This study was undertaken to examine the effects of electro-acupuncture with direct current on peripheral nerve regeneration. Fifty-five 7 month old male rats were used in the present study. Sciatic nerve of each rat was crushed at the thigh, then the subject were divided into four groups as Cathode distal group (n=15), Anode distal group (n=14), Sham group (n=13), and Control group (n=13) . In the Cathode distal group, an insulated acupuncture needle which was inserted at lcm distal to the injured site was used as cathodal electrode, while a needle inserted at lcm proximal to the lesion was used as anodal electrode. In the Anode distal group, the needle at lcm distal and pro. ximal to the lesion were used as the anodal and the cathodal electrodes respectively. In the Sham group, no electrical stimulation were given to the insulated needle inserted at the same site as the aforementioned groups. In the Control group, no operation was given after crush injury. Regeneration of the sciatic nerve were evaluated with the number and the latency of the evoked EMG recorded at 12 sites in the foot, the behavioral test score (BTS) at 1, 2, 3, and 4 week after crush injury, weight ratio of the tibialis anterior and morphological study at 4 weeks after crush injury. Every kind of evaluation indicated that regeneration of the peripheral nerve was faster in the Cathode distal group than those in the other group. In the Anode distal group, the number of the evoked EMG and BTS were significantly lower than those in the Control group with tendency of longer latency and lesser muscle weight ratio. We suggested that electro-acupuncture with cathode distal orientation accelerated regeneration of the peripheral nerve after crush injury, while anode distal orientation delayed the regeneration. The electro-acupuncture with cathode distal orientation might be one of the useful treatment having advantage to perform deeper insertion with minimal invasion.

[Objective]To examine the effect of electroacupuncture on the healing process in a rat model of a tibia fracture.
[Methods]Thirty twelve week old male Wister rats underwent unilateral open osteotomies of the tibiae. Then the rats were assigned randomly to three groups:electroacupuncture group (EA group, n = 10), sham group (n = 10), and control group (n = 10). In the EA group, a cathodal electrode was connected to an acupuncture needle percutaneously penetrating directly at the osteotomy site. An acupuncture needle was inserted 15 mm proximal to the osteotomy site and was used as an anodal electrode. Electroacupuncture was performed daily for 3weeks. Using an electrical stimulator, 5ms square pulses at a frequency of 50 Hz were delivered at 20 μA for 20 minutes. In the sham group, no electrical stimulation was given to the acupuncture needle inserted at the same site as the above described group. In the control group, no treatment was given. The response was determined at one, three, four, and six weeks after osteotomy by radiographic examination. Rats were sacrificed on the sixth week for a macroscopic and mechanical examination.
[Results]The EA groups showed acceleration of the bone healing process compared with the sham and control group (three weeks after osteotomy ;p<0.05 ), and accretion of the callus in the EA group was observed compared with that in the other group at six weeks after (radiographic evaluation;p < 0.05, gross maximum longitudinal dimensions of the callus;p < 0.01, gross maximum transverse dimensions of the callus;p < 0.05). Moreover, biomechanically, there was an excellent result in the EA group compared with the other group at six weeks after osteotomy (p < 0.05). There was no difference between the sham and control group in any evaluation.
[Discussion and Conclusion]Callus formation was promoted in the EA group over the sham and control group. The results of this study indicated that the use of electroacupuncture can enhance callus development and bone mineralization of the bone healing process.

