Placebo effect in patients with algic syndrome

Introduction: In recent years, the placebo effect has become more of a target of scientific inquiry, rather than a nuisance factor in clinical research setting. A better understanding of the neurobiology of the placebo and nocebo responses will represent the basis for designing behavioral protocols that can be employed as supportive therapy together with standard pharmacological regimen, in order to maximize the therapeutic outcome for the patients benefit. Objectives: to study the psychological profile of patients respondent and non-respondent to placebo; to study the factors that have an impact on the magnitude of placebo response; to study the autonomic profile of patients respondent and non-respondent to placebo; to determine sensitivity to placebo; to develop a screening test to estimate the sensitivity to placebo. Materials and methods: Subjects: a group of 15 patients with chronic migraine, selected according to HIS 2004 criteria, with average age of 29.9±2.6 years. Pain induction: pain was induced experimentally by means of the tourniquet technique. Drugs: for the placebo condition, calcium gluconate was administered; for analgesic control condition was used baralghetas. Results: This group was divided into respondent and non respondent to placebo subgroups. As criterion of division had served the decrease of the pain reported degree between control condition of natural flow and the placebo condition, with at least 10%. In the group respondent to placebo (8 patients, 53.3%), during the placebo condition, pain decreased by 23.17% (p<0.001) and pain tolerance value increased by 28.4% (p<0.05) compared to control condition of natural flow. For the SCL90 questionnaire scale were obtained higher degrees of non-respondents to placebo in comparison with respondents to placebo for the following scale: depression (2.03±0.01 in comparison with 1.35±0.08, p<0.001), anxiety (1.7±0.04 in comparison with 1.11±0.24, p<0.05), psychotic scale (1.45±0.06 in comparison with 0.98±0.2, p<0.05). Higher degrees of non-respondents to placebo were obtained on the following scales of autonomic profile (Ion Moldovanu 2011): anxiety and panic attacks (16±0 in comparison with 11.5±1.4, p<0.01), thermoregulation (40.5±5.9 in comparison with 20.33±3.4, p<0. 05). Degree of suggestibility was obtained higher among respondents to placebo compared to non-respondents. Conclusion: In patients with chronic migraine the presence of placebo response depends on anxiety, depression and the degree of suggestibility. Thus it is possible to perform a screening test containing questions from the questionnaire scales used, where there have been registered statistically significant differences between the groups respondent and non-respondent to placebo

The MODE family of on-orbit experiments: The Middeck Active Control Experiment (MACE)

A flight experiment entitled the Middeck Active Control Experiment (MACE), proposed by the Space Engineering Research Center (SERC) at the Massachusetts Institute of Technology, is described. This is the second in a family of flight experiments being developed at MIT. The first is the Middeck 0-Gravity Dynamics Experiment (MODE) which investigates the nonlinear behavior of contained fluids and truss structures in zero gravity. The objective of the MACE program is to investigate and validate the modeling of the dynamics of an actively controlled flexible, articulating, multibody platform free floating in zero gravity. A rationale and experimental approach for the program are presented. The rationale shows that on-orbit testing, coupled with ground testing and a strong analytical program, is necessary in order to fully understand both how flexibility of the platform affects the pointing problem, as well as how gravity perturbs this structural flexibility causing deviations between 1- and 0-gravity behavior. The experimental approach captures the essential physics of multibody platforms, by identifying the appropriate attributes, tests, and performance metrics of the test article and defines the tests required to successfully validate the analytical framework

Non-Anatomic Proximal Realignment for Recurrent Patellar Dislocation Does Not Sufficiently Prevent Redislocation

Several operative techniques have been described for recurrent patellar dislocation. Clinical results vary depending on the procedure and indication. The present study aimed to evaluate the clinical outcome of Insall’s proximal realignment for recurrent patellar dislocation at mid-term follow-up. Forty-five patients were reviewed with a mean follow-up period of 49 months after having undergone Insall’s procedure. Outcome measures included reports of redislocations, complications, patient-reported outcome scores (Kujala, Tegner activity scale) and subjective assessment. No statistically significant improvements (p < 0.05) in patient-reported outcome measures were noted. Sixteen patients (35%) had poor to fair results using the Kujala score. Subjective assessment revealed that 12 patients (27%) were dissatisfied with the outcome of their surgery and would not undergo the same procedure. Ten patients (22%) had suffered from redislocation at the latest follow-up. In 4 cases (9%), intra-articular knee hematoma occurred which required arthroscopic intervention. The overall mid-term outcome of the present study shows low patient satisfaction. Non-anatomic realignment for recurrent patellar dislocation does not adequately prevent redislocation

Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE). We provide a detailed and comprehensive review of the soft tissue, arterial system, and innervation to the patellofemoral joint in order to supply the clinician with the knowledge required to assess the anatomy and make recommendations to patients identified as potentially at risk. The purpose of this article is to review knee anatomy and the literature regarding potential risk factors associated with patellofemoral pain syndrome and prehabilitation strategies. A comprehensive review of knee anatomy will present the relationships of arterial collateralization, innervations, and soft tissue alignment to the possible multifactoral mechanism involved in PFPS, while attempting to advocate future use of different treatments aimed at non-soft tissue causes of PFPS