Needle Contact Research Articles

Transcorneal aspiration for management of primary iris cysts in the standing horse.

Equine primary iris cysts are usually incidental findings but, if associated with clinical signs, may require intervention. The use of laser (Nd:Yag or diode) has been reported but requires specialised equipment. Transcorneal aspiration has not been previously evaluated in the standing horse. To review outcomes of standing transcorneal aspiration of primary iris cysts (STAPIC) in horses. Horses were identified from electronic patient records from 2018 to 2024 across four collaborating centres. Clinical presentation and outcomes were identified and reported using descriptive statistics. Eighteen horses were identified. Behavioural signs reported included 'spooking' and changes in rideability often associated with jumping. Single large unilateral cysts were present in 11 horses, bilateral cysts in three horses and multiple unilateral cysts in four horses. Following treatment, one horse developed uveitis and fibrin in the anterior chamber associated with needle contact with the iris stroma due to movement, and a second horse developed fibrin within the anterior chamber. Both conditions resolved with anti-inflammatory medication and administration of tissue plasminogen activator. No other adverse effects were reported. Follow-up was available from all horses (median: 6months, interquartile range [IQR]: 4-11months) with no recurrence, although one horse developed an iris cyst in the contralateral eye after 3years. All owners reported improvement in clinical signs, with 61% reporting no further signs. STAPIC is an effective and easily accessible alternative for treating iris cysts in horses rarely associated with complications.

Needle contact test in auricular acupuncture for shoulder pain and where effective auricular acupoints identified are positioned on the map: A controlled study

Active Points Test on auricle was renamed Needle Contact Test (or NCT), considered an extremely effective method to select most efficient auricle acupoint for Auricular Acupuncture (or AA) therapy. Our aims were to evaluate NCT efficiency as viable diagnostic option to identify the most appropriate AA acupoints to be selected for SupraSpinatus Tendinopathy (SST) associated shoulder pain treatment and to evaluate which auricle area has greater concentration of NCT positive acupoints in subjects with SST shoulder pain, comparing results with available AA ear maps. 45 subjects with SST diagnosis were enrolled. On 30 subjects in treatment group, NCT was performed on acupoints of the auricle shoulder representation areas (i.e., Scaphoid Fossa), while in 15 subjects of control group, NCT was performed on auricle areas not shoulder associated. Statistically significant lower Numeric Pain Rating Scale scores were seen for study group over time and compared to control. A small sample showed statistically significant increase of SST shoulder maximum abduction range of Movements. NCT identified best SST shoulder pain AA acupoints in Scaphoid Fossa (or SF1 and SF2). In conclusion NCT is a viable tool to efficiently identify the best AA acupoints in SST shoulder pain treatment.

초전도 아크유도형 DC 차단기의 유도침 설계를 위한 방법론

As renewable energy sources increase, DC transmission and distribution systems are attracting attention. Renewable energy sources are exposed to accidents such as fire, so a DC breaker must be used safely. However, the previously invented DC circuit breakers have a short mechanical life. This research team proposed a superconducting arc-induction type DC circuit breaker to solve this problem. The superconducting arc-induction type DC circuit breaker comprises DC power, normal load, induction needle, and mechanical breaking contact. This paper proposes considerations when designing an induction needle, which is the most important element of a superconducting arc induction type DC circuit breaker. For this purpose, the interrupting time according to the curvature radius and location of the induction needle was analyzed. As a result, when the radius of curvature of the induction needle was 0.2 mm, the position of the induction needle was optimal at 4.7 mm on the x-axis and 11.05 mm on the y-axis.

Investigation of Reactive Silver Ink Formula for Reduced Silver Consumption in Silicon Heterojunction Metallization

Silver is the most expensive non-silicon component in photovoltaic cells. This is particularly salient for silicon heterojunction (SHJ) cells, which rely on large quantities of low-temperature silver pastes (LT-SP). SHJ cells would benefit greatly from an industrially scalable metallization process that simultaneously offers low silver consumption, low finger resistivities (<20 μΩ·cm), and low processing temperatures. Printed reactive silver inks (RSI) are an innovative candidate to this end. This work furthers the research on RSI metallization by investigating the impact of ink formula on properties pertinent to SHJ cells, including electrical properties, line width, ink splatter, silver consumption, cell performance, and adhesion. We introduce a scalable, high-throughput flexible needle contact printing approach for metallization that solves many of the issues associated with drop-on-demand printing. The printed silver fingers are characterized using electrical measurements and top-down and cross-sectional microscopy. The best performing ink, consisting of silver acetate, ethylamine, and formic acid, achieved silver fingers with total resistivities of 3.1 μΩ·cm and contact resistivities of 3.2 mΩ·cm2 when printed at 61 °C. This ink metallized a full-sized 156 mm × 156 mm SHJ cell. This is the first reported data for RSI metallization of a full-sized SHJ cell and shows how an optimized RSI can achieve similar performances to LT-SP while consuming 80–90% less silver.

