Efficacy and safety of acupuncture for chronic pain caused by gonarthrosis: A study protocol of an ongoing multi-centre randomised controlled clinical trial [ISRCTN27450856]

BACKGROUND: Controlled clinical trials produced contradictory results with respect to a specific analgesic effect of acupuncture. There is a lack of large multi-centre acupuncture trials. The German Acupuncture Trial represents the largest multi-centre study of acupuncture in the treatment of chronic pain caused by gonarthrosis up to now. METHODS: 900 patients will be randomised to three treatment arms. One group receives verum acupuncture, the second sham acupuncture, and the third conservative standard therapy. The trial protocol is described with eligibility criteria, detailed information on the treatment definition, blinding, endpoints, safety evaluation, statistical methods, sample size determination, monitoring, legal aspects, and the current status of the trial. DISCUSSION: A critical discussion is given regarding the considerations about standardisation of the acupuncture treatment, the choice of the control group, and the blinding of patients and observers

The Fab region of IgG impairs the internalization pathway of FcRn upon Fc engagement

Binding to the neonatal Fc receptor (FcRn) extends serum half-life of IgG, and antagonizing this interaction is a promising therapeutic approach in IgG-mediated autoimmune diseases. Fc-MST-HN, designed for enhanced FcRn binding capacity, has not been evaluated in the context of a full-length antibody, and the structural properties of the attached Fab regions might affect the FcRn-mediated intracellular trafficking pathway. Here we present a comprehensive comparative analysis of the IgG salvage pathway between two full-size IgG1 variants, containing wild type and MST-HN Fc fragments, and their Fc-only counterparts. We find no evidence of Fab-regions affecting FcRn binding in cell-free assays, however, cellular assays show impaired binding of full-size IgG to FcRn, which translates into improved intracellular FcRn occupancy and intracellular accumulation of Fc-MST-HN compared to full size IgG1-MST-HN. The crystal structure of Fc-MST-HN in complex with FcRn provides a plausible explanation why the Fab disrupts the interaction only in the context of membrane-associated FcRn. Importantly, we find that Fc-MST-HN outperforms full-size IgG1-MST-HN in reducing IgG levels in cynomolgus monkeys. Collectively, our findings identify the cellular membrane context as a critical factor in FcRn biology and therapeutic targeting

Using psychological theory and qualitative methods to develop a new evidence-based website about acupuncture for back pain.

INTRODUCTION: Potential acupuncture patients seek out information about acupuncture from various sources including websites, many of which are unreliable. We aimed to create an informative, scientifically accurate and engaging website to educate patients about acupuncture for back pain and modify their beliefs in a way that might enhance its clinical effects. METHODS: We used psychological theory and techniques to design an evidence-based website, incorporating multimedia elements. We conducted qualitative "think aloud" audio-recorded interviews to elicit user views of the website. A convenience sample of ten participants (4 male; aged 21-64 years from the local community) looked at the website in the presence of a researcher and spoke their thoughts out loud. Comments were categorised by topic. RESULTS: The website comprises 11 main pages and addresses key topics of interest to potential acupuncture patients, including beneficial and adverse effects, mechanisms of action, safety, practicalities, and patients' experiences of acupuncture. It provides information through text, evidence summaries and audio-clips of four patients' stories and two acupuncturists' descriptions of their practice, and three short films. Evidence from the think aloud study was used to identify opportunities to make the website more informative, engaging, and user-friendly. CONCLUSIONS: Using a combination of psychological theory and qualitative interviews enabled us to produce a user-friendly, evidence-based website that is likely to change patients' beliefs about acupuncture for back pain. Before using the website in clinical settings it is necessary to test its effects on key outcomes including patients' beliefs and capacity for making informed choices about acupuncture

Multi-year water and surface energy budget of a high-latitude polythermal glacier : evidence for overwinter water storage in a dynamic subglacial reservoir.

This paper examines the water budget and surface energy balance of a Svalbard glacier (midre Lovénbreen) over a 6 year period (1997-2002). Fresh-water yields are found to lie between 1.1 and 1.5 m a−1 and reflect variable amounts of glacier ice ablation (0.27 ± 0.15 m a−1) and more consistent amounts of snowmelt and summer precipitation (0.40 ± 0.10 and 0.49 ± 0.12 m respectively). Between 24% and 36% of the annual runoff is thought to pass through a subglacial drainage system. Although the site is heavily influenced by stable maritime air masses during the summer, surface melting is achieved largely by net shortwave radiation fluxes (74-100% of ablation). Water budget analysis shows that the annual runoff yields may be strongly influenced by water storage within the glacial system. Storage can occur over the winter period and force the early development of the subglacial drainage system during the following summer. Thus annual water fluxes from this glacier cannot be estimated from glacial mass-balance data alone and there is a need to assess the implications of overwinter storage for our understanding of glacial dynamics, annual fluvial process rates and mixing processes in Svalbard's fjords

Traditionally trained acupuncturists’ views on the World Health Organization traditional medicine ICD-11 codes: A Europe wide mixed methods study

Introduction: The diagnostic categories used in Traditional Medicine (TM) that originated in China and are now used around the world have been classified for inclusion as a chapter within the World Health Organization's International Classification of Diseases (ICD). As a new chapter in ICD, the TM ICD codes were subject to international field testing. A pilot field test of the TM ICD codes was conducted to investigate their clinical utility in the European context. Design: A mixed methods approach, including a Europe wide survey of practitioner views on TM ICD codes; and investigating the coding process of case study vignettes to explore coders’ experiences of using TM ICD codes. Results: Survey: The majority of participants felt TM ICD codes provide a meaningful way to classify TM disorders and patterns; felt their patients’ diagnoses could be represented within the codes; and felt the codes would be important in their clinical practice. Coding of vignettes: In 60.7% of cases the specificity of the assigned code was perceived as ‘just right’. Participants experienced difficulties assigning a single TM ICD disorder and pattern code, due to multiple codes being viewed as appropriate for the case. Conclusions: The European TM practitioners who participated in this study largely perceive the TM ICD codes as valuable, conceptually accurate, and incorporating the range of TM diagnoses utilized within clinical practice. The TM ICD codes could be improved for European TM practitioners by expanding the scope of TM ICD codes, and adopting a multidimensional approach whereby more than one disorder and/or pattern code can be applied to single patients.</p

How to treat a patient with chronic low back pain - methodology and results of the first international case conference of integrative medicine

Background and objective: Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine.The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool ‘‘case conference on IM’’ is also described. Methods: The interactive case conference took place on November 20th, 2009 as part of the‘‘2nd European Congress of IM’’ in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM. Results: In this case conference, the expert panel agreed on a diagnosis of ‘‘chronic non-specificLBP with somatic and psychological factors’’ and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient—physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted