Acupuncture and Related Therapies最新文献

Hand-held electroacupuncture devices have been traditionally used as a tool to locate “acupoints” trough detection of differences in skin conductivity. While teaching at the Post-Graduation Courses on Medical Acupuncture in Portugal, both at the Universidade Nova de Lisboa and at the Universidade do Minho, the hand-held acupuncture device has become a fundamental tool for location of acupoints and teaching functional muscular neuroanatomy. Unlike traditional use, the device is used after needle insertion. After correct identification of the insertion site and needling, the needles are stimulated with the hand held device, enabling the students to check if the needle is correctly inserted and also visualize the action of the needled muscle. The hand held device is also a good tool for musculo-skeletal diagnosis and treatment.

EU is facing a growing health crisis due to the aging population and the rising levels of chronic diseases, aggravated with the context of economic austerity.

A better use of healthcare budgets improving treatments cost efficiency may be the most reliable answer for a sustainable health system. Assessing the contribution of acupuncture to the improvement of Public Health should be based on solid evidence. Economic evaluations of several Complementary Alternative Medicines (CAM) performed recently demonstrated a positive impact with cost savings when compared with usual care. Nevertheless, the different approaches, levels of education and practices of acupuncture raise questions of extrapolation of these results. The physicians interested in acupuncture have now some challenges for the next years so that a consensus can be achieved to harmonise the clinical practice and the education at the highest level and according to the best scientific knowledge.

In the past, the teaching of acupuncture to medical doctors in Portugal was mostly linked to Traditional Chinese Medicine (TCM) concepts. The presentation of the complex TCM diagnostic methods and treatment strategies to medical doctors touches the frontier of “suspension of disbelieve” in order to be able to understand and, in particular, apply those concepts to the treatment. Most of the TCM concepts are almost impossible to translate to western medical terms, making the communication among health professionals difficult, thus preventing acupuncture from integrating into current health care.

Increasing evidences attribute a central role to oxidation/reduction (redox) homeostasis in controlling cell physiology, with redox transitions of glutathione and sensitive cysteines in protein constituting the major players. Thiol redox control of protein activity and gene expression ultimately extends to the proliferation/differentiation switch. Several diseases, including the highest causes of mortality, have been attributed to a shift toward a more oxidized environment. Interfering with thiol redox transitions in diseases therefore appears a major clinical objective, N-acetyl-cysteine (NAC) being the most obvious candidate drug. Targets comprise diseases related to altered control of proliferation/differentiation, adhesion, inflammation. To quote a few benign disorders, gynecological diseases can include endometriosis, polycystic ovary syndrome, sterility originating from defective embryo implantation; dermatological diseases can include acne, alopecia, psoriasis, and vitiligo. We review here our journey with NAC, from mechanisms identified in cells, though an animal model and finally to the clinic where cases of successful patient's treatment are reported, some unpublished before. NAC effect was eventually enhanced by a combination with melatonin and selenium, both involved in the pathway of redox regulation. Further studies can well extend NAC use to several other diseases, while providing better treatment modalities and helping in identifying further specifically targeted compounds.

A female paediatric patient aged 9 years presented with right long thoracic nerve palsy for the second time. The first injury that occurred in 2011 was due to a fall and although the patient had a paralysis of the serratus anterior muscle and was unable to elevate the arm, with rehabilitation and conventional physiotherapy, she recovered completely according to the nerve conduction test that was conducted six months post recovery.

The second injury to the long thoracic nerve was due to a ballet movement that occurred in 2012. Besides the nerve palsy that reoccurred there was also a complication of severe pain and evidence of a complex regional pain syndrome (CRPS). The second injury was limited by the inability to participate in rehabilitation exercises and physiotherapy due to pain and hyperaesthesia in the distribution of C5 and C6 dermatome both in the trapezius and shoulder region. The third nerve conduction test deteriorated to those recorded after the first nerve conduction test.

A different physiotherapy approach was then applied – initially to reduce pain and decrease hyperaesthesia and then to attempt to increase nerve conduction by the inclusion of an electrical device that simultaneously delivers both a low and a high frequency current. This treatment was combined with various pain resolving tactics including acupuncture, individual sub-liminal, low and high frequency electrical currents. Several interventions were applied to tailor the treatment to the patient to achieve maximal improvement in pain and mobility. It is therefore difficult to attribute improvement to one particular modality or even natural resolution of the condition however previous clinical application and experience of activating nerve conduction with the combination current in other conditions implied that improvement could be expected. This particular electrical current is a combination of a low frequency and a magnetic field.

The condition resolved completely with full movement and no pain after 13 treatments over two months – it was evident that the combination of treatment had an effect on expediting the healing in the nerve. The patient was able to resume all her normal activities including gymnastics and ballet.

Exhaled breath contains thousands of volatile organic compounds (VOCs) of which the composition varies depending on status of the individual and the environment. Different metabolic processes within the body produce volatile substances that are released into the blood. When the blood reaches the lungs the products are released into lung tissue and airways.

Also, chronic inflammation and/or oxidative stress can result in the excretion of volatile compounds that generate unique VOC patterns. Therefore, measuring the presence of VOCs in exhaled air (breathomics), for clinical diagnosis and monitoring purposes has gained increased interest over the last years.

This paper describes one methodology based on gas chromatography (GC) and deep ultraviolet (DUV) spectroscopy. Spectra of compounds found in exhaled breath are presented.

Pain is a vital sign in infants and children and is essential for survival. Pain is subjective and it is only the individual who can describe the pain or the anticipation of pain. In infants, observation of behaviors that suggests pain, physiological and biological markers are used in the clinical assessment.

It is well established that infants from the gestational age of about 20 weeks have a functional pain system, even if immature, which can perceive and respond to tissue injury. Prolonged or repetitive nociceptive input and stress is harmful to the nervous system especially in the neonatal period of life. The nervous system shows a high degree of plasticity and untreated pain can lead to long-term undesired changes. Preventing or treating pain is therefore a primary goal in infants and children.

Over the last decades, the practice of pediatric pain management has advanced rapidly. Pain management includes analgesics as well as non-pharmacological approaches. A multimodal strategy is often advocated. Among the non-pharmacological methods medical acupuncture has emerged as an alternative in its own right in for example baby colic.

Objectives

Incidence of postoperative nausea and vomiting (PONV) ranges from 20 to 30% in, routine procedures, up to 70–80% in high-risk patients. Prevention of PONV is usually based on, antiemetic drugs but pharmacological interventions are only partially effective, so we tested efficiency, of acupressure in PONV prevention.

Design

We included 180 patients American Society of Anaesthesiologists physical status classification, I and II, who underwent a laparotomy. The study was prospective, and placebo controlled. Nausea and, vomiting were separately monitored on patients with intravenous and epidural analgesia. Patients were allocated in six groups, with 30 patients in each group: group I (epidural analgesia + acupressure), group II (epidural analgesia + metoclopramide), group III (epidural analgesia + sham acupressure), group IV (intravenous analgesia + acupressure), group V (intravenous analgesia + metoclopramide) and, group VI (intravenous analgesia + sham acupressure).

Results

Acupressure reduced PONV from 57 to 37% (P < 0.001) in patients with intravenous, postoperative analgesia, and from 63 to 20% (P < 0.001) in patients with epidural postoperative, analgesia compared to placebo. Metoclopramide has also reduced the incidence of PONV from 57 to 40% (P = 0.003) in patients with intravenous postoperative analgesia and in patients with epidural, postoperative analgesia from 63 to 17% (P < 0.001) compared to placebo.

Conclusions

Our study confirmed positive effect of acupressure in PONV prevention in patients after, elective laparotomy, regardless of the type of postoperative analgesia, intravenous or epidural. Thus, since acupressure is a simple and inexpensive method of PONV prevention, without side effects, it, should be considered as standard for PONV prevention on laparatomy patients.

The aim was to investigate the mechanisms behind sensory stimulation which can be used to desensitize CNS in patients with atypical orofacial pain. Earlier studies have shown that the kappa-receptor in the periaqueductal gray (PAG) is involved in sensory stimulation induced antinociception. A possible antinociceptive role for dynorphin B (DynB) in supraspinal regions was tested. The behavioral effect of sensory stimulation in conscious rats, by stroking the fur, was tested using the nociceptive test hotplate and the hindpaw withdrawal latency (HWL) was measured. In anesthetized rats sensory stimulation during different modalities, stroking or pinching was performed and the microdialysis technique was used to determine the extra cellular level of DynB in the ventrolateral PAG. To evaluate the antinociception after sensory stimulation DynB was microinjected into the PAG and the effect was measured with the HWL to heat. The results showed that sensory stimulation in conscious rats significantly increased the HWL as an antinociceptive effect. Innocuous sensory stimulation such as stroking the fore paw significantly elevated the DynB level in the PAG compared to internal control. After pinching a tendency to delayed release of DynB was seen and a possible discharge of the nerve terminals could be speculated upon. The blood pressure did significantly increase after pinching but not after stroking. An intra-PAG injection of DynB into the PAG increased the HWL to heat after 24 h compared to basal level of HWL and to saline treated animals. In conclusion, DynB is involved in the antinociception that is triggered by sensory stimulation.

Electroacupuncture (EA) has been widely used for the management of chronic pain, but the mechanism of EA-induced analgesia is not yet fully understood. The present study evaluated the effectiveness of intrathecal antagonists of serotonergic (methysergide), α1- (WB4101) and α2- (idazoxan) adrenoceptors, opioid (naloxone), muscarinic (atropine), GABA_A (bicuculline) and GABA_B (phaclofen) receptors in blocking 2/100-Hz electroacupuncture-induced analgesia (EAIA) in the rat tail-flick test. Rats were taken for determination of baseline tail-flick latency (TFL). Vehicle or drug was then injected intrathecally in a volum of 10 μl and EA was applied bilaterally to the Zusanli and Sanyinjiao acupoints under light isoflurane anesthesia. TFL was measured within 30 s after the end of stimulation and at 10-min intervals for up to 60 min. Twenty minutes of 2/100 Hz EA significantly increased TFL. The EAIA was completely inhibited by intrathecal methysergide (30 μg), significantly reduced in intensity and duration by intrathecal idazoxan (50 μg), naloxone (20 μg) or phaclofen (20 μg), and reduced in duration by intrathecal WB4101 (10 μg), atropine (20 μg) or bicuculline (3 μg). The intensity of the 2/100 Hz-EAIA depends on serotonergic and α2-noradrenergic descending mechanisms, and involves spinal opioid and GABA_B modulation. The duration of 2/100 Hz-EAIA depends on both α1- and α2-noradrenergic descending mechanisms, and involves spinal opioid, muscarinic cholinergic, and GABA_A and GABA_B modulation.