Efficacy of pulsed radio frequency energy therapy in temporomandibular joint pain and dysfunction

This randomized double-blind study evaluated the effectiveness of pulsed radio frequency energy therapy (PRFE) in patients with temporomandibular joint arthralgia. Forty subjects (age range 22 to 55 yrs.) were assigned randomly into two equal groups: (1) Experimental group received PRFE using the Energex unit (Energex, Inc. Emerson, New Jersey) and (2) Control group received PRFE placebo treatment using a sham device. Both groups received six applications to the TMJ area over two weeks. Data were analyzed for the following times: baseline, first and second follow-up visits. Numerical Rating Scale scores for TMJ pain showed a significant reduction over time for the experimental group (mean = 6.13 to 3.05, p < 0.001). There was also a significant effect for the controls (mean = 5.35 to 4.20, p = 0.01). The effect for experimental subjects was a mean reduction of 3.07 versus 1.15 for controls. The significant reduction in controls was attributed to the placebo effect. The experimental group showed a significant increase in mouth opening (mean = 34.95 to 41.70 mm, p = 0.002), right lateral movement (mean = 7.85 to 10.80 mm, p = 0.001) and left lateral movement (mean = 7.65 to 10.85 mm, p < 0.0001). No significant (p > 0.1) change in the control group occurred for mouth opening (mean = 38.50 to 39.65 mm), right lateral movement (mean = 8.60 to 8.75 mm) and left lateral movement (mean = 8.50 to 8.80 mm). No side effects were reported during the treatment and the two week follow-up. These results suggest strongly that PRFE is a safe and effective treatment for TMJ arthralgia as well as for increasing mandibular range of motion.     

Iloprost inhibits superoxide formation and gp91phox expression induced by the thromboxane A2 analogue U46619, 8-isoprostane F2alpha, prostaglandin F2alpha, cytokines and endotoxin in the pig pulmonary artery

Since the roles of thromboxane A2 (TXA2), prostacyclin (PGI2) and 8-isoprostane F2alpha in mediating vascular O2*- formation and its relation to adult respiratory distress syndrome (ARDS) is unknown, the effects of these eicosanoids on the expression of gp91phox (catalytic subunit of NADPH oxidase) and O2*- release from cultured pig pulmonary artery (PA) segments, PA vascular smooth muscle cells (PAVSMCs) and PA endothelial cells (PAECs) were investigated. PA segments, PAVSMCs and PAECs were incubated with the TXA2 analogue, U46619, (+/-LPS, tumour necrosing factor-alpha (TNF-alpha) or IL-1alpha), 8-isoprostane F2alpha and+/-iloprost (a stable PGI2 analogue) for 16 h. The formation of superoxide dismutase-inhibitable O2*- was then measured spectrophotometrically and gp91phox expression assessed using Western blotting. In parallel experiments, whole PA segments were treated with LPS, TNF-alpha and IL-alpha after which time TXA2, PGI2, PGF2alpha and 8-isoprostane F2alpha formation was measured using enzyme-linked immunoassays. U46619, PGF2alpha and 8-isoprostane F2alpha promoted the formation of O2*- in PA segments, PAVSMCs and PAECs, an effect inhibited by diphenyleneiodonium and apocynin (both NADPH oxidase inhibitors) and upregulated the expression of gp91phox in PAECs and PAVSMCs. These effects were augmented by LPS, TNF-alpha and IL-1alpha but inhibited by iloprost. Under identical incubation conditions, IL-1alpha, LPS and TNF-alpha all induced an increase in the formation of TXA2, PGF2alpha and 8-isoprostane F2alpha but reduced the concomitant formation of PGI2. These data demonstrate that LPS and cytokines influence the relative balance of TXA2, PGI2, PGF2alpha and 8-isoprostane F2alpha in pig PA, which in turn alter NADPH oxidase expression and O2*- formation. These novel findings have implications in devising effective strategies for treating ARDS.British Journal of Pharmacology (2004) 141, 488-496. doi:10.1038/sj.bjp.0705626     

半夏泻心汤及其拆方对幽门螺杆菌相关性胃炎小鼠血清炎性相关因子的影响

目的:探讨半夏泻心汤治疗幽门螺杆菌感染所致胃黏膜炎症的内在机制。方法:用幽门螺杆菌菌液给小鼠灌胃造模,然后随机分成10组,分别给予相应的药物治疗。观察各组小鼠胃黏膜的形态学改变及血清中NO和IL-8含量的变化。结果:模型组小鼠血清中NO、IL-8水平较空白组显著升高(P<0·01),各治疗组NO、IL-8水平均有不同程度的降低,其中以半夏泻心汤组、苦寒组、半夏加苦寒组、苦寒加甘温组降低最为显著,与模型组比较差异具有显著性意义(P<0·01)。结论:半夏泻心汤通过降低血清中NO、IL-8的含量而减轻胃黏膜的炎症反应,从而发挥其对胃黏膜的保护作用。     

Female androgen insufficiency: the Princeton consensus statement on definition, classification, and assessment