Objective
The purpose of this trial was to compare the cumulative and sustained effect of repeated acupuncture treatment and repeated local injection of anesthesia for localized low back pain.
Methods
A computer program was used to randomly allocate 26 patients with low back pain to either an acupuncture group (n=13) or a local injection group (n=13). Patients in both groups received treatment at the most painful points (from 2 to 5 points) once a week for a total of 4 weeks. For the acupuncture treatment, a 0.18mm diameter stainless steel needle was inserted to a depth of 10 to 20mm and then manual stimulation using the sparrow pecking method (1Hz) was given. For the local injection, injection needle (25G, 0.5mm in diameter) was inserted to a depth of 10 to 20mm before injection of the anesthetic (a mixture of local anesthetic and neurotropin). The visual analog scale (VAS: 100mm) was used to measure subjective pain intensity before and directly after the first treatment, before subsequent treatments, and at two and four weeks after completion of the treatment. The Roland-Morris Disability Questionnaire (RDQ) and Pain Disability Assessment Scale (PDAS) were also used to evaluate Quality of Life (QOL) of the subject at before the first treatment, at the time of completion of treatment, and at two and four weeks after the completion of treatment.
Results
There was a significant difference (p=0.0016) in changes in the VAS scores between two groups, with more favorable results in the acupuncture group than in the local injection group. Calculation of the degree of change from the initial scores indicated that acupuncture group showed significantly better results than those in the local injection group at directly after the first treatment (p=0.0348), and there was a significant cumulative effect (at the end of treatment: p=0.0076) and sustained effect (two weeks after treatment: p=0.0096, four weeks after treatment: p=0.0128). Similarly, RDQ and PDAS were also better in the acupuncture group compared to the local injection group.
Discussion
Both local injection and acupuncture reduced low back pain. The superior effect of acupuncture directly after treatment and its superior cumulative and sustained effect, indicate that it could be an effective treatment for low back pain. The reason for the disparity between the effects could be due to differences in the mechanisms of pain suppression.

The effects of electrical acupuncture at the patellar tendon and electrical stimulation of the femoral nerve on patellar tendon blood flow were evaluated using laser Doppler flowmetry in anesthetized rats. In most subjects the blood flow in the patellar tendon rapidly decreased for 30 seconds after the start of local electrical acupuncture and then increased above baseline. Changes in blood flow did not necessarily follow changes in arterial blood pressure. Changes in tendon blood flow induced by electrical stimulation of the femoral nerve were similar to those induced by electrical acupuncture at the patellar tendon. Arterial blood pressure and heart rate were not affected by electrical stimulation of the femoral nerve. Phentolamine administration abolished the decreased patellar tendon blood flow seen after initiating electrical acupuncture at the patellar tendon, whereas atropine abolished the increased patellar tendon blood flow seen after terminating electrical acupuncture at the patellar tendon. Furthermore, atropine did not evoke increased blood flow following electrical stimulation of the femoral nerve. These results suggest that the decrease of blood flow seen after initiating electrical acupuncture may be controlled by sympathetic vasoconstrictor nerves and the increase of blood flow following electrical acupuncture may be controlled by cholinergic vasodilator nerves.

[Objective] The purpose of this study was to compare the effectiveness of acupuncture and local injection for neck pain.
[Methods] A randomized controlled clinical trial was conducted in which 33 patients with neck pain were randomly allocated to either an acupuncture group or a local injection group. For the acupuncture group (n=16), a stainless steel needle was inserted to a depth of 10 to 20 mm and manually stimulated (sparrow pecking method) for 20 seconds. A 25 gauge needle was inserted to a depth of 10 to 20 mm and neovitacain (dibucaine hydrochloride 0.1%, sodium salicylate 0.3%, calcium bromide 0.2%) and neurotropin (non protein component extracted from the skin of rabbits treated with vaccinia virus) were injected for the local injection groups (n=17). Both groups received each treatment at the most painful points weekly for four weeks. Primary outcome measurement was intensity of the pain evaluated with a visual analogue scale (VAS). Secondary outcomes were the Neck Disability Index (NDI) and a standardized questionnaire of cervical root disease (developed by Tanaka et al. at Tohoku Univ.). The evaluations were independent from the therapists.
[Results] The acupuncture groups showed better results in all the outcome measurements than those in the local injection group for the effect immediately after the treatment, the effect of sequential treatment and the continuing effect after completion of treatment.
[Discussion] The result of this study suggested that acupuncture can be a useful treatment method compared with local injection. The difference in the effects between the two treatment methods may be due to the difference in the mechanism to suppress pain.

[Objective]As fundamental research on the acupuncture treatment to shin-splints, we studied what kind of acupuncture stimulus raises the pain threshold and deep tissue temperature of the periosteal part of the tibia.
[Methods]Twelve healthy subjects (Age: 22 ± 2years old) participated in this study. We recorded how the pain threshold of the periosteum would change under the influence of the kind of stimulus of leaving a needle, sparrow pecking a needle and no stimulation. Simultaneously, we measured the deep tissue temperature near the measured part of pain threshold with a deep tissue thermometer.
[Results]The pain threshold of leaving a needle group rose significantly (p < 0.05) as compared with the control group. The sparrow pecking group showed an upward tendency. There was no significant difference in the deep tissue temperature between each group at all times.
[Conclusion]The leaving the needle technique is suitable for needle stimulus to shin-splints. It was suggested that pain control was expected with a leaving needle stimulus. The needle stimulus did not show a remarkable effect on the reaction of regional circulation.

