylin and eosin staining. The muscle cross sectional area was examined by image analysis (Axiovision LE software). In addition, immunohistochemical staining was carried out using the free-floating method, and the number of apoptotic related proteins were counted (anti-BAX, anti-Bcl-2). Results Dokhwalgisaeng-tang showed a significant protective effect against the reduction of the left gastrocnemius muscle (weight and muscle cross sectional area) compared with the control group. Moreover, the treatment with Dokhwalgisaeng-tang significantly reduced protein expression of BAX and increased protein expression of Bcl-2 in the gastrocnemius muscle compared with the control group. Conclusions Dokhwalgisaeng-tang showed protective effects against disuse muscle atrophy, potentially through altered BAX and Bcl-2 protein expression in the gastrocnemius muscle.

Background The purpose of this study was to review whether Korean medicine treatment was effective to maintain the spinal stability and to relieve spinal symptom by reviewing medical records of 18 vertebral compression fracture patients. Methods The subjects were 18 thoracolumbar compression fracture patients who were taken more than two lateral view x-rays of fractured vertebra from Jan, 2010 to June, 2018. They were divided into two groups: the time admitted into Department of Acupuncture & Moxibustion Medicine, Pohang Korean Medical Hospital of Daegu Hanny University from onset (Research 1) and whether or not they have a past history of osteoporosis (Research 2). Then, they were follow-up observed and compared by compression ratio and numerical rating scale (NRS) and so on. Results The amount of weekly compression rate increase of 18 patients was 1.76% per week. According to the result of Research 1, the patients group (14 patients) who were admitted into the hospital within 1-2 weeks from getting injury was 1.88% per week whereas the patients group(4 patients) who were admitted into the hospital within 3-4 weeks from getting injury was 1.22% per week. By Research 2 result, the patients group (7 patients) who had been diagnosed as an osteoporosis patient was 2.19% per week, and those (11 patients) who had not was 1.49% per week. There was a statistical significance in the change of the amount of compression rate increase in the case of Research 1, but there was not in the case of Research 2. NRS was decreased without significant difference regardless of the time admitted into the hospital and whether or not the patients had the past history of osteoporosis. Conclusions Considering that there were more amount of compression rate increase at 1-4 weeks from onset, it is necessary to offer treatment more actively on early time from onset. Further research is needed into the increase of compression rate by the patients’ having a past history of osteoporosis or not. Given that NRS decreased without significant difference, it is assumed that Korean medicine treatment has a meaningful effect on relieving subjective symptom of patients who are diagnosed as vertebral compression fractures.

Emotion recognition research has been conducted using various physiological signals. In this paper, we propose an efficient photoplethysmogram-based method that fuses the deep features extracted by two deep convolutional neural networks and the statistical features selected by Pearson’s correlation technique. A photoplethysmogram (PPG) signal can be easily obtained through many devices, and the procedure for recording this signal is simpler than that for other physiological signals. The normal-to-normal (NN) interval values of heart rate variability (HRV) were utilized to extract the time domain features, and the normalized PPG signal was used to acquire the frequency domain features. Then, we selected features that correlated highly with an emotion through Pearson’s correlation. These statistical features were fused with deep-learning features extracted from a convolutional neural network (CNN). The PPG signal and the NN interval were used as the inputs of the CNN to extract the features, and the total concatenated features were utilized to classify the valence and the arousal, which are the basic parameters of emotion. The Database for Emotion Analysis using Physiological signals (DEAP) was chosen for the experiment, and the results demonstrated that the proposed method achieved a noticeable performance with a short recognition interval.

Physiological signals contain considerable information regarding emotions. This paper investigated the ability of photoplethysmogram (PPG) signals to recognize emotion, adopting a two-dimensional emotion model based on valence and arousal to represent human feelings. The main purpose was to recognize short term emotion using a single PPG signal pulse. We used a one-dimensional convolutional neural network (1D CNN) to extract PPG signal features to classify the valence and arousal. We split the PPG signal into a single 1.1 s pulse and normalized it for input to the neural network based on the personal maximum and minimum values. We chose the dataset for emotion analysis using physiological (DEAP) signals for the experiment and tested the 1D CNN as a binary classification (high or low valence and arousal), achieving the short-term emotion recognition of 1.1 s with 75.3% and 76.2% valence and arousal accuracies, respectively, on the DEAP data.