Abstract
Background:
Burns are defined as tissue damage that occurs as a result of the action of heat. Although many advanced treatments have been made in burn therapy, slow wound healing remains a challenge in burn treatment. Acupuncture can accelerate burn healing through its anti-inflammatory effect, increasing re-epithelialization and angiogenesis.
Objectives:
This study assessed the effect of manual acupuncture and laser acupuncture on the healing of burns that were observed macroscopically and microscopically.
Methods:
Thirty-six male Wistar rats with deep partial thickness burns were randomly divided into control group (n = 12), acupuncture group (n = 12), and laser acupuncture group (n = 12). Wound measurements and treatments were given every 2 days for 14 days.
Results:
On the 14th day of macroscopic evaluations, there was a significant difference (P = 0.009) between the acupuncture group (66.96 ± 9.17) and the control group (49.93 ± 9.15), and a significant difference (P = 0.009) between laser acupuncture group (72.48 ± 14.62) and the control group. However, there was no significant difference (P = 0.451) between acupuncture and laser acupuncture groups. On the 14th day of microscopic evaluations, there was a significant difference (P < 0.001) between the acupuncture group (16.17 ± 1.17) and the control group (10.33 ± 1.21), and a significant difference (P = 0.004) between the laser acupuncture group (17.83 ± 1.47) and the control group. However, there was no significant difference (P = 0.058) between acupuncture and laser acupuncture groups.
Conclusion:
The results showed that either acupuncture therapy or laser acupuncture therapy could be used as an adjunct therapy to accelerate burn healing.
Keywords: acupuncture, laser acupuncture, burns, wound closure
INTRODUCTION
Burns are injuries that can occur either at home or at workplace. According to the World Health Organization (WHO), there are 180,000 deaths every year from burns, and in 2004, nearly 11 million people worldwide had burns and required medical treatment.1 At RSUPN Dr. Cipto Mangunkusumo, Indonesia, in the period from January to December 2019, there were 244 cases of burns that needed treatment.2 The results from RISKESDAS 2013 revealed that burns ranked 6th in accidental injuries, with a total of 0.7% of all injuries.3 According to an epidemiologic study conducted in Indonesia from 2013 to 2015, it was shown that deep partial and full thickness burns were the most common.4 Burns can affect patient morbidity and mortality for at least 5–10 years after the injury.5
Although many therapeutic advances have been made in the treatment of burns, slow wound healing, the incidence of infection, and scarring are still major challenges in burn care.6 Further research is still needed on the best treatment to accelerate the healing of burns.
Several studies have shown that manual acupuncture helps accelerate burn healing through its anti-inflammatory effects, stimulate re-epithelialization and angiogenesis, improve microcirculation, reduce the risk of scar tissue, and speed-up the duration of wound healing phases.7–9 Laser acupuncture is a therapeutic modality that uses low-energy laser to stimulate acupuncture points,10 it has advantages over other acupuncture modalities because it is noninvasive, painless, reduces the risk of infection and bleeding, and has a shorter duration of therapy.11 Although there are not many researches on the effect of laser acupuncture on burn healing,12–14 the choice of laser acupuncture modality is worth considering.
Research on burn treatment has been carried out on experimental animals, especially rats. They have a subcutaneous panniculus carnosus muscle that facilitates skin healing by wound contraction and collagen formation, which make the duration of wound healing shorter.15 This mechanism of wound healing made rats more resistant to both sepsis and immunosuppression, and allowed researchers to investigate the mechanism of wound healing more quickly.16
This study aims to see whether manual acupuncture therapy and laser acupuncture therapy can affect the speed of wound healing both macroscopically and microscopically in rats with burn injury.
MATERIALS AND METHODS
This study used randomized control experimental study design and was conducted at Animal Laboratory National Institute of Health Research and Development, Jakarta, Indonesia. This research was approved by the Medical Research Ethics Committee of Faculty of Medicine, Universitas Indonesia, Ethics Approval No: KET-74/UN2.F1/ETIK/PPM.00.02/2021 on February 1, 2021.
This study used 36 male Wistar rats obtained from the experimental animal laboratory. The inclusion criteria were as follows: (1) rats weighing 250 ± 50 g17; (2) active and healthy rats (active movement and no dull hair, hair loss, or balding) with a good appetite for food and drink; (3) no signs of inflammation or infection at the acupuncture point location. The exclusion criteria were rats that were unable to adapt during study.
Rats were placed in 50 × 50 × 40 cm cages with 3 rats per cage at temperature of 24°C ± 1°C and 55% ± 5% humidity. The light–dark cycle was performed every 12 hours. Food and drinking water were provided ad libitum. Each cage was kept clean, bedding replacement was performed every 1 to 2 days.
Experimental Grouping
Thirty-six rats were randomly divided into 6 groups: groups 1 and 2 rats with burns that were not given any treatment, groups 3 and 4 rats with burns that received manual acupuncture treatment, and groups 5 and 6 rats with burns that received laser acupuncture treatment. Half of the population, which are groups 1, 3, and 5, were terminated on day 7, and the remaining half, which are groups 2, 4, and 6, were terminated on day 14 (Fig. 1).
FIG. 1.
Diagram of methods used in this study. Color images are available online.
Establishment of Burn Injury Model
Rats were given anesthesia in the form of ketamine injection (0.075 mg/g body weight) and xylazine (0.02 mg/g body weight) intramuscularly. Then the burn injury was induced by using metal with a diameter of 2 cm and a weight of 100 g that was heated until temperature of 250°C. The heated metal then was placed in the lower quadrant of the dorsal rat for 5 seconds. In preliminary experiments, placing 250°C heated metal for 5 seconds duration was sufficient to create a deep partial burn injury confirmed by histologic examination of the skin. Rats were given fluid resuscitation in the form of RL injection (2 mL/100 g body weight) intraperitoneally.8,17 Paracetamol as analgesic was mixed into drinking water. Silver sulfadiazine ointment was applied over the wound and changed every 2 days.
Intervention
In the manual acupuncture group, acupuncture needles were inserted at 1.5 mm depth at the ST36 Zusanli point, LI4 Hegu bilaterally, and 4 points around the wound at a distance of 1 cm from the wound edge for 20 minutes, using a Dongbang brand disposable needle, 0.25 × 0.25 mm. The procedure was carried out every 2 days, at days 0, 2, 4, 6, 8, 10, and 12. In the laser acupuncture group, laser treatment was given at wavelength of 785 nm, energy density 6 J/cm2, continuous wave frequency, and power 5 mW, using RJ laser diode.
The duration of treatment was 38 seconds for each point and the beam size was 2 mm in diameter. Laser beam was applied directly on the skin surface at the ST36 Zusanli point, LI4 Hegu, and 4 points around the wound with a distance of 1 cm from the wound edge, the procedure was carried out every 2 days, at day 0, 2, 4, 6, 8, 10, and 12.
Measurement of Wound Closure
The wound was photographed using a digital camera with a distance of 20 cm above, then the wound area was measured using Image J software on days 0, 2, 4, 6, 8, 10, 12, and 14. Any size changes of wound closure were calculated in percentage by comparing with the wound size on day 0.13 Wound closure calculation (%): [(Tn)–(T0)] × 100/T0,
where T0 is wound size on day 0
and Tn is wound size on day n.
Descriptive observations were also made of the wound healing process that occurred, which included the observations of hemostasis, inflammation, proliferation and remodeling phases.