OBJECTIVE: To evaluate the evidence for and against androgen insufficiency as a cause of sexual and other health-related problems in women and to make recommendations regarding definition, diagnosis, and assessment of androgen deficiency states in women. DESIGN: Evaluation of peer-review literature and consensus conference of international experts. SETTING: Multinational conference in the United States. PATIENT(S): Premenopausal and postmenopausal women with androgen deficiency. INTERVENTION(S): Evaluation of peer-review literature and development of consensus panel guidelines. RESULT(S): The term "female androgen insufficiency" was defined as consisting of a pattern of clinical symptoms in the presence of decreased bioavailable T and normal estrogen status. Currently available assays were found to be lacking in sensitivity and reliability at the lower ranges, and the need for an equilibrium dialysis measure was strongly emphasized. Causes of androgen insufficiency in women were classified as ovarian, adrenal, hypothalamic-pituitary, drug-related, and idiopathic. A simplified management algorithm and clinical guidelines were proposed to assist clinicians in diagnosis and assessment. Androgen replacement is currently available in several forms, although none has been approved for treatment of sexual dysfunction or other common symptoms of female androgen insufficiency. Potential risks associated with treatment were identified, and the need for informed consent and careful monitoring was noted. Finally, the panel identified key goals and priorities for future research. CONCLUSION(S): A new definition of androgen insufficiency in women has been proposed along with consensus-based guidelines for clinical assessment and diagnosis. A simplified management algorithm for women with low androgen in the presence of clinical symptoms and normal estrogen status has also been proposed.     

Radiofrequency tumor ablation: insight into improved efficacy using computer modeling

OBJECTIVE: To use computer modeling of the Bio-Heat equation to demonstrate factors influencing RF ablation tissue heating. CONCLUSION: Computer modeling demonstrates the importance of energy deposition, tumor and background tissue electrical and thermal conductivity, and perfusion on RF ablation outcomes.     

Impact of an educational program and policy changes on decreasing catheter-associated bloodstream infections in a medical intensive care unit in Brazil

BACKGROUND: Central venous catheter-associated bloodstream infections (CVC-BSI) are a frequent cause of morbidity and mortality in intensive care settings. Many strategies have been used to decrease the risk of CVC-BSI; however, few studies have explored the educational intervention as an approach to reduce the CVC-BSI rates. OBJECTIVE: The purpose of this study was to determine the impact of an educational program targeted to specific points observed during CVC care practices on decreasing CVC-BSI in a medical intensive care unit. METHODS: An educational program was developed by a multidisciplinary task force to highlight correct practices for CVC care. Relative risk ratios, 95% confidence intervals, and P values were determined for all primary and secondary outcomes. The chi 2 linear test for trends of CVC-BSI rates was performed during the study period and the following year. RESULTS: Forty-eight primary bloodstream infections occurred in 2450 catheter-days (20 per 1000 catheter-days) in the 16 months before the intervention. After the educational intervention and policy changes such as standardized povidone-iodine use during dressing care, the number of CVC-BSI dropped to 16 in 1381 catheter-days (11 per 1000 catheter-days), a decrease of 40%. The rate of CVC-BSI remained almost the same, 22 in 1701 catheter-days (12 per 1000 catheter-days), during the following year after the educational intervention (P = .07). The distribution of pathogens was different comparing the pre- and postintervention period. Staphylococcus aureus was the most common pathogen in preintervention, decreasing significantly during the study period (P = .02). The adhesion to the overall catheter care policy improved significantly in the postintervention period (P < .01). CONCLUSION: A multiple approach included an educational strategy, targeted to specific problems observed during a careful evaluation of CVC care practices, and policy changes can decrease rates of CVC-BSI. However, despite the good results, our rates are still high, and reinforcement of CVC care practices will be continued.     

Migraine treatment throughout the lifecycle

The treatment of migraine headache is often suboptimal despite significant advances in our understanding of the pathophysiology and treatment of migraine. Children, adolescents, women and the elderly are particularly at risk of receiving inadequate or inappropriate therapy. In this review, the reader is brought up-to-date with changes to the International Headache Society diagnostic criteria for migraine. The pathophysiology of migraine is also reviewed, with a special emphasis on the evolving concept of central sensitization and cutaneous allodynia since this concept has led to a paradigm shift in the way migraines are managed. A review of the evidence supporting the benefits of early treatment before pain becomes moderate-to-severe is provided. Recommendations for acute and prophylactic treatments throughout the lifecycle are made in light of clinical practice guidelines and more recent evidence. Lastly, the current optimal treatment of migraine is provided and the potential role of calcitonin gene-related peptide antagonists in the future is discussed.     

The 1st annual meeting of the American Society of Gene Therapy

The inaugural meeting of the American Society of Gene Therapy (ASGT) attracted over 1700 participants to the Pacific gateway city of Seattle, Washington for a multifaceted 4 day meeting organised into a series of symposia, workshops, poster sessions and educational opportunities representative of gene therapy's immense diversity. Presentations from the international assemblage of industrial and academic scientists covered a blend of data from cutting edge research to current clinical investigations across a spectrum of therapeutic targets. Unique educational sessions allowed participants to gain basic information regarding areas of gene therapy research in which they lacked familiarity, whereas several 'Meet the Investigator' sessions allowed participants to interact directly with experts in small group settings in order to obtain a more sophisticated perspective through informal dialogue. A large majority of the symposia and poster presentations showcased the development and current successes of viral-mediated gene therapy although non-viral approaches received their share of attention. Despite the fact that promising results were presented from ongoing clinical trials using viral-mediated gene therapy, much of the symposia addressed the accompanying problems of immunogenicity, low levels of gene expression and lack of control of gene expression that are presently limiting the clinical success of virally mediated gene transfer.