Viral dynamics and immune responses to foot-and-mouth disease virus in African buffalo (Syncerus caffer)

Foot-and-mouth disease (FMD) is one of the most important livestock diseases restricting international trade. While African buffalo (Syncerus caffer) act as the main wildlife reservoir, viral and immune response dynamics during FMD virus acute infection have not been described before in this species. We used experimental needle inoculation and contact infections with three Southern African Territories serotypes to assess clinical, virological and immunological dynamics for thirty days post infection. Clinical FMD in the needle inoculated buffalo was mild and characterised by pyrexia. Despite the absence of generalised vesicles, all contact animals were readily infected with their respective serotypes within the first two to nine days after being mixed with needle challenged buffalo. Irrespective of the route of infection or serotype, there were positive associations between the viral loads in blood and the induction of host innate pro-inflammatory cytokines and acute phase proteins. Viral loads in blood and tonsil swabs were tightly correlated during the acute phase of the infection, however, viraemia significantly declined after a peak at four days post-infection (dpi), which correlated with the presence of detectable neutralising antibodies. In contrast, infectious virus was isolated in the tonsil swabs until the last sampling point (30 dpi) in most animals. The pattern of virus detection in serum and tonsil swabs was similar for all three serotypes in the direct challenged and contact challenged animals. We have demonstrated for the first time that African buffalo are indeed systemically affected by FMD virus and clinical FMD in buffalo is characterized by a transient pyrexia. Despite the lack of FMD lesions, infection of African buffalo was characterised by high viral loads in blood and oropharynx, rapid and strong host innate and adaptive immune responses and high transmissibility.

A human donor (cadaveric) observation study of three needle placements in the piriformis muscle

ABSTRACT Objective To compare the safety and accuracy of three dry needling locations in the piriformis muscle using human donors. Design Observational dissection study of embalmed human donors. Methods A licensed physical therapist of 17 years clinical experience and 5 years teaching dry needling placed three needles in a medial, midpoint, and lateral location of 14 piriformis muscles of seven embalmed human donors. Block dissection allowed for observation of tissues the needles traversed and recording of the structures that the needles pierced. Results The lateral needle pierced piriformis in 3/14 trials, and contacted sciatic nerve in 0/14 trials. The medial needle pierced both piriformis and sciatic nerve in 11/14 trials. The midpoint needle pierced the piriformis in 11/14 trials, and contacted sciatic nerve in 3/14 trials. Fisher’s Exact test (p < 0.001) found a nonrandom association between dry needle placement, and dry needle contact. Conclusions When dry needling the piriformis, a lateral approach can avoid the sciatic nerve, but cannot accurately pierce the piriformis tendon. Furthermore, while a midpoint and medial approach finds the piriformis muscle with the same accuracy, the midpoint location avoided the sciatic nerve more often.

Single center experience on the rate of discontinuation and safety of cervical transforaminal epidural steroid injections using the modified approach in an office setting without sedation

BackgroundCervical transforaminal epidural steroid injections (CTFESI) are commonly used in the treatment of upper extremity radicular pain. Recently, a modification of the conventional technique has been developed and validated which has a theoretical safety advantage of less risk of needle contact of the spinal nerve and vertebral artery. The new approach involves a needle trajectory under fluoroscopic guidance which is directly based upon the specific superior articular process angle measurement on MRI. ObjectiveThe purpose of this study was to evaluate the discontinuation rate of the modified approach CTFESI procedure in a non-sedated patient population. The study was also undertaken to confirm the safety of the procedure in an office-based setting. MethodsA retrospective review was performed of the authors' (DL, SH) practice to identify all CTFESI using the modified approach, performed between October 2018 through January 2021 through a query of the investigators’ (DL and SH) electronic medical record system. Any discontinued CTFESI procedure was identified. The reason for discontinuation was determined through medical record review. In addition, any significant neurologic or cardiovascular event occurring during or immediately following any completed or discontinued CTFESI was identified. Mild vasovagal reaction was not considered a significant complication. ResultsA total of 973 CTFESI procedures were performed using the modified approach during the study period. Twelve procedures, 1.2% (95% CI 0.7–2.1%) were discontinued. Nine were aborted due to vascular flow not resolved with needle repositioning. Only three, 0.3% (95% CI 0.1–0.9) were aborted due to patient intolerance. There were zero significant neurologic or cardiovascular complications. ConclusionThe performance of the modified approach CTFESI appears to be well tolerated with a very low rate, 0.3%, of discontinuation due to intolerance in non-sedated patients. The zero incidence of neurologic or cardiovascular complication contributes to the current literature on the safety of this procedure.