Histologic Examination
The skin tissue was taken right after the rat was euthanized, then the tissue paraffin block was made using 10% formaldehyde buffer fixative. Microscopic slide sets were made with hematoxylin-eosin staining. Skin histology was assessed using a microscope at 40 × magnification to measure (1) degree of re-epithelialization and (2) growth of granulation tissue. Then followed by 400 × magnification in 3 different fields of view that have the best tissue healing gradations on the left, middle, and right edges of the wound tissue to calculate: (1) the number of inflammatory cells and (2) angiogenesis. The results of histology observations were then recorded and the value was determined based on the modification of the scoring system table for histologic changes in burn healing (Table 1).18 All image analyses were done using Image Raster 3.0 software.
Table 1.
Modification of the Scoring System Table for Histologic Changes in Burn Healing
| Re-epithelialization | Granulation | Inflammatory cells | Angiogenesis | |
|---|---|---|---|---|
| 0 | Absence of epithelial proliferation in tissue | Granulation found in 100% tissue | >500 inflammatory cells per histologic field | Absence of angiogenesis |
| 1 | Epithelial proliferation in >0%–20% tissue | Granulation found in >80%–100% tissue | >300–500 inflammatory cells per histologic field | >0–2 vessels per histologic field |
| 2 | Epithelial proliferation in >20%–40% tissue | Granulation found in >60%–80% tissue | >200–300 inflammatory cells per histologic field | >2–4 vessels per histologic field |
| 3 | Epithelial proliferation in >40%–60% tissue | Granulation found in >40%–60% tissue | >100–200 inflammatory cells per histologic field | >4–6 vessels per histologic field |
| 4 | Epithelial proliferation in >60%–80% tissue | Granulation found >20%–40% tissue | >50–100 inflammatory cells per histologic field | >6–8 vessels per histologic field |
| 5 | Epithelial proliferation in >80%–100% tissue | Granulation found in 0%–20% tissue | 0–50 inflammatory cells per histologic field | >8 vessels per histologic field |
Statistical Analysis
The collected data were then statistically processed using SPSS software version 20. One way analysis of variance (ANOVA) was used to compare the basic characteristics of the 3 groups. Saphiro–Wilk test was carried out to observe the normality distribution of the data. Levene's test was conducted to observe the homogeneity of the data. If the data distribution is normal, independent t test was used to compare the mean values between groups, otherwise Mann–Whitney test was used if data distribution was not normal. The significance of test results was determined based on P < 0.05.
RESULTS
In this study, assessment of the characteristics of subjects was carried out that could potentially cause bias in the results (Table 2). All values of the basic characteristics of subjects in the 3 groups were tested for normality using the Saphiro–Wilk test, which gave the results of P > 0.05 for each characteristic. Then the one-way ANOVA test was carried out to assess the mean difference between groups. From the data shown, overall, there was no statistically significant difference (P > 0.05) of the basic characteristics between the 3 groups.
Table 2.
Basic Characteristics of Subjects
| Characteristics | Group |
P | ||
|---|---|---|---|---|
| Control (n = 12) | Manual acupuncture (n = 12) | Laser acupuncture (n = 12) | ||
| Weight (gram) | 278.83 ± 10.36 | 277.50 ± 11.56 | 280.58 ± 9.53 | 0.773* |
| Age (weeks) | 16 | 16 | 16 | |
| Wound size (mm2) | 369.46 ± 31.22 | 338.97 ± 28.73 | 359.01 ± 37.59 | 0.083* |
One way ANOVA test.
ANOVA, analysis of variance.
In this study, the speed of wound closure was observed between controls and manual acupuncture therapy (Table 3). Independent t test was used because the data distribution was normal. Using Levene's test, the data were homogeneous with a P-value >0.05. Then the mean values between the control group and the manual acupuncture group were compared, where the results of the independent t test showed that there was no significant difference in the percentage of wound closure between the control group and manual acupuncture group on day 6 (P > 0.05). However, on day 14, the results of the independent t test showed a statistically significant difference between the 2 groups (P < 0.05).
Table 3.