The effects of acupuncture and moxibustion on lower back pain in clinical trials were reviewed. First, the effects of Western medicine on lower back pain, patients with specific and nonspecific lower back pain, were systematically reviewed based on online data, and possible mechanisms were discussed. Secondly, the role and potential of acupuncture and moxibustion on lower back pain were considered based on a review of research literature. Finally, the effectiveness of acupuncture and moxibustion on several kinds of lower back pain was systematically examined based on online data. These results suggest that acupuncture and moxibustion may be more effective on non-specific lower back pain.

[Objective]The purpose of this study was to compare the effects of superficial and deep insertion of acupuncture needles in the treatment of patients with low back pain and to search for more effective acupuncture methods.
[Methods]A randomized controlled clinical trial was conducted in which 32 patients with low back pain for more than three months of duration were randomly allocated either to a superficial acupuncture group (n = 16) or a deep acupuncture group (n = 16). Treatment was done for the most painful points of the patients. In the superficial insertion group, the needle was only inserted to a depth of 5 mm, whereas in the deep insertion group, the needle was inserted to a depth of about 20 mm, and was manually stimulated (sparrow pecking method) for 20 seconds. Both groups were treated weekly for four weeks. The visual analog scale (VAS) of pain, Roland-Morris Disability Questionnaire (RDQ), and Pain Disability Assessment Scale (PDAS) were used for outcome measurement.
[Result]VAS, RDQ and PDAS scores showed significant differences between groups (VAS:p < 0.05, RDQ:p <0.001, PDAS:p < 0.05) in change over time with the deep insertion group having more favorable results than the superficial insertion group. The degree of change from the baseline at the time of each evaluation was calculated and results for the two groups were compared. The deep insertion group was significantly better in tendency to improve directly after the first treatment (p < 0.01), in cumulative effect after repeated treatment (VAS:p = 0.13, RDQ:p < 0.05, PDAS:p < 0.01), and in sustained effect after completion of treatment (VAS:p < 0.05, RDQ:p < 0.01, PDAS:p <0.05).
[Discussion and Conclusion]The study showed that deep stimulation is a more effective treatment than superficial stimulation. It is thought that the differences of the effects are due to different influences of the treatments on the pain threshold, muscle blood flow, and muscle tones.

A 47-year-old man was referred to our hospital for multiple rib fractures and pneumohemothorax due to a traffic accident. After admission, tricuspid valve regurgitation and hypoxemia were also diagnosed. Although fixation of the fractured ribs with plates and removal of hematoma in the pleural cavity were performed, hypoxemia did not improve. He was discharged on home oxygen therapy. Ten months and 3 years after the traffic accident, pulmonary perfusion scintigraphy suggested a right-to-left shunt. Transesophageal echocardiography demonstrated an opening of the foramen ovale and a right-to-left interatrial shunt. Direct closure of the patent foramen ovale and tricuspid valve replacement with the Carpentier-Edwards bioprosthesis were performed and hypoxemia disappeared after the second operation. Traumatic tricuspid valve regurgitation with cyanosis is extremely rare. However, it is important to take the possibility of patent foramen ovale into consideration in patients with traumatic tricuspid valve regurgitation and cyanosis.

Effects of acupuncture stimulation on the lumbar area and those of electrical stimulation of the sciatic nerve on blood flow to the sciatic nerve were studied using laser Doppler flowmetry in anesthetized rats. Changes in the nerve blood flow induced by acupuncture stimulation were not similar. Half of the blood flow responses correlated with changes in arterial blood pressure. In the other half, responses did not always agree with changes in arterial blood pressure. Electrical stimulation was administered to the sciatic nerve contralateral or ipsilateral to the blood flow measurement site. Electrical stimulation of the ipsilateral side increased nerve blood flow without increasing arterial pressure. Administraton of atropine slightly diminished the response. Contralateral nerve stimulation, changes in nerve blood flow were not accompanied by arterial pressure changes. These results suggested that nerve blood flow may increase without increment of the arterial pressure in response to certain types of acupuncture stimulation.