Needle Group Research Articles

A Protocol for the Validation of Novel Sham Acupuncture in Patients Who Have Had a Stroke

Background: A sham control group enhances the quality of clinical trials by controlling for the placebo effect. To ensure rigorous blinding to enhance the quality of clinical trials on acupuncture treatment it is important to develop a more sophisticated sham needle. Discrepancies in perceived needling sensation and treatment expectations between patients and healthy volunteers may affect study outcomes. Thus, it may be inappropriate to generalize the findings of a sham needle validation study in healthy adults to patients who have had a stroke. Therefore, this is a protocol for a clinical trial in patients who have had a stroke to validate a newly developed sham needle to be used in double-blind trials.Methods: Sixty-six patients who have had a stroke will be randomly assigned to the verum or sham needle group using a 1:1 ratio. As the verum and sham needles are identical in appearance, both participants and practitioners will be unaware of the needle type used for acupuncture treatment. After the acupuncture procedure, the participants will be asked whether they believe they received the verum or sham acupuncture treatment and indicate penetration, pain, and de qi sensation for each acupuncture point. A between-group comparison of needle-related adverse events will be performed.Discussion: This double-blind randomized controlled trial will be the first study to validate a newly developed sham acupuncture needle for patients who have had a stroke. The results of this study may inform clinical trial study design for acupuncture treatment of patients who have had a stroke.

Utility of Acquire 22G-fine needle biopsy (FNB) needle vs the standard 22G needle during Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA): A Randomized Controlled Trial (RCT)

ABSTRACT Background Various types of needles are available to perform endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). A relatively new needle for EBUS-TBNA, the Acquire Fine Needle Biopsy (FNB) device, has recently become available. Methods Consecutive subjects with lymphadenopathy >1 cm undergoing EBUS-TBNA were randomized to the Acquire 22-G EBUS-FNB needle and the standard 22-G EBUS-TBNA needle groups. Results A total of 86 subjects were randomized (43 in each group). The diagnostic yield of EBUS-TBNA was similar between the two groups: (36/43) 83.7% in the 22-G EBUS-FNB group and (34/43) 79.1% in the standard 22-G EBUS group (p = 0.58). The sampling adequacy, stations sampled, number of stations sampled, number of needle passes, and mean duration of the procedure between the two groups were also similar. Visible tissue clot core was obtained in a significantly greater proportion of subjects in the 22-G EBUS-FNB group (93.0% vs 46.5%, p < 0.001). Visibly bloody samples were more frequent in the 22-G EBUS-FNB group (74.4% vs 51.2%, p = 0.03). There was no difference in the complication rates between the two groups (p = 0.15). Conclusion We did not observe a difference in the diagnostic yield of the Acquire 22-G EBUS-FNB needle compared with the standard 22-G EBUS needle. Clinical trial registration Clinical Trial Registry of India (CTRI) https://ctri.nic.in/ (CTRI/2021/08/035589).

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background &amp; Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P &lt; 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P &gt; 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

Safety and efficacy of electro-thumbtack needle for acute mountain sickness patients: a protocol of a randomized, single-blinded, and placebo-controlled study

BackgroundAcute mountain sickness (AMS) is considered the most common altitude sickness. It can be detrimental to the health of tourists who rapidly ascend high mountains, and can also impair the performance of individuals who move to the plateau for work or education. Acupuncture has been shown to improve AMS as a simple, safe, and effective nonpharmacological method, in case electro-thumbtack needle (ETN) is a more convenient form of acupuncture for both doctor and patient. There are no studies validating the effectiveness of electro-thumbtack needle in improving symptoms in participants with AMS. In this study, we will conduct a randomized controlled trial to evaluate the clinical efficacy and safety of electro-thumbtack needle in participants with AMS. Our hypothesis is that electro-thumbtack needle is safe and effective in treating participants with AMS.MethodsThis study is a single-center, randomized, single-blinded, and placebo-controlled study involving at least 114 participants who were diagnosed with AMS. The participants randomly assigned in a 1:1 ratio to the electro-thumbtack needle group and the sham acupuncture group. The treatment protocol involved stimulation of seven predefined acupuncture points, including Zhong Wan (RN12), bilateral Nei Guan (PC6), bilateral He Gu (LI4), and bilateral Tai Yang (EX-HN5), for approximately one minute each, with continuous application over 48 h. The primary outcome was improvement in 2018 Lake Louise score (LLS) after 48 h of treatment. Secondary outcome indicators included the incidence of participants with moderate-to-severe AMS (AMS > 5)and AMS, the LLS, visual analogue scale of headache, clinical functioning scores, the Groningen Sleep Quality Survey, the Stanford Somnolence Scale, blood pressure, oxygen saturation, and heart rate, in addition to treatment-related adverse events were also captured.DiscussionThis trial aims to ascertain the therapeutic benefits of ETN in mitigating AMS symptoms, thereby contributing to the evidence base for traditional medical practices, particularly acupuncture, in high-altitude medicine.Trial registrationChinese Clinical Trials Registry: ChiCTR2300073882. Registered on 24 July 2023.