Comparison of Wound Closure in the Control Group and Manual Acupuncture
| Group |
P | ||
|---|---|---|---|
| Control | Manual acupuncture | ||
| Wound closure (%) day 6, (n = 12) | 15.78 ± 8.01 | 16.52 ± 12.32 | 0.86* |
| Wound closure (%) day 14, (n = 6) | 49.93 ± 9.15 | 66.96 ± 9.17 | 0.009* |
Independent t test.
In this study, the speed of wound closure was observed between controls and laser acupuncture treatment (Table 4). Independent t test was used because the data distribution was normal. Using Levene's test, the data were homogeneous with a P-value >0.05. Then it was continued to compare the mean values between the control group and the laser acupuncture group, where the results of the independent t test showed a statistically significant difference in the value of wound closure between the 2 groups, both on day 6 (P < 0.05) and day 14 (P < 0.05).
Table 4.
Comparison of Wound Closure in the Control Group and Laser Acupuncture
| Group |
P | ||
|---|---|---|---|
| Control | Laser acupuncture | ||
| Wound closure (%) day 6, (n = 12) | 15.78 ± 8.01 | 24.11 ± 10.64 | 0.041* |
| Wound closure (%) day 14 (n = 6) | 49.93 ± 9.15 | 72.48 ± 14.62 | 0.009* |
Independent t test.
In this study, the speed of wound closure was observed between manual acupuncture therapy and laser acupuncture therapy (Table 5). Independent t test was used because the data distribution was normal. Using Levene's test, the data were homogeneous with a P-value >0.05. Then the mean values between the manual acupuncture group and the laser acupuncture group were compared, where the results of the independent t test showed no statistically significant difference in the value of wound closure between the 2 groups, both on day 6 (P < 0.05) and day 14 (P < 0.05).
Table 5.
Comparison of Wound Closure in Manual Acupuncture and Laser Acupuncture Groups
| Group |
P | ||
|---|---|---|---|
| Manual acupuncture | Laser acupuncture | ||
| Wound closure (%) day 6, (n = 12) | 16.52 ± 12.32 | 24.11 ± 10.64 | 0.121* |
| Wound closure (%) day 14, (n = 6) | 66.96 ± 9.17 | 72.48 ± 14.62 | 0.451* |
Independent t test.
Looking at the chart of wound closure (Fig. 2), there was a significant difference in the speed of wound closure between the laser acupuncture group and the control group since day 6. An independent t test, wherein the mean value of the laser acupuncture group on day 6 was 24.11 ± 10.64 and the mean value of the control group on day 6 was 15.78 ± 8.01, showed a statistically significant difference (P < 0.05). Meanwhile, the significant difference between manual acupuncture groups and control group was only shown on day 14. An independent t test, wherein the mean value of the manual acupuncture group on day 14 was 66.96 ± 9.17 and the mean value of the control group on day 14 was 49.93 ± 9.15, shows a statistically significant difference (P < 0.05).
FIG. 2.
Chart of wound closure among the 3 groups. *P < 0.005. Color images are available online.
Descriptive observations on burn healing were carried out every 2 days, on days 0, 2, 4, 6, 8, 10, 12, and 14. Descriptive observations were made to assess the process of healing phase that occurred among the 3 groups, which include the hemostatis phase, the inflammatory phase, the proliferative phase, and the remodeling phase. Looking at the chart of observation (Fig. 3), it can be seen that the wound healing phase, which consists of the inflammatory, proliferative, and remodeling phases, progresses faster in the manual acupuncture and laser acupuncture groups than in the control group. The hemostasis phase could not be assessed because the burn model in this study used hot metal that acts as a cautery to stop bleeding. Comparison of macroscopic wound healing between the three groups can be seen in the figure below (Fig. 4).
FIG. 3.
Descriptive observation chart of burn healing. Color images are available online.
FIG. 4.
Comparison of wound closure among control group (A), manual acupuncture group (B), and laser acupuncture group (C). It appears that the wound healing in the manual acupuncture and laser acupuncture groups was better than the control group. Color images are available online.