Comparative Anesthesia Effect of Brachial Plexus Block Based on Smart Electronic Medical Ultrasound-Guided Positioning and Traditional Anatomical Positioning.

With the intensification of population aging, the improvement of visualization technology, and the concept of accelerated rehabilitation surgery, the anesthesia method of upper extremity surgery is gradually changing. However, these methods are often caused by anatomical variations and often have low block success rates and patient satisfaction. The neuroanatomical position should be accurately located so that the puncture needle is right next to the nerve bundle or in the nerve sheath. This is very important for implementing accurate brachial plexus anesthesia. This article uses ultrasound-guided positioning technology and traditional anatomical positioning technology for brachial plexus block treatment, aiming to explore the anesthesia effect of brachial plexus block with different techniques. This article selects 120 patients undergoing brachial plexus block surgery for forearm or hand surgery and divides these 120 patients into 6 groups with 20 people in each group. The first 3 groups were treated with brachial plexus block using ultrasound-guided positioning technology. The latter 3 groups were treated with brachial plexus block using traditional anatomical positioning technology. Experiments proved that during anesthesia, compared with the ultrasound group, the heart rate of the traditional anatomy group was significantly decreased (P < 0.05), and the average arterial pressure of the six groups of patients at each time point had no statistical difference (P > 0.05). This shows that whether it is ultrasound-guided positioning technology or traditional anatomical positioning technology, it has no effect on the average arterial pressure of the patient at each time point. In addition to intuitive and accurate viewing of needle and nerve contact, ultrasound real-time guidance allows intuitive viewing of anesthesia. This is a special advantage of nerve block under ultrasound guidance.

Do length and gauge of dental needle affect success in performing an inferior alveolar nerve block during extraction of adult mandibular molars? A prospective, randomized observer-blind, clinical trial.

Association between length and gauge of dental needle and success rate and pain perception during an inferior alveolar nerve block (IANB) has not been investigated using a randomized clinical trial (RCT). This RCT aimed to compare the success rate of IANB and perceived pain using 27- or 30-gauge needles for the extraction of adult mandibular molars. A prospective RCT was conducted on two hundred and twelve adult patients requiring extraction of mandibular molars using standard methods as described by Malamed with 1.8ml of 2% lidocaine with 1:80,000 adrenaline. One hundred six patients received IANB using 27-gauge needles (32mm × 0.2mm) and one hundred six patients received IANB using 30-gauge needles (25mm × 0.15mm). Predictor variables were 27-gauge and short and 30-gauge. Outcome variables were the success rate of IANB and pain perception during injection using a visual analogue scale. There was a highly significantly increase in the success of IANB using 27-gauge needle (95.28%) versus 30-gauge needle (41.51%) (P = 0.001). There was a significant increase in pain perception for patients who received IANB by shorter and thinner needle (30-gauge) when compared to the long and thicker needle (27-gauge). This RCT demonstrated that 27-gauge needle seems to be associated with a higher success rate of IANB and lower pain perception during injection when compared to 30-gauge needle in the extraction of adult mandibular molars when compared to 30-gauge needles. For adult patients, when thickness of soft tissue to be penetrated is essential to achieve bony contact, long or large gauge dental needle is preferred to get a higher success rate of IANB with less pain perception during injection.

Sample chamber for synchrotron based in-situ X-ray diffraction experiments under electric fields and temperatures between 100 K and 1250 K.

Many scientific questions require X-ray experiments conducted at varying temperatures, sometimes combined with the application of electric fields. Here, a customized sample chamber developed for beamlines P23 and P24 of PETRA III at DESY to suit these demands is presented. The chamber body consists mainly of standard vacuum parts housing the heater/cooler assembly supplying a temperature range of 100 K to 1250 K and an xyz manipulator holding an electric contact needle for electric measurements at both high voltage and low current. The chamber is closed by an exchangeable hemispherical dome offering all degrees of freedom for single-crystal experiments within one hemisphere of solid angle. The currently available dome materials (PC, PS, PEEK polymers) differ in their absorption and scattering characteristics, with PEEK providing the best overall performance. The article further describes heating and cooling capabilities, electric characteristics, and plans for future upgrades of the chamber. Examples of applications are discussed.