Echogenic needles versus non-echogenic needles for in-plane ultrasound-guided infraclavicular axillary vein cannulation, a randomized controlled trial.

Echogenic needles improve the reflection of the ultrasound beam. The aim of the study was to compare needle performance during ultrasound-guided cannulation of the infraclavicular axillary vein with an in-plane needle approach, using echogenic needles or non-echogenic standard needles. One hundred adult patients undergoing surgical procedures that required a central venous catheter were randomized for either echogenic or non-echogenic needles. The primary outcome was access time. Secondary outcomes encompassed total procedure time, success in first attempt, number of attempts, number of skin punctures, change of site for vascular access, catheter placement, subjective experience with needle visualization and needle procedure, and adverse events. Median (IQR) [range] venous access time was 21 (15-56) [6-440] in echogenic needle group and 26 (14-91) [6-925] in the non-echogenic needle group (p = 0.40). No statistically significant differences were found in the secondary outcome measures. One patient (non-echogenic needle group) experienced pneumothorax. In three patients in each group (6%) arterial puncture occurred. Echogenic needles did not significantly improve needle control or safety when used for infraclavicular axillary vein cannulation with an in-plane needle approach. The results indicate that standard needles are appropriate for ultrasound guided subclavian vascular access in a perioperative situation.

Efficacy and Safety of 20G vs. 22G Needles in CT-Guided Transthoracic Fine Needle Aspiration Biopsies

Aim: This study aims to compare the diagnostic accuracy and complication rates of 20G and 22G needles in transthoracic fine needle aspiration biopsy (TFNAB). Method: This retrospective study reviewed lung biopsy results from procedures performed between January 2018 and March 2020. Patients included had non-diagnostic bronchoscopic biopsies or were deemed inappropriate for bronchoscopic biopsy. A total of 127 patients underwent Computed tomography (CT) guided TFNAB using either 20G or 22G needles. Data on lesion size, localization, diagnostic adequacy, and complications were collected and analyzed. Results: The study cohort included 127 patients with a mean age of 63.21 years. Of these, 72 underwent biopsies with a 22G needle and 55 with a 20G needle. The overall diagnostic accuracy was 96.8%, with no significant differences between the 20G and 22G needle groups (p=0.206). Complications occurred in 59 patients (46.5%), with pneumothorax being the most common, and two cases required chest tube placement. The rate of pulmonary hemorrhage was 18.9%. There were no significant differences in complication rates between the needle sizes (p=0.985). Conclusion: CT-guided TFNAB using both 20G and 22G needles is safe and effective, with high diagnostic accuracy and low complication rates. The choice of needle size does not significantly impact diagnostic outcomes or complication rates, allowing clinicians flexibility based on patient-specific factors and procedural requirements.

Deflection of Needles, Used for Local Anesthesia in the Dental Practice – Comparative Study

The mandibular nerve blocks prove to be one of the most challenging anesthetic techniques for the dental practitioner. Many factors have a role in the success of these nerve blocks and one of them is the accuracy of the deposition of the anesthetic which can be influenced to a certain degree by the deflection of the injection needle. In this study, three types of injection needles (Septoject XL 30G, Septoject XL 27G and Medoject 23G) were tested for deflection in a reversible hydrocolloid (agar-agar). They were divided into three groups of 30 needles each and were all inserted in the agar-agar at a depth of 20 mm with the help of a dental surveyor. Two mutually perpendicular radiographs were made for each needle in order to calculate the deviation in mm. The results were analyzed and showed that the mean deflection in the 30G needles group was 5.32±1.91 mm, the deviation in the 27G group – 3.37±0.67 mm and none of the needles in the 23G group showed a deviation upon insertion in the hydrocolloid. The results in this study showed that dentists should always prefer needles with a smaller gauge, because they provide smaller deflection figures and therefore better accuracy in the deposition of the anesthetic.

Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial

Introduction Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients. Patients and methods Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion. Results Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn’t last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01). Conclusions Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical ). Trial registration The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.

Assessment of the deformation rate of venous diameter during internal jugular vein puncture using a newly developed thin-tip three-dimensional needle.

The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture. This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate. The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle (p = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively (p = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter (r = 0.24 and 0.41, respectively), with no correlation in the 3D needle group. The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.

Percutaneous Achilles tendon tenotomy in clubfoot with a blade or a needle: a single-centre randomized controlled noninferiority trial.

The gold standard for percutaneous Achilles tendon tenotomy during the Ponseti treatment for idiopathic clubfoot is a tenotomy with a No. 15 blade. This trial aims to establish the technique where the tenotomy is performed with a large-bore needle as noninferior to the gold standard. We randomized feet from children aged below 36 months with idiopathic clubfoot on a 1:1 basis in either the blade or needle group. Follow-up was conducted at three weeks and three months postoperatively, where dorsiflexion range, Pirani scores, and complications were recorded. The noninferiority margin was set at 4° difference in dorsiflexion range at three months postoperatively. The blade group had more dorsiflexion at both follow-up consultations: 18.36° versus 18.03° (p = 0.115) at three weeks and 18.96° versus 18.26° (p = 0.001) at three months. The difference of the mean at three months 0.7° is well below the noninferiority margin of 4°. There was no significant difference in Pirani scores. The blade group had more extensive scar marks at three months than the needle group (8 vs 2). No major complications were recorded. The needle tenotomy is noninferior to the blade tenotomy for usage in Ponseti treatment for idiopathic clubfoot in children aged below 36 months.

Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning

IntroductionThis ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs. MethodsMesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT. ResultsA substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05). ConclusionWhen used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria.

Prospective comparison of minimally invasive glaucoma surgery techniques for goniotomy in primary congenital glaucoma: Optimizing intraocular pressure control

BackgroundA family of less invasive glaucoma procedures has been developed to provide moderate reductions in intraocular pressure and medication burden in eyes with therapeutic needs that may not warrant the risks associated with trabeculectomy and tube shunt implantation. This study aims to compare the effectiveness and clinical outcomes of pediatric goniotomy using minimally invasive glaucoma surgery techniques to manage primary congenital glaucoma. Materials and methodsUsing a computer-generated set of random numbers, the patients were randomized into three groups: Kahook blade group, microvitreoretinal blade group, and 23G needle group. Each group contained 22 eyes. All patients underwent anesthesia for intraocular pressure measurement, corneal diameter evaluation, and fundoscopy. Preoperative intraocular pressure at presentation and postoperative intraocular pressure were recorded during a one-year follow-up period. Outcome measures included decreases in corneal diameter from preoperative size, mean postoperative reduction in intraocular pressure for each minimally invasive glaucoma surgery technique and absence of intraoperative or postoperative complications. Surgical success was defined as a postoperative intraocular pressure of ≤20 mmHg without antiglaucoma medications or reoperation, based on the last recorded intraocular pressure during postoperative follow-up. ResultsA total of 66 eyes were diagnosed with primary congenital glaucoma and underwent goniotomy surgeries during the study period in 2022. The majority (89%) were bilateral cases. Among the patients, there were 26 males and 9 females, which makes up an 8: 2 male-to-female ratio, with an average age range of 2 months to 2 years. After a one-year postoperative follow-up, a significant reduction in intraocular pressure was achieved of ≤18 mmHg. In terms of surgical success with minimally invasive glaucoma surgery techniques, goniotomy with a 23-gauge needle had the most postoperative intraocular pressure, followed by the microvitreoretinal blade and the Kahook blade. On average, the 23-gauge needle had a corneal diameter of 13.8 mm, while the microvitreoretinal blade was 13.9 mm and the Kahook blade recorded 14 mm. ConclusionsGoniotomy using minimally invasive glaucoma surgery techniques has been proven to be an effective surgical technique for the management of childhood glaucoma among Nigerian patients. A reduction in postoperative intraocular pressure, corneal diameter, and absence of complications provide clinical evidence of successful glaucoma management and preservation of outcomes of visual function in patients. Level of evidenceLevel 1 (Prospective study)

Effects of Shugan Tiaoshen intradermal needling intervention on attentional networks in subthreshold depression: a randomized controlled trial