In this study, microscopic observations of burn healing were carried out between controls and manual acupuncture treatment (Table 6). Statistical analysis used is the independent t test if the data distribution is normal, or Mann–Whitney test if the data distribution is not normal. The results of the statistical test showed a significant difference (P < 0.005) on the 7th day of microscopic scoring between the control group (mean value 4 ± 0.89) and the manual acupuncture group (mean value 8.83 ± 1.17). Likewise, on the 14th day, there was a statistically significant difference in microscopic scoring (P < 0.005) between the control group (mean value 10.33 ± 1.21) and the manual acupuncture group (mean value 16.17 ± 1.17).
Table 6.
Comparison of Microscopic Scoring Between Control Group and Manual Acupuncture Group
| Group |
P | ||
|---|---|---|---|
| Control | Manual acupuncture | ||
| Microscopic scoring value day 7, (n = 6) | 4 ± 0.89 | 8.5 (8–11) | 0.003* |
| Microscopic scoring value day 14, (n = 6) | 10.33 ± 1.21 | 16.17 ± 1.17 | <0.001** |
Mann–Whitney test.
Independent t test.
In this study, microscopic observations of burn healing were carried out between controls and laser acupuncture treatment group (Table 7). Statistical analysis used is Mann–Whitney test because the data distribution is not normal. The results of statistical tests showed a significant difference (P < 0.005) on day 7 of microscopic scoring between the control group (mean value 4 ± 0.89) and the laser acupuncture group (mean value 8.5 ± 0.84). Likewise, on the 14th day of microscopic scoring, there was a statistically significant difference (P < 0.005) between the control group (mean value 10.33 ± 1.21) and the laser acupuncture group (mean value 17.83 ± 1.47).
Table 7.
Comparison of Microscopic Scoring Between Control Group and Laser Acupuncture Group
| Group |
P | ||
|---|---|---|---|
| Control | Laser acupuncture | ||
| Microscopic scoring value day 7, (n = 6) | 4 ± 0.89 | 8 (8–10) | 0.003* |
| Microscopic scoring value day 14, (n = 6) | 10.33 ± 1.21 | 18.5 (16–19) | 0.004* |
Mann–Whitney test.
In this study, microscopic observations of burn healing were carried out between manual acupuncture and laser acupuncture (Table 8). Statistical analysis used is the Mann–Whitney test because the data distribution is not normal. The mean value of the manual acupuncture group (8.83 ± 1.17) was relatively the same as the mean value of the laser acupuncture group (8.5 ± 0.84) on the 7th day of microscopic scoring, where the statistical test results did not show a significant difference (P > 0.005). Meanwhile, on the 14th day of microscopic scoring, the mean value of the laser acupuncture group (17.83 ± 1.47) was better than the mean value of the manual acupuncture group (16.17 ± 1.17), but there was no statistically significant difference (the mean value of the manual acupuncture group) (P > 0.005).
Table 8.
Comparison of Microscopic Scoring Between Manual Acupuncture and Laser Acupuncture Groups
| Group |
P | ||
|---|---|---|---|
| Manual acupuncture | Laser acupuncture | ||
| Microscopic scoring value day 7, (n = 6) | 8.5 (8–11) | 8 (8–10) | 0.589* |
| Microscopic scoring value day 14, (n = 6) | 16.17 ± 1.17 | 18.5 (16–19) | 0.058* |
Mann–Whitney test.
Looking at the microscopic scoring chart (Fig. 5) on day 7, it can be seen that both manual acupuncture and laser acupuncture groups had a better effect than controls, especially in reducing inflammatory cells and accelerating the growth of angiogenesis in wounds. Whereas on the 14th day, it can be seen that manual acupuncture and laser acupuncture groups had a better effect than controls on all aspects of microscopic observation of burn healing. The comparison of microscopic wound healing between the three groups can be seen in the attached figure (Fig. 6).
