The effectiveness of cupping therapy on low back pain: A systematic review and meta-analysis of randomized control trials

This study aims to investigate the effectiveness of cupping therapy on low back pain (LBP). Medline, Embase, Scopus and WANFANG databases were searched for relevant cupping RCTs on low back pain articles up to 2023. A complementary search was manually made on 27 September for update screening. Full-text English and Chinese articles on all ethnic adults with LBP of cupping management were included in this study. Studies looking at acute low back pain only were excluded. Two independent reviewers screened and extracted data, with any disagreement resolved through consensus by a third reviewer. The methodological quality of the included studies was evaluated independently by two reviewers using an adapted tool. Change-from-baseline outcomes were treated as continuous variables and calculated according to the Cochrane Handbook. Data were extracted and pooled into the meta-analysis by Review Manager software (version 5.4, Nordic Cochrane Centre). Eleven trials involving 921 participants were included. Five studies were assessed as being at low risk of bias, and six studies were of acceptable quality. High-quality evidence demonstrated cupping significantly improves pain at 2-8 weeks endpoint intervention (d=1.09, 95% CI: [0.35-1.83], p = 0.004). There was no continuous pain improvement observed at one month (d=0.11, 95% CI: [-1.02-1.23], p = 0.85) and 3-6 months (d=0.39, 95% CI: [-0.09-0.87], p = 0.11). Dry cupping did not improve pain (d=1.06, 95% CI: [-0.34, 2.45], p = 0.14) compared with wet cupping (d=1.5, 95% CI: [0.39-2.6], p = 0.008) at the endpoint intervention. There was no evidence indicating the association between pain reduction and different types of cupping (p = 0.2). Moderate- to low-quality evidence showed that cupping did not reduce chronic low back pain (d=0.74, 95% CI: [-0.67-2.15], p = 0.30) and non-specific chronic low back pain (d=0.27, 95% CI: [-1.69-2.24], p = 0.78) at the endpoint intervention. Cupping on acupoints showed a significant improvement in pain (d=1.29, 95% CI: [0.63-1.94], p 50%). High- to moderate-quality evidence indicates that cupping significantly improves pain and disability. The effectiveness of cupping for LBP varies based on treatment durations, cupping types, treatment locations, and LBP classifications. Cupping demonstrated a superior and sustained effect on pain reduction compared with medication and usual care. The notable heterogeneity among studies raises concerns about the certainty of these findings. Further research should be designed with a standardized cupping manipulation that specifies treatment sessions, frequency, cupping types, and treatment locations. The actual therapeutic effects of cupping could be confirmed by using objective pain assessments. Studies with at least six- to twelve-month follow-ups are needed to investigate the long-term efficacy of cupping in managing LBP. This systematic review was initially registered on PROSPERO with registration code: CRD42021271245 on 08 September 2021

Genetic Manipulation of a “Vacuolar” H+-PPase: From Salt Tolerance to Yield Enhancement under Phosphorus-Deficient Soils

Article on the genetic manipulation of a vacuolar H+ -PPase and salt tolerance to yield enhancement under phosphorous-deficient soils

Continental-Scale Projections of Potential Climate Cbange Effects on Small Lakes in the Contiguous U .8. Vol. 2 Effects of Projected Future Climate Conditions on Lake Water Temperatures and Dissolved Oxygen

This study is concerned with projections of climate change effects on lakes, especially small lakes with surface areas up to 10 km2 and depths up to '24m in the cold regions of the contiguous U.S. For this study, we have chosen lake parameters which are most directly influenced by climate and which in tum have much influence on aquatic lifeforms, water quality and water uses. The two main parameters studied herein are lake water temperature (T) and dissolved oxygen (DO) concentration. In the process, we have also obtained projections on evaporative water losses from lakes, ice covers on lakes and sediment temperatures below lakes. Potential changes of fish habitat (as constrained by T and DO) in lakes have also been estimated. To make such a broad study, we had to develop and apply process-oriented, simulation models which link atmospheric conditions to lake water conditions. Before the models were applied at the continental-scale in this report, the model formulations and assumptions were reviewed to examine what geographically variable parameters had to be introduced. The models were used on 27 different types of lakes. The lakes' chosen differed by surface area, maximum depth and transparency as measured by Secchi depth. These three parameters are known to have a crucial influence on lake water temperatures and DO concentrations. The Secchi depth was related to transparency as well as trophic state of a lake. This is a major assumption which will not hold true in lakes which show turbidity from inorganic suspended sediments. Secchi depth was related to mean annual phytoplankton chlorophyll-a concentration in a lake. This made it possible to estimate photosynthetic oxygen production without specification of nutrient inputs from the watershed. Lakes were also treated as having constant volume and long hydraulic residence times.US Environmental Protection Agency, Office of Research and Development; Lamar University Department of Civil Engineerin

Evaluation of the heel external rotation test in soft tissue deficiencies associated with adult acquired flatfoot deformity (AAFD). A cadaver sectioning analysis.

BACKGROUND: To date, evaluation of the heel external rotation test has not been taken with respect to AAFD. Traditional 'gold standard' tests do not account for the contribution of the midfoot ligaments towards instability. These tests would be flawed as any midfoot instability may produce a false positive result. AIMS: To evaluate the differential contribution of the spring, deltoid and other local ligaments in external rotation generated at the heel. METHODS: Serial ligament sectioning was performed on 16 cadaveric specimens, with a 40 N-external rotation force applied to the heel. These were divided into four groups with different sequences of ligament sectioning. Measurements of the total amount/range of external, tibiotalar and subtalar rotation were made. RESULTS: The deep component of the deltoid ligament (DD) was the main ligament influencing heel external rotation (P  0.05). CONCLUSION: Clinically relevant external rotation (>20 degrees) is solely attributable to DD failure in the presence of intact lateral ligaments (LL). This test may improve detection of DD instability and allow clinicians to subclassify patients with Stage 2 AAFD into those where DD may or may not be compromised

Differential contribution of lateral plantar foot ligaments to lateral column stability - A cadaver based sectioning analysis.

Lateral column (LC) instability occurs in adult acquired flatfoot deformity (AAFD). Differential ligament contribution to LC stability is unknown. The primary aim was to quantify this by using cadaver sectioning of lateral plantar ligaments. We also determined the relative contribution of each ligament to dorsal translation of the metatarsal head in the sagittal plane. 17 below-knee cadaveric specimens, preserved by vascular embalming method, were dissected to expose plantar fascia, long/short plantar ligaments (L/SPL), calcaneocuboid (CC) capsule and inferior 4th/5th tarsometatarsal (TMT) capsule. Dorsal forces of 0 N, 20 N and 40 N were applied to the plantar 5th metatarsal head after sequential ligament sectioning in different orders. Pins provided linear axes on each bone, allowing relative angular bone displacements to be calculated. Photography and ImageJ processing software were then used for analysis. The LPL (and CC capsule) had the greatest contribution to metatarsal head motion (107 mm) after isolated sectioning. In the absence of other ligaments, sectioning these resulted in significantly increased hindfoot-forefoot angulation (p ≤ 0.0003). Isolated TMT capsule sectioning demonstrated significant angular displacement even when other ligaments remained intact (with intact L/SPL, p = 0.0005). CC joint instability required both LPL and capsular sectioning for significant angulation to occur, whilst TMT joint stability was largely dependent on its capsule. The relative contribution of static restraints to the lateral arch has not yet been quantified. This study provides useful information on relative ligament contribution to both CC and TMT joint stability, which may in turn improve understanding of surgical interventions used to restore arch stability