To analyze the effects of Shugan Tiaoshen (regulating liver and harmonizing spirit) intradermal needling protocol on the attentional networks of patients with subthreshold depression using the attention network test (ANT). Eighty patients with subthreshold depression were randomly divided into an intradermal needling group (40 cases) and a sham needling group (40 cases, 2 cases dropped out), with an additional 43 healthy subjects as a normal group. The intradermal needling group received intradermal needling treatment, while the sham needling group received sham intradermal needling, with the needle tip not penetrating the skin. The bilateral Xinshu (BL 15), Ganshu (BL 18), Shentang (BL 44) as well as auricular points Xin (CO15) and Gan (CO12) were selected alternately. Treatments were administered twice a week for a total of 6 weeks in the two groups. The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder (GAD-7) scores were observed before treatment, after 3 weeks of treatment, after treatment, and at 1 month after the end of treatment (follow-up), and the ANT of the two groups of patients with subthreshold depression before and after treatment as well as the normal group of healthy subjects was compared. The PHQ-9 and GAD-7 scores of the patients with subthreshold depression were decreased after 3 weeks of treatment, after treatment, and in follow-up in the two groups (P<0.05), the differences in PHQ-9 and GAD-7 scores before and after treatment were greater in the intradermal needling group than those in the sham needling group (P<0.01). Before treatment, the executive control network reaction time of the subthreshold depression group (the intradermal needling group and the sham needling group) was higher than that of the normal group (P<0.05). Compared before treatment, the executive control network reaction time of the patients in the intradermal needling group and the sham needling group was decreased after treatment (P<0.05), and the alerting network reaction time of the intradermal needling group was increased after treatment (P<0.05); the difference in alerting network reaction time before and after treatment was greater in the intradermal needling group than that of the sham needling group (P<0.01). Regulating liver and harmonizing spirit intradermal needling protocol could effectively improve depressive and anxious symptoms in patients with subthreshold depression, and enhance the efficiency of the alerting network.

Biomechanically based Fu’s subcutaneous needling treatment for senile knee osteoarthritis: protocol for a randomized controlled trial

IntroductionFu’s subcutaneous needling (FSN) is a new type of acupuncture that uses subcutaneous tissue to oscillate from side to side to improve muscle pathology status and can be effective in treating Knee osteoarthritis. Nonetheless, whether the clinical effect is similar to that of most commonly used drugs is unclear. Thus, this study aims to determine the pain-relieving effect and improvement in the joint function of the FSN therapy by comparing it with that of a positive control drug (celecoxib). Furthermore, this clinical trial also aims to evaluate the effect of FSN on gait and lower limb muscle flexibility, which can further explore the scientific mechanisms of the FSN therapy.Methods and analysisThis study is a randomized, parallel-controlled, single-center prospective clinical study that includes 60 participants, with an FSN group (n = 30) and a drug group (n = 30). The Fu’s subcutaneous needling (FSN) group undergo the FSN therapy 3 times a week for 2 weeks, while the drug group receives 0.2 g/day oral celecoxib for 2 weeks, with a follow-up period of 4 weeks after the completion of treatment. The primary outcome is the difference in the visual analog scale score after 2 weeks of treatment compared with baseline. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, joint active range of motion test, three-dimensional gait analysis, and shear wave elastic imaging technology analysis in lower limb muscles are also performed to demonstrate clinical efficacy.Ethics and disseminationThe trial is performed following the Declaration of Helsinki. The study protocol and consent form have been approved by the Ethics Committee of Guangdong Provincial Hospital of Chinese Medicine. All patients will give informed consent before participation and the trial is initiated after approval. The results of this trial will be disseminated through publication in peer-reviewed journals.Trial registration number: NCT06328153.

Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study.