FIG. 5.
Microscopic scoring chart of burn healing among the 3 groups. Color images are available online.
FIG. 6.
Microscopic view of wounds on day 14, control group (A, B), manual acupuncture group (C, D), and laser acupuncture group (E, F). Re-epithelialization (blue arrow), blood vessel growth (yellow arrow), and inflammatory cell (red arrow) count were better in the manual acupuncture and laser acupuncture groups than in the control group. Images (A, C, E) use 4 × 10 magnification, whereas images (B, D, F) use 40 × 10 magnification. Color images are available online.
DISCUSSION
This study is the first to date to compare the effect between manual acupuncture modalities and laser acupuncture on burn healing. It is also the first burn experiment using a combination of local points around the wound together with acupuncture points ST36 Zusanli and LI4 Hegu.
Male Wistar rats were chosen because they generally cost less than female Wistar rats of the same size. Another thing to consider is the influence of hormones on wound healing, as it has been reported that estrogen deficiency is associated with impaired skin wound healing. In addition, the thinner skin in female rats causes a faster wound healing speed by the wound contraction mechanism, whereas male rats have a wound healing mechanism by epithelialization that is more similar to that of humans.16
The degree of burn used in this study was deep partial thickness burns. The reason for choosing that degree of injury is based on epidemiologic studies that have been carried out in Indonesia, showing that deep partial thickness and full thickness burns are the most common.4 In addition, deep partial thickness burns have a lower risk of infection and faster healing time than full thickness burns, making them more ideal to use in this research.
Silver sulfadiazine ointment is often used as a topical antibacterial in the treatment of burns. In this study, silver sulfadiazine ointment can be considered as an equal treatment given to each group so it does not cause research bias.
The frequent measurements that were conducted every 2 days are expected to give more accurate results regarding the effect of treatment on wound healing in rats. In addition, the rats in this study did not receive general anesthesia during manual acupuncture treatment or during laser acupuncture treatment to reduce the stress burden on rats that can inhibit wound healing.
The unavailability of infrared thermography is a limitation of this study. Infrared thermography is a noninvasive tool to measure burn wound depth and healing potential.19 It can be used to ensure that the protocol used in the study correctly produces the desired burn depth. However, in a preliminary experiment, it was confirmed by histologic examination that deep partial thickness burns were successfully created using the protocol.
Based on previous studies, the selection of points around the wound has been shown to accelerate wound healing through local anti-inflammatory mechanisms, stimulate the growth of granulation tissue, and increase angiogenesis and re-epithelialization.7,8,20 Whereas the reason for choosing the ST36 Zusanli and LI4 Hegu points in this study is because these 2 acupoints have a role in systemic anti-inflammatory effects.21 Another mechanism of the ST36 Zusanli and LI4 Hegu points is the release of endorphins, which will be captured by endorphin receptors on the skin, resulting in an increase of granulation tissue proliferation in the wound.22–24 The combination of local and remote points, such as ST36 Zusanli and LI4 Hegu, is expected to further strengthen the effect on wound healing.25
Based on the data from this study, both the manual acupuncture group and the laser acupuncture group showed better wound closure speed than the control group at day 14. However, based on the chart (Fig. 2), it can be seen that the laser acupuncture group has started to show a significant difference when compared with the control group since day 6 (P = 0.041). Whereas the manual acupuncture group only started showing a significant difference when compared with the control group on day 14 (P = 0.009).
Looking at the course of the chart line, it appears that the laser acupuncture group has an advantage over the manual acupuncture group, although it is not statistically significant. So it can be concluded that laser acupuncture group may have a better effect on the healing speed of burns than the manual acupuncture group. However, further research in a longer observation period is still needed to ensure this.
