Ist die analgetische Wirkung der Akupunktur ein Placeboeffekt?

The German acupuncture trials ART and GERAC have shown that acupuncture and sham or minimal acupuncture were equally effective in the reduction of chronic pain symptoms. These results have prompted an ongoing discussion as to whether acupuncture exerts its effects through a placebo response. Increasing knowledge about the neurobiology of pain and its intrinsic control suggests a combination of acupuncture-specific neurophysiologic effects combined with effects that match those of expectation-induced placebo analgesia.     

Inverse MCP-1/IL-8 ration in effluents of CAPD patients with peritonitis and in isolated cultured human peritoneal macrophages

An important event in intraperitoneal inflammation is the influx of leukocytes into the peritoneal cavity. Chemokines such as interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) play a major role in the recruitment of immune cells to the site of inflammation. We determined the concentrations of two members of the chemokine family, IL-8 and MCP-1, in the dialysate effluents of 18 continuous ambulatory peritoneal dialysis (CAPD) patients with peritonitis and of 18 non-infected CAPD patients by specific enzyme-linked immunosorbent assays (ELISA). Isolated peritoneal macrophages (PMs) from CAPD peritonitis patients were cultured and IL-8 and MCP-1 production was determined on protein (ELISA) and mRNA level (Northern blot) at designated timepoints over a 72-h culture period. PMs from non-infected patients served as controls. Much higher concentrations of IL-8 and MCP-1 were found in dialysate effluents of peritonitis patients than in effluents of non-infected patients: IL-8 2.39&plusnn;1.15 vs 0.05±0.01 ng/ml and MCP-1 release by cultured PMs from peritonitis patients and non-infected patients revealed significant differences: IL-8 40.3±2.2 ng/ml after 3 h and 194.2 ±34.9 ng/ml after 12 h compared to 21.02±6.15 ng/ml after 3 h and 89.64±30.28 ng/ml after 12 h, respectively; MCP-1 3.3±0.9 ng/ml after 3 h and 25.7±7.4 ng/ml after 12 h compared to 1.1±0.2 ng/ml and 1.8±0.2 ng/ml, respectively. Interestingly, the ratio of IL-8 to MCP-1 concentrations in the dialysate effluents (1:9.4) is reversed in the supernatants of cultured PMs. In the effluents and in the culture supernatants of PMs from CAPD peritonitis patients high amounts of IL-8 and MCP-1 are detectable, suggesting that PMs are an important source for these chemokines during peritonitis. Because of the inverse ratio of IL-8 and MCP-1 in the effluents and culture supernatants it can be assumed that PMs are responsible for the MCP-1 concentration to a lesser extent than for the IL-8 concentration in the effluents.     

Altered erythrocyte sodium-lithium counter-transport and Na+/K+-ATPase activity in cystic fibrosis

Patients with cystic fibrosis (CF) exhibit normal concentrations of sodium and chloride in spite of the disturbance of Cl^- and Na+ transport in epithelial cells. To characterize compensatory mechanisms in the regulation of sodium homeostasis, erythrocytes of 13 CF patients were analysed for sodium-lithium counter-transport (SLC), Na+/K+ -ATPase activity and intracellular sodium content. Values were compared to those of healthy controls. Patients with CF had normal serum sodium and chloride concentrations and renal excretions of these ions were within the physiological range. Intracellular sodium concentration was similar in the CF and the control group (6.8 ± 2.2 vs 5.7 ± 1.0 mmol/l RBCs). Red blood cells' SLC and Na+/ K+ -ATPase activity were elevated in CF patients (381 ± 106 μmol/h/l RBCs vs 281 ± 64; p < 0.01) and (445 ± 129 μmol ATP mg prot/h vs 322 ± 84, p < 0.01). Our study demonstrates that transmembrane cation transport systems are highly activated in CF. The increased sodium transport may be part of a compensatory mechanism of sodium homeostasis in children with CF.     

Patterns of complementary and alternative medicine (CAM) use in patients with inflammatory bowel disease: perceived stress is a potential indicator for CAM use

INTRODUCTION: The reasons for using complementary and alternative medicine (CAM) and the perception of stress in a group of patients with inflammatory bowel disease (IBD) who are actively interested in CAM were compared with those of a randomly selected group of IBD patients (controls). METHODS: Participants in a national lay workshop on CAM of the German Crohn's and Ulcerative Colitis Association (DCCV) (the study group) and a representative sample of the approximately 16,000 members and associates of the DCCV (the control group) were asked to complete a self-administered questionnaire that covered socio-demographic data, past medical history, stress perception, current conventional treatment, and interest in, and usage of, CAM. RESULTS: One-hundred and twelve (80%) of the approximately 140 participants of the lay workshop and 684 (68.8%) of the 994 IBD patients in the control group completed and returned the questionnaires. The duration of illness, taken as the time since diagnosis, was shorter for the participants of the lay workshop than for the control group (p=0.0035), and fewer workshop patients stated that their disease was currently "in remission" (p=0.0377). The two groups did not differ significantly in their experiences with CAM use. Among personal reasons given for CAM use, the "lack of success of conventional therapy" (p=0.014), the wish "to take a holistic therapeutic approach" (p=0.0008), and "a different point of view from that of my physician about the cause of, and treatment options for, IBD" (p=0.038) were chosen more often in the group of workshop participants than in the control patients. A total of 92% of the workshop patients perceived stress as having a negative effect on their IBD; this is a significantly greater percentage than in the control group (70.5%; p=0.0001). CONCLUSIONS: A group of IBD patients with an active interest in CAM showed distinct differences from a randomly selected group of IBD patients in their reasons for using CAM, particularly in their wish to take a holistic therapeutic approach. Patients who think that stress has a negative effect on their IBD appear to be more likely to use CAM.     

Tubular proteinuria in IgA glomerulonephritis

In the renal biopsy samples of some patients with IgA glomerulonephritis (IgA GN), tubulointerstitial changes and a significant correlation between these changes and the serum creatinine levels had been observed earlier. In order to get an insight into the function of the tubules, 45 patients with IgA GN have been examined for proteinuria with special reference to low molecular weight (LMW) proteins, also called tubular proteins using sodium-dodecylsulphate polyacrylamide gel electrophoresis (SDS-PAGE). Thirty-seven of the 45 patients had proteinuria (200-1890 mg/day). On the basis of the middle molecular weight/high molecular weight (MMW/HMW) protein ratio, the proteinuria was non-selective in 28. Twenty-nine patients had 40-200 mg LMW protein/day in the urine. There was a statistically significant correlation between the tubulointerstitial changes seen in the renal biopsy samples (characterized by the tubulointerstitial index) and the tubular proteinuria. On the basis of these results it is suggested that in most patients with IgA GN there is, in addition to the glomerular lesion, also morphological and functional tubulointerstitial damage, which is in connection with the progression of the disease.