The aim of the current study was to evaluate the penetration depth and smear layer removal of root canal irrigant using various irrigation activation techniques. In this investigation, sixty single-rooted premolars extracted for orthodontic purposes were chosen. Diamond burs were used to create an access cavity, and #10 K-file was used to determine the patency. About sixty samples were divided into the following three groups (20 samples in each group), group I: Irrigation with conventional needle, group II: Activation of EndoVac system, group III: Passive ultrasonic irrigation (PUI). The efficacy of the smear layer was assessed using a scanning electron microscopy at a ×2000 magnification. One-way ANOVA was used to record and analyze the data. All statistical analyses were performed with a significance level of p < 0.05. At coronal third, the maximum smear layer was removed in group II (1.26 ± 0.02) followed by group III (1.84 ± 0.16) and group I (2.89 ± 0.21). At middle third, smear layer removal was maximum in group I (1.18 ± 0.10) followed by group III (1.72 ± 0.09) and group I (2.66 ± 0.18). At apical third, the more smear layer was removed in group II (1.02 ± 0.01) followed by group III (1.58 ± 0.08) and group I (2.38 ± 0.06). There was a highly significant difference found between the three different irrigation systems at all three levels (p < 0.001). In conclusion, every irrigation device that was evaluated was successful in removing the smear layer from the root canal. However, the EndoVac system group removed a greater amount of smear layer compared with PUI and conventional needle group. With the goal of promoting cleaning that is beyond the ability of mechanical devices, irrigation is a crucial part of root canal therapy. If an efficient irrigation delivery system is used, the irrigants can reach the working length (WL). This type of distribution system needs to provide a suitable amount of irrigants up to the WL, as well as have enough flow and be effective at debriding the entire canal system. How to cite this article: Pujari MD, Das M, Das A, et al. Assessment of Smear Layer Removal and Penetration Depth of Root Canal Irrigant Using Different Irrigation Activation Systems: A Comparative Study. J Contemp Dent Pract 2024;25(4):331-334.

Intradermal needling and acupuncture in prevention and treatment of leukopenia after chemotherapy with spleen-kidney deficiency: a randomized controlled trial

To compare the clinical effect of intradermal needling and acupuncture in prevention and treatment of leukopenia after chemotherapy with spleen-kidney deficiency. A total of 90 patients with malignant tumor who received chemotherapy were randomly divided into a intradermal needling group (30 cases, 1 case dropped out), an acupuncture group (30 cases, 2 cases dropped out, 1 case was eliminated) and a control group (30 cases). The control group received conventional symptomatic treatment after chemotherapy. On the basis of the treatment in the control group, the intradermal needling group received intradermal needling at Guanyuan (CV 4), Dazhui (GV 14) and bilateral Geshu (BL 17), Zusanli (ST 36)，Shenshu (BL 23), the needles were retained for 48 h, once every other day. On the basis of the treatment in the control group, the acupuncture group received conventional acupuncture at the same acupoints as the intradermal needling group, once every other day. The treatment started from the first day of chemotherapy, for a total of 2 weeks in the three groups. The white blood cell count, neutrophil count, hemoglobin content, platelet count and Karnofsky performance status (KPS) score before treatment and on 3rd, 7th, 14th, and 21st days after treatment were compared among the three groups. The incidence and grading of leukopenia and the usage of leukocyte-boosting drug during chemotherapy cycle was recorded. On 7th day after treatment, the white blood cell count in the intradermal needling group and the acupuncture group was higher than that in the control group (P<0.01, P<0.05). On the 14th day after treatment, the hemoglobin content in the intradermal needling group and the acupuncture group was higher than that in the control group (P<0.01). On the 7th, 14th, and 21st days after treatment, the platelet count in the acupuncture group was higher than that in the control group (P<0.01), on the 14th and 21st days after treatment, the platelet count in the intradermal needling group was higher than that in the control group (P<0.01). There was no statistically significant difference among the three groups after treatment in terms of neutrophil count, KPS score, incidence and grading of leukopenia, and the usage of leukocyte-boosting drug (P>0.05). Both intradermal needling and acupuncture can effectively increase peripheral blood white blood cell count, hemoglobin content and platelet count during chemotherapy cycle, reduce the toxicity of chemotherapy drug to bone marrow hematopoietic function, and alleviate bone marrow suppression after chemotherapy. The two treatments are equally effective.

Effectiveness of Dry Needling versus Cupping Therapy for Pain in Piriformis Syndrome

