Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

寰枢整复手法治疗气滞血瘀型椎动脉型颈椎病的临床观察

Objective: To investigate the clinical effect of spinal manipulation therapy for the treatment of cervical spondy-losis of vertebral artery type (CSA) combine with atlanto-axial joint instability. Methods: A deep analysis of previous randomized controlled trial was performed on 51 CSA combine with atlanto-axial joint instability patients from January 2016 to September 2019. The treatment group (n=27) accepted spinal manipulation therapy, while the control group (n=24) was treated with electro-acupuncture therapy. The effectiveness and changes of hemodynamic indexes of vertebra-basilar arterial system in the two groups before and after treatment were observed and compared. Results: The improvement of all the hemodynamic indexes in the treatment group was more significant than that in the control group (P<0.05). After treatment,the clinical effective rate was 96.30% in the treatment group and 87.50% in the control group,the difference being significant (P<0.05). Conclusion: Spinal manipulation therapy can improve the symptoms of CSA combine with atlanto-axial joint instability effectively. However, the assessment of the patient before treatment is necessary.     

仰卧旋转扳法联合电针治疗腰椎间盘突出症的临床效果观察

目的 研究仰卧旋转扳法联合电针治疗腰椎间盘突出症的临床效果。方法 选取2017 年11 月～2019 年11 月浙江中医药大学附属第三医院收治的腰椎间盘突出症患者为研究对象,采用随机分组法将纳入标准的腰椎间盘突出症患者104 例分为观察组与对照组,每组各52 例,对照组采用仰卧旋转扳法,观察组在对照组的治疗基础上加用电针治疗。比较两组治疗后的总有效率、SF-McGill 疼痛评分、ODI 评分、SOD 与α1-AGP 指标。结果 治疗后观察组治疗总有效率为96.2%,高于对照组的75.0%;观察组PRI、VAS、PPI 的评分较对照组显著下降,SOD 指标较对照组显著升高,α1-AGP 较对照组显著下降,差异均有统计学意义（P＜0.05）。结论 仰卧旋转扳法联合电针治疗腰椎间盘突出症能提高临床效果,值得推广。     

The molecular basis of ubiquitin-like protein NEDD8 deamidation by the bacterial effector protein Cif

The cycle inhibiting factors (Cifs) are a family of translocated effector proteins, found in diverse pathogenic bacteria, that interfere with the host cell cycle by catalyzing the deamidation of a specific glutamine residue (Gln40) in NEDD8 and the related protein ubiquitin. This modification prevents recycling of neddylated cullin-RING ligases, leading to stabilization of various cullin-RING ligase targets, and also prevents polyubiquitin chain formation. Here, we report the crystal structures of two Cif/NEDD8 complexes, revealing a conserved molecular interface that defines enzyme/substrate recognition. Mutation of residues forming the interface suggests that shape complementarity, rather than specific individual interactions, is a critical feature for complex formation. We show that Cifs from diverse bacteria bind NEDD8 in vitro and conclude that they will all interact with their substrates in the same way. The "occluding loop" in Cif gates access to Gln40 by forcing a conformational change in the C terminus of NEDD8. We used native PAGE to follow the activity of Cif from the human pathogen Yersinia pseudotuberculosis and selected variants, and the position of Gln40 in the active site has allowed us to propose a catalytic mechanism for these enzymes.     

Reduction in nerve root compression by the nucleus pulposus after Feng's Spinal Manipulation

Ninety-four patients with lumbar intervertebral disc herniation were enrolled in this study. Of these, 48 were treated with Feng’s Spinal Manipulation, hot fomentation, and bed rest (treatment group). The remaining 46 patients were treated with hot fomentation and bed rest only (control group). After 3 weeks of treatment, clinical parameters including the angle of straight-leg raising, visual analogue scale pain score, and Japanese Orthopaedic Association score for low back pain were improved. The treatment group had significantly better improvement in scores than the control group. Magnetic resonance myelography three-dimensional reconstruction imaging of the vertebral canal demonstrated that filling of the compressed nerve root sleeve with cerebrospinal fluid increased significantly in the treatment group. The diameter of the nerve root sleeve was significantly larger in the treatment group than in the control group. However, the sagittal diameter index of the herniated nucleus pulposus and the angle between the nerve root sleeve and the thecal sac did not change significantly in either the treatment or control groups. The effectiveness of Feng’s Spinal Manipulation for the treatment of symptoms associated with lumbar intervertebral disc herniation may be attributable to the relief of nerve root compression, without affecting the herniated nucleus pulposus or changing the morphology or position of the nerve root.     

Association between heart rate variability and manual pulse rate

Introduction:

One model for neurological assessment in chiropractic pertains to autonomic variability, tested commonly with heart rate variability (HRV). Since HRV may not be convenient to use on all patient visits, more user-friendly methods may help fill-in the gaps. Accordingly, this study tests the association between manual pulse rate and heart rate variability. The manual rates were also compared to the heart rate derived from HRV.

Methods:

Forty-eight chiropractic students were examined with heart rate variability (SDNN and mean heart rate) and two manual radial pulse rate measurements. Inclusion criteria consisted of participants being chiropractic students. Exclusion criteria for 46 of the participants consisted of a body mass index being greater than 30, age greater than 35, and history of: a) dizziness upon standing, b) treatment of psychiatric disorders, and c) diabetes. No exclusion criteria were applied to the remaining two participants who were also convenience sample volunteers. Linear associations between the manual pulse rate methods and the two heart rate variability measures (SDNN and mean heart) were tested with Pearson’s correlation and simple linear regression.

Results:

Moderate strength inverse (expected) correlations were observed between both manual pulse rate methods and SDNN (r = −0.640, 95% CI −0.781, −0.435; r = −0.632, 95% CI −0.776, −0.425). Strong direct (expected) relationships were observed between the manual pulse rate methods and heart rate derived from HRV technology (r = 0.934, 95% CI 0.885, 0.962; r = 0.941, 95% CI 0.897, 0.966).

Conclusion:

Manual pulse rates may be a useful option for assessing autonomic variability. Furthermore, this study showed a strong relationship between manual pulse rates and heart rate derived from HRV technology.     

Compare the Traditional Chinese Medicine Manipulation With Rehabilitation on In-Patients After Total Knee Arthroplasty

This prospective, randomized, and controlled study was conducted to assess Traditional Chinese Medicine (TCM) for pain control, alone and in conjunction with a standard inpatient rehabilitation program, during the five days immediately following total knee arthroplasty (TKA). Forty-one patients undergoing primary unilateral TKA between February, 2010 and January, 2011 were randomly assigned to one of three groups. Levels of pain were then monitored using a Visual Analogue Scale (VAS). Significant alleviation of pain and diminution of flexion contractures were achieved using TCM, with and without standard rehabilitation. These outcomes support use of TCM immediately post-TKA to facilitate patient recovery.