Image-based non-contact monitoring of changes in facial skin texture induced by the contact needle technique of acupuncture

In this study, we verified whether or not feature values of the facial skin texture can be used for facial complexion diagnosis. A total of 10 patients with fatigue were recruited and categorized under two groups: acupuncture group and blank control group. In the acupuncture group, the contact needle technique was used, while in the blank control group, the patients rested for 30 min in the supine position. We captured images of the facial skin using a digital camera before and after the intervention and then analyzed feature values from the images. The standard deviation (SD) of short-line inclination angles significantly decreased with acupuncture treatment. There was a significant difference in the SD of short-line inclination angles between the two groups. This study was approved by the Clinical Research Ethics Committee of Kanazawa University Hospital in Japan [for human study: approval no. 2018-154 (2912)] in December 2018.

The efficacy of a traditional Japanese acupuncture method, contact needle therapy (CNT), on peripheral blood flow of the skin

To improve skin condition, it is considered to be important to make good blood circulation in the epidermis and papillary dermis. In Japan, acupuncture becomes more and more popular to improve facial skin condition. We have been used to one of the traditional Japanese acupuncture methods, Tohokai method, especially Contact Needle Therapy (CNT), for various diseases. The purpose of this study is to investigate the effect of CNT by evaluating changes in blood flow. The skin of four healthy males who have no scratches or disease on the skin of the measurement part (inner forearm) were measured with Optical Coherence Tomography (OCT) before CNT, during CNT, immediately after CNT, and one minute after CNT. OCT is an imaging technique that uses low-coherence light to capture micrometer-resolution, two- and three-dimensional images from within optical scattering media (e.g., biological tissue). CNT consists of a root intervention according to the meridian theory and branch intervention for local effects. Statistical analyses were performed using two-sample paired t test and Wilcoxon Signed-rank test. OCT blood flow signal (150–500 μm) was gradually increased during CNT, and significantly increased immediately after CNT compared with that before treatment (P < 0.05). When comparing the time course of OCT blood flow signal by depth, blood flow increased significantly at 300–350 μm compared to that before treatment (P < 0.05). This is the first study to evaluate the effect of acupuncture on bloodstream increase with OCT. In this research, the blood flow of skin significantly increased after CNT, especially in the depth of 300–350 μm from the surface of the skin. It may lead to increased skin moisture and improvement of the appearance of the skin. We suppose that the skin condition can be influenced and improved by CNT.

Reducing the risk of non-sterility of aseptic handling in hospital pharmacies, part B: risk control

ObjectivesTo determine prospectively the risk reducing measures of non-sterility during aseptic handling and to develop a method for prioritising these measures.MethodsIn the first part of this series of articles, we...

Comparative Analgesic Effects of Intradermal and Subdermal Injection of Sterile Water on Active Labor Pain.

BackgroundThe labor pain is one of the factors encouraging pregnant women for cesarean section delivery. Recently, intradermal and subdermal injection of distilled water has shown to be effective in improving this pain.ObjectivesThe present study aimed to determine which method has a greater impact on labor pain reduction.MethodsIn this double-blind, randomized clinical trial, 121 nulliparous women with a gestational age of ≥ 37 weeks were randomly divided into three groups: (1) 0.5 cc sterile water injection subdermally at four sacral points with insulin needles (n = 40); (2) 0.5 cc sterile water injection intradermally (n = 39); and (3) needle contact with the mentioned points as the placebo (n = 42). Before the intervention, the VAS score was measured for labor pain, and it was repeated 10, 30, 60, and 90 min after the intervention. The results were compared between the three groups.ResultsBefore the intervention, the mean VAS pain score had no significant difference between the three groups. However, 30, 60, and 90 min after the intervention, the mean pain score was significantly lower in the intradermal and subdermal injection groups than in the control group (P = 0.001); however, the difference between the intradermal and subdermal injection groups was not significant.ConclusionsThe injection of distilled water by either intradermal or subdermal method was associated with a significant reduction in the pain score during labor, but there was no difference between these two methods in terms of decreasing labor pain. As sterile water injection is a safe, effective, and low-cost method, it is proposed to increase the knowledge of midwives and obstetricians about this method.

