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Kim TH, Lee MS, Birch S, Alræk T, Norheim AJ, Kang JW. Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies. Heliyon 2023; 9:e20577. [PMID: 37842566 PMCID: PMC10569964 DOI: 10.1016/j.heliyon.2023.e20577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Case reports on acupuncture-related adverse events (AEs) have been consistently published in the literature. This review aims to assess the current publication status of case reports on acupuncture-related AEs and evaluate their reporting quality in order to identify areas for improvement. Methods This study is a systematic review (SR) of case reports. Studies describing cases for acupuncture-related AEs between 2010 and 2023 (until July) were searched in PubMed, Embase, and local databases (China and Korea), as well as by hand-searching references included in published relevant SRs. A bibliometric analysis was conducted to examine the publication trends of the included literature. The appropriateness of the acupuncture described in the cases, the causality assessment between AEs and acupuncture treatment, and the presence of necessary items from the CAse REport guidelines (CARE) checklist were narratively analyzed. Results A total of 169 case reports were included in this review. Over the past decade, an average of 12 case reports on acupuncture-related AEs were published annually. However, only 38.2% of the articles provided sufficient information to determine the appropriateness of the acupuncture treatment used in the reported cases, and considerable numbers of the included case reports did not suggest enough information for the assessment of a causal relationship. The majority of cases did not report the timeline (n = 164), patient perspectives (n = 157), and informed consent (n = 121) items from the CARE checklist. Discussion Acupuncture-related AEs persist in being frequently reported in the literature. Nonetheless, the information concerning acupuncture and causality assessment within these publications is still found to be insufficient. The development of reporting guidelines for future case reports on acupuncture-related AEs is anticipated to promote an academic environment conducive to more comprehensive reporting.
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Affiliation(s)
- Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Myeong Soo Lee
- Division of Clinical Medicine, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Stephen Birch
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Terje Alræk
- School of Health Sciences, Kristiania University College, Oslo, Norway
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Arne Johan Norheim
- Department of Community Medicine, Faculty of Medicine, National Research Center in Complementary and Alternative Medicine, UiT the Arctic University of Norway, Tromso, Norway
| | - Jung Won Kang
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, South Korea
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Wong YM, Suzuki S, Odagiri K. Letter to the Editor: Revisit of Cun-Based Needling Depth for BL40. Med Acupunct 2021; 33:313-314. [PMID: 34471449 DOI: 10.1089/acu.2020.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yiu Ming Wong
- Health Science Unit, Hong Kong Physically Handicapped & Able Bodied Association, Shamshuipo, Kowloon, Hong Kong
| | - Shinji Suzuki
- Department of Acupuncture and Moxibustion, Okinawa College of Integrative Medicine, Urasoe, Okinawa, Japan
| | - Kouhei Odagiri
- Department of Acupuncture and Moxibustion, Okinawa College of Integrative Medicine, Urasoe, Okinawa, Japan
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Hou HK, Liu CZ, Lin LL. Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40. Acupunct Med 2020; 39:343-350. [PMID: 33032445 DOI: 10.1177/0964528420958714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI). METHODS One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle. RESULTS Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%-19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%-15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%-94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°-10.55°) and 9.75° ± 3.46° (95% CI, 9.10°-10.41°), respectively. CONCLUSION We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.
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Affiliation(s)
- Hai-Kun Hou
- Department of Acupuncture and Moxibustion, Beijing JiShuiTan Hospital, Beijing, China
| | - Cun-Zhi Liu
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China.,School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lu-Lu Lin
- Acupuncture Research Center, Beijing University of Chinese Medicine, Beijing, China.,School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Abstract
OBJECTIVES There are safety issues associated with acupuncture treatment. Previous studies regarding needling depth of acupuncture points revealed inconsistent results due to vague depth definition, acupuncture point localisation and measuring tools. The objective of this study is to find and compare the differences of the mean depths of 11 acupuncture points in the neck and shoulder region between subjects, with variables including gender and body mass index (BMI). SETTING This study was conducted at a single medical center in Taiwan. PARTICIPANTS Three hundred and ninety-four participants were included in this study. Participants were grouped according to gender and BMI. Acupuncture points were localised by WHO standard and measured by MRI. OUTCOME MEASURES The distance from the needle insertion point (surface of the skin) to any tissues that would cause possible/severe complications. RESULTS Mean depths of 11 points were obtained in groups of different BMI and gender. Mean depths of all participants regardless of BMI and gender are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. Participants with higher BMI had greater measured depths in both gender groups. Male participants had larger mean depths than female participants regardless of BMI except in SI17 and LI18. When taking BMI into consideration, depths in male participants are greater than in female participants in most of the points except the following: GB21, TE16 in obesity group; ST9 in underweight and obesity group; SI16 in ideal body weight, overweight and obesity group; SI17, LI18 in each group. CONCLUSIONS Participants with higher BMI had greater measured depths and males tended to have greater depths in most of the points. Clinical practitioners are recommended to consider this information to prevent complications when applying acupuncture treatment to their patients.