Background: Piriformis syndrome is characterized by discomfort in the buttocks and throughout the course of the sciatic nerve. Dry needling modulates pain perception, disrupts pain signaling pathways, and induces local tissue responses. Cupping therapy facilitates localized blood flow, lymphatic drainage, and tissue oxygenation to alleviate muscular tension and improve circulation. Both interventions have shown promise in improving symptoms of piriformis syndrome. Objective: The purpose of this study was to evaluate the efficacy of dry needling versus cupping therapy in managing piriformis pain syndrome. Methods: This experimental study was conducted at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore, from October 2023 to May 2024. Eighty participants diagnosed with piriformis syndrome, aged between 18 and 65 years, were randomly assigned to one of two groups: Group A (dry needling) and Group B (cupping therapy). Exclusion criteria included pregnancy and previous surgical interventions for piriformis syndrome. Both groups received their respective treatments three times a week for six weeks. Pain intensity was measured using the Visual Analogue Scale (VAS), disability was assessed with the Oswestry Disability Index (ODI), and quality of life was evaluated using a standardized questionnaire. Data were analyzed using SPSS version 25, with paired sample t-tests used for within-group comparisons and independent sample t-tests for between-group comparisons. Statistical significance was set at p &lt; 0.05. Results: In the dry needling group, the mean VAS score decreased from 6.216 ± 1.931 to 3.432 ± 0.987 (p &lt; 0.001), while the cupping therapy group saw a reduction from 6.108 ± 2.195 to 4.189 ± 1.697 (p &lt; 0.001). The mean ODI score in the dry needling group decreased from 27.432 ± 7.617 to 10.054 ± 3.036 (p &lt; 0.001), and in the cupping therapy group from 26.270 ± 7.209 to 12.918 ± 7.495 (p &lt; 0.001). Quality of life scores improved significantly in both groups, with the dry needling group showing a mean reduction from 12.702 ± 3.673 to 7.270 ± 1.627 (p &lt; 0.001), and the cupping therapy group from 13.027 ± 3.523 to 8.270 ± 1.609 (p &lt; 0.001). Conclusion: Both dry needling and cupping therapy are effective interventions for managing piriformis pain syndrome, with dry needling showing greater improvements in pain reduction, disability reduction, and quality of life. These findings support the use of dry needling as a preferred therapeutic option for piriformis syndrome.

INJEX50 could improve the success rate of local anesthesia for arterial cannulation in the pediatric intensive care unit: Arandomized, double-blind, single-center study.

Quick arterial cannulation is required in pediatric emergency situation, which require effective local anesthesia to avoid withdrawal movement. However, pediatric local anesthesia could be difficult because of withdrawal movement. Jet injectors, which are needleless and provide local anesthesia quickly, could be helpful for pediatric local anesthesia during arterial cannulation. This study aimed to examine whether new jet injector "INJEX50" could improve the success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with the current standard of care, infiltration using a 26-gauge needle. This study was a randomized, double-blind, single-center study. Participants were infants and young children in the pediatric intensive care unit, who required an arterial line. Local anesthesia was performed with either a 26-gauge needle (group C) or INJEX50 (group I) before arterial cannulation. The primary outcome (success of local anesthesia) was the presence of withdrawal movement at the time of skin puncture for arterial cannulation. The secondary outcomes included rescue sedation during arterial cannulation. Data were analyzed using Fisher's exact test and the Mann-Whitney U-test, with values of p < .05 considered statistically significant. Seventy patients were randomly assigned to groups C and I. The local anesthesia success rate in group I (30/35 [86%]) was significantly higher than that in group C (15/35 [43%], odds ratio, 8.00; 95% confidence interval, 2.51-25.5; p = .0005). In conclusion, INJEX50 could improve success rate of local anesthesia for arterial cannulation in pediatric intensive care unit compared with 26-gauge needle.

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the “static needling”, the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception.Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1).

Percutaneous Surgery for Trigger Finger Treatment Using a Novel Surgical Device: An Experimental Study on Fresh Cadavers

Trigger finger, a stenosing tenosynovitis of the flexor tendon at the A1 pulley, can cause pain and impair daily activities. Despite common surgical interventions, postsurgical complications are frequent, prompting the search for less invasive techniques. An experimental study was conducted on fresh cadavers to compare three techniques: the first using a PulleyCut without ultrasound guidance, the second using a PulleyCut with ultrasound guidance, and the third using a percutaneous needle technique. The complete release of the A1 pulley, integrity of the A2 pulley, flexor tendons, and neurovascular bundles were assessed. The new device group and the ultrasound-guided group demonstrated 100% complete release of the A1 pulley, whereas the needle group achieved only 38% success. There were no A2 pulley injuries in any group. Flexor tendons were injured in 7% of cases in the new device group and 77% in the needle group. A neurovascular injury occurred in the needle group. Compared with the percutaneous needle technique, the new device proved safe and effective for A1 pulley release, minimizing damage to flexor tendons and neurovascular structures. Ultrasound did not provide significant advantages, suggesting that the new device can be confidently used without ultrasound assistance. The PulleyCut represents a promising percutaneous technique for trigger finger treatment, demonstrating superiority over the needle technique in terms of efficacy and safety. These results encourage future clinical investigations to validate its practical application. Therapeutic IIc.