The wound healing process consists of various dynamic and overlapping phases: (1) hemostasis phase, (2) inflammatory phase, (3) proliferative phase, and (4) remodeling phase. Therefore, descriptive observations on wound healing are needed to assess not only the speed of wound healing, but also the description of the wounds that occur in each of these phases. Based on the chart (Fig. 3), it can be concluded that each phase of wound healing in the manual acupuncture and laser acupuncture groups was faster and better than the control group.
In line with the results of the macroscopic assessment discussed earlier, the microscopic observations of burn healing treated using manual acupuncture and laser acupuncture also gave better results than the control group. The wound healing progresses faster at the microscopic level than at the macroscopic level. This may explain why microscopic observations in the manual acupuncture group on the 7th day already showed a statistically significant difference compared with the control group (P = 0.003). Meanwhile in macroscopic observation, a significant difference in the manual acupuncture group compared with the control group was seen on the 14th day (P = 0.009).
The certain reason why laser acupuncture gives better results than manual acupuncture is not known. However, it is suspected that the reason is related to the mechanism of action of laser acupuncture that is more directly targeted into the cellular level. The molecular and cellular mechanism of laser acupuncture starts from the absorption of photons by the mitochondria.
Subsequently, there is an increase in low-level ATP and ROS production, which then activates transcription factors, such as nuclear factor kappa B, to induce many of the gene transcript products responsible for the beneficial effects of laser,26 such as anti-inflammatory responses, growth factors production, cell proliferation, and extracellular matrix deposition.12,27,28 This mechanism is thought to cause a better wound healing process in the laser acupuncture group than in the manual acupuncture group, although statistically it did not show a significant difference.
CONCLUSION
Both manual acupuncture and laser acupuncture can be given as an adjunct therapy to accelerate the healing of burns in patients, especially laser acupuncture, which has the advantages of being noninvasive, painless, and lower risk of infection, making it more ideal for use in treating burn patients than manual acupuncture.
AUTHOR DISCLOSURE STATEMENT
Authors declare no conflict of interest.
FUNDING INFORMATION
No funding was received for this paper.
To receive CME credit, you must complete the quiz online at: www.medicalacupuncture.org/cme
CME Quiz Questions
Article learning objectives: After studying this article, participants should be able to explain the differential benefit between Laser Acupuncture and Manual Acupuncture in experimental burn wound healing outcomes; describe the adjunctive role of acupuncture in wound healing; and identify the clinical advantages of Laser Acupuncture over Manual Acupuncture.
Publication date: August 18, 2022
Expiration date: August 31, 2025
Disclosure Information:
None of the authors, editors, or reviewers of this educational activity, have relevant financial relationship(s) with ineligible companies to disclose.
Questions:
-
1.
According to the article, one advantage of low energy Laser Acupuncture over Manual Acupuncture is?
-
A.
It is painless
-
B.
It has a longer duration of treatment
-
C.
It is associated with an increased risk of infection
-
D.
It is more invasive
-
A.
-
2.
Manual acupuncture accelerates burn healing by?
-
A.
Increased fibroblast proliferation and scar formation
-
B.
Reducing inflammation, Improving micro-circulation
-
C.
Prolonging the multiple phases of wound healing
-
D.
Increasing inflammatory response
-
A.
-
3.
The panniculus carnosus muscle
-
A.
Increases the duration of wound healing
-
B.
Restricts micro-circulation
-
C.
Facilitates healing
-
D.
Increases the risk of systemic infection, sepsis
-
A.
-
4.
The experimental acupuncture treatment administered was
-
A.
bilateral LI4 and ST36
-
B.
4 needles surrounding the experimental wound
-
C.
Tai Yin/ Yang Ming subcircuit
-
D.
bilateral LI4, bilateral ST36, 4 needles around wound
-
A.
-
5.
The Laser Acupuncture used was in what spectrum?
-
A.
Infra-Red
-
B.
Yellow
-
C.
Green
-
D.
Violet
-
A.
Continuing Medical Education – Journal Based CME Objectives:
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