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Affiliation(s)
- Pei-Chi Chou
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Traditional Chinese Medicine, China Medical University Hospital Eastern Branch, Taichung, Taiwan
| | - Yu-Chuen Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Jen Hsueh
- Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jaung-Geng Lin
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Heng-Yi Chu
- Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Soumer K, Benomrane S, Derbel B, Laribi J, Benmrad M, Elleuch N, Kalfat T, Khayati A. Popliteal pseudoaneurysm and arteriovenous fistula after acupuncture. ACTA ACUST UNITED AC 2015; 40:58-62. [PMID: 25623503 DOI: 10.1016/j.jmv.2014.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/17/2014] [Indexed: 11/28/2022]
Abstract
Most popliteal arteriovenous fistula and pseudoaneurysm formation are related to trauma. Few cases have previously been reported after acupuncture therapy. Such events are typically observed when the procedure is performed by non-medical acupuncturist. They may present with acute ischemia, recent claudication, distal emboli, or less commonly rupture. Duplex ultrasound should be considered as the 1st method of investigation. Computed tomography scanning is particularly accurate in making the diagnosis. Treatment strategies consist of surgery or endovascular management. The most commonly performed surgical technique for popliteal pseudoaneurysm repair is resection with bypass grafting, whereas popliteal arteriovenous fistula are usually treated surgically with ligation and primary repair. Endovascular procedure using a stent-graft is thought to be a reasonable option for treating popliteal false aneurysm or even arteriovenous fistula. We will describe two cases of an arteriovenous fistula and pseudoaneurysm of the popliteal artery that developed after acupuncture needling in the region of the popliteal artery.
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Affiliation(s)
- K Soumer
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - S Benomrane
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - B Derbel
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - J Laribi
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - M Benmrad
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - N Elleuch
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - T Kalfat
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
| | - A Khayati
- Department of Cardiovascular Surgery, La Rabta Hospital, College of Medicine, University of Tunis El Manar, Tunis, Tunisia.
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Adverse events of acupuncture: a systematic review of case reports. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:581203. [PMID: 23573135 PMCID: PMC3616356 DOI: 10.1155/2013/581203] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 02/08/2013] [Indexed: 12/17/2022]
Abstract
Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient's sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.
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Interventional embolization therapy of puerile congenital deep femoral arteriovenous fistula. Exp Ther Med 2013; 5:503-506. [PMID: 23407852 PMCID: PMC3570193 DOI: 10.3892/etm.2012.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 11/06/2012] [Indexed: 12/02/2022] Open
Abstract
This study aimed to investigate the treatment efficiency of interventional embolization therapy in puerile congenital deep femoral arteriovenous fistula. A retrospective analysis was conducted for 9 cases of congenital deep femoral arteriovenous fistulae treated in our department in the past 5 years. B-ultrasound examination indicated that all puerile patients suffered from deep femoral arteriovenous fistulae, which was confirmed by angiography examination. For all patients, endovascular interventional embolization therapy was conducted and angiography re-examination was implemented after 4 weeks. If there were residual orificium fistulae, the interventional embolization therapy was conducted again. In the 6 month to 2 year follow-up period, improvement of clinical symptoms was observed. Following interventional embolization, 9 cases of deep femoral arteriovenous fistulae were completely occluded and the clinical symptoms were improved. No relapses occurred. In addition, after three embolization treatments, the disease condition of one case was controlled well and the disease condition did not progress. Interventional embolization therapy has a number of advantages, including simple surgery and reliable treatment efficacy. Therefore, it is worthy of promotion and application in the clinic.
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