Conhecimento e atitudes da equipe de enfermagem sobre cateter com dispositivo seguro em um hospital brasileiro

Objetivo: descrever o conhecimento e atitudes dos profissionais de enfermagem sobre um Dispositivo Seguro com Controle de Engenharia. Método: estudo transversal descritivo, realizado em um hospital público brasileiro, especializado para o tratamento de HIV/aids. Foram entrevistados profissionais de enfermagem no período de maio a julho de 2015. Os dados foram analisados por meio da estatística descritiva e inferencial. Resultados: dos 180 entrevistados, 72,2% não participaram de treinamento que propiciava conhecimento para o uso do cateter com dispositivo de segurança. Quanto às atitudes de risco, a reinserção de um mesmo cateter periférico antes de acionar a proteção da agulha, em mais de uma punção, no mesmo paciente foi citada como prática rotineira por 48 (26,7%) participantes. Conclusão: a maioria dos profissionais de enfermagem não recebeu treinamentos para uso de dispositivos, mas reconheceu características e mecanismos de proteção contra picada de agulha e contato com sangue.

A modular application specific active test environment for high-temperature wafer test up to 300 °C

Abstract Applications in harsh environment such as high temperatures require electronic devices for signal amplification, calculations and digital interfaces. These devices often contain ASICs (application specific integrated circuits) which are suitable for high temperatures above 125 °C. For functionality verification of these high-temperature ASICs a high-temperature wafer test environment is necessary. This article describes a high-temperature wafer test setup which can be used up to 300 °C. It is based on a modular concept for a maximum of 48 test channels. The combination of three modular components (contact needle system, thermal insulation chamber and active probe card) allows adapting the setup to different ASICs and pad layouts. The active probe card operates at temperatures below 65 °C during 300 °C wafer test temperature. It is mounted on the thermal insulation chamber for signal amplification, defined loads or generation of precise input signals. This modular concept significantly shortens the development time for the high-temperature wafer test and thus saves time and reduce the costs of ASIC development.

Depth and Lumen Diameter of the Superior Labial Artery with a Clinical Application to Dermal Filler Injection

IntroductionSince 2000, the annual administration of dermal filler treatments has risen by over 250 percent, stemming from their minimally invasive and relatively inexpensive nature compared to traditional cosmetic surgery. Currently, numerous levels of healthcare practitioners administer over 160 temporary and permanent filler treatments for correcting age‐related wrinkles/folds and non‐age‐related tissue volume defects from surgery or trauma. Unfortunately, the variance in clinician level of training combined with the use of unapproved products has increased the incidence of dermal filler complications in recent years. While common complications such as bruising, erythema, and edema are relatively mild and temporary, the rarer complication of vascular occlusion and subsequent tissue necrosis is disfiguring and difficult to reverse. Lip and nasolabial fold injections—which involve regions supplied by the superior labial artery—are the most likely to result in tissue necrosis.PurposeThe purpose of this study was to examine anatomic features of the superior labial artery (SLA) relevant to dermal filler injection in the clinical setting.Materials &amp; MethodsEighteen adult embalmed cadavers (36 hemi‐faces; 9 males, 9 females; ages 52–99) were dissected. Cutaneous SLA depth, lumen diameter, external diameter, plane, and common variable location at pre‐determined points in the lip and nasolabial fold regions were measured. These points included the SLA branch point (from the facial artery), P1 (labial commissure), P2 (midpoint between labial commissure and peak of Cupid's bow), P3 (peak of Cupid's bow), and P4 (midline). ANOVA, independent samples t‐tests, and paired samples t‐tests were conducted to compare measurements between sites.ResultsThe lumen diameter of the SLA was largest at point P1 (labial commissure; 0.85 ± 0.34 mm) and smallest at point P4 (midline; 0.56 ± 0.21 mm). The SLA branch point was found to have the deepest mean cutaneous depth (5.49 ± 1.95 mm), while point P2 (midpoint between the labial commissure and the peak of Cupid's bow) was found to have the most superficial mean cutaneous depth (4.29 ± 1.54 mm). There were no significant differences between left and right hemifaces as well as between male and female arterial parameters.ConclusionsAll SLA parameters should be interpreted carefully; for example, the point with the largest mean external diameter (P1; labial commissure) represents a greater chance of needle contact, but the point with the smallest mean lumen diameter (P4; midline) represents a smaller bolus of filler required to occlude the arterial lumen. Commonly used 27‐gauge filler needles are 0.41 mm in diameter; since the smallest mean lumen diameter was 0.56 mm (P4; midline), this means that the needle could potentially enter the lumen of the SLA and result in intra‐arterial injection at any point along the SLA course from its origin to the midline. Overall, the SLA's variable, superficial, and large‐caliber course places it at significant risk for intra‐arterial injection with dermal filler at all points in its course.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Optical examination of the efficacy of contact needle therapy for chemotherapy-induced peripheral neuropathy: integration of inspection in Kampo therapy with color spectrum information

Cancer chemotherapy-induced peripheral neuropathy (CIPN) deteriorates the patient’s quality of life, often resulting in discontinuation of treatment with potentially effective chemotherapy. Contact needle therapy (CNT) is one of the traditional Japanese acupuncture methods based on the concept of Kampo (Japanese traditional) medicine. CNT on CIPN has been considered effective empirically, but an objective evaluation has proven difficult. We have focused on the oxygen saturation besides the symptom score. We have already proposed optical path-length matrix method (OPLM) for estimating oxygen saturation of the skin, which may help in locating peripheral tissue damage, including neuronal damage. Four patients with CIPN were treated with CNT. The severity of CIPN was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4 and FACT/GOG-Ntx before and after CNT. We also measured oxygen saturation and hemoglobin concentration at the right toe-tip. Correlations among the values were calculated as correlation coefficients. There were significantly improvements in FACT/GOG-Ntx and hemoglobin post-CNT than in pre-CNT (p < 0.05). The oxygen saturation showed broad correlation (0.5 < |r| < 1) with hemoglobin. The oxygen saturation of skin reflects tissue injury and blood stagnation status, and can help in objective evaluation by measuring skin color spectrum. CNT might be considered as one of the safe and effective alternative therapeutic options for CIPN. Our method of evaluation using skin color spectrum information integrates, in a sense, the inspection in Kampo (Japanese traditional medicine) therapy and scientific methodology.

Closed-Loop Active Compensation for Needle Deflection and Target Shift During Cooperatively Controlled Robotic Needle Insertion

Intra-operative imaging is sometimes available to assist needle biopsy, but typical open-loop insertion does not account for unmodeled needle deflection or target shift. Closed-loop image-guided compensation for deviation from an initial straight-line trajectory through rotational control of an asymmetric tip can reduce targeting error. Incorporating robotic closed-loop control often reduces physician interaction with the patient, but by pairing closed-loop trajectory compensation with hands-on cooperatively controlled insertion, a physician's control of the procedure can be maintained while incorporating benefits of robotic accuracy. A series of needle insertions were performed with a typical 18G needle using closed-loop active compensation under both fully autonomous and user-directed cooperative control. We demonstrated equivalent improvement in accuracy while maintaining physician-in-the-loop control with no statistically significant difference (p > 0.05) in the targeting accuracy between any pair of autonomous or individual cooperative sets, with average targeting accuracy of 3.56mmrms. With cooperatively controlled insertions and target shift between 1 and 10mm introduced upon needle contact, the system was able to effectively compensate up to the point where error approached a maximum curvature governed by bending mechanics. These results show closed-loop active compensation can enhance targeting accuracy, and that the improvement can be maintained under user directed cooperative insertion.

Auricular Acupuncture for the Treatment of Pediatric Migraines in the Emergency Department.

Headache remains a frequent complaint for children presenting to a pediatric emergency department (ED). Typical treatments include oral or intravenous medications, but do not always relieve pain. An alternative intervention is auricular acupuncture. It has been shown to be effective in the treatment of migraines in adults. The objective of this study was to evaluate the utility and adverse effects of auricular acupuncture in the treatment of pediatric migraines in the ED. This was a prospective, interventional, cohort study of patients 8 to 18 years of age. Efficacious ear points were located by needle contact or electrical point finder with attention to 2 migraine lines on the ear. ASP gold semipermanent ear needles were placed in the efficacious points and patients were monitored for 15 minutes. The primary outcome was the change in preintervention and postintervention pain scores using a numerical self-reported pain visual analog scale (VAS). Nineteen patients elected to enroll in the study. The mean change in the VAS scores was both clinically and statistically significant at 7.03 (interquartile range, 6-8.5) with a P value of less than 0.001. Two patients elected to withdraw from the study secondary to incomplete resolution of migraine pain despite improvement in VAS scores. There were no known adverse events. With all subjects showing improvement or resolution of migraine headache, this pilot study introduces an alternative intervention to pediatric migraine management. Further studies are needed to evaluate the duration of symptom resolution and comparative effectiveness; auricular acupuncture seems to be a valid alternative.