31 research outputs found
Study protocol for a pragmatic randomised controlled trial in general practice investigating the effectiveness of acupuncture against migraine
<p>Abstract</p> <p>Background</p> <p>Migraine is a chronic neurologic disease that can severely affect the patient's quality of life. Although in recent years many randomised studies have been carried out to investigate the effectiveness of acupuncture as a treatment for migraine, it remains a controversial issue. Our aim is to determine whether acupuncture, applied under real conditions of clinical practice in the area of primary healthcare, is more effective than conventional treatment.</p> <p>Methods/Design</p> <p>The design consists of a pragmatic multi-centre, three-armed randomised controlled trial, complemented with an economic evaluation of the results achieved, comparing the effectiveness of verum acupuncture with sham acupuncture, and with a control group receiving normal care only.</p> <p>Patients eligible for inclusion will be those presenting in general practice with migraine and for whom their General Practitioner (GP) is considering referral for acupuncture. Sampling will be by consecutive selection, and by randomised allocation to the three branches of the study, in a centralised way following a 1:1:1 distribution (verum acupuncture; sham acupuncture; conventional treatment). Secondly, one patient in three will be randomly selected from each of the acupuncture (verum or sham) groups for a brain perfusion study (by single photon emission tomography). The treatment with verum acupuncture will consist of 8 treatment sessions, once a week, at points selected individually by the acupuncturist. The sham acupuncture group will receive 8 sessions, one per week, with treatment being applied at non-acupuncture points in the dorsal and lumbar regions, using the minimal puncture technique. The control group will be given conventional treatment, as will the other two groups.</p> <p>Discussion</p> <p>This trial will contribute to available evidence on acupuncture for the treatment of migraine. The primary endpoint is the difference in the number of days with migraine among the three groups, between the baseline period (the 4 weeks prior to the start of treatment) and the period from weeks 9 to 12. As a secondary aspect, we shall record the index of laterality and the percentage of change in the mean count per pixel in each region of interest measured by the brain perfusion tomography, performed on a subsample of the patients within the real and sham acupuncture groups.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN98703707.</p
Neotenic phenomenon in gene expression in the skin of Foxn1- deficient (nude) mice - a projection for regenerative skin wound healing
Extended transsphenoidal approach for surgical management of pituitary adenomas invading the cavernous sinus
Chapter 5 - Intraoperative neurophysiological monitoring during brainstem surgery
Brainstem surgery is challenging due to the high concentration of essential neural structures such as cranial nerve nuclei, sensorimotor and auditory pathways, as well as the reticular formation. Therefore, even a small injury to the brainstem can hinder the functional integrity of one or more of these neural pathways and result in neurological deficits. Intraoperative neurophysiology aims not merely to predict but also to prevent neurological injury, thanks to the tailored intraoperative use of standard clinical neurophysiological techniques such as electromyography, and somatosensory, brainstem auditory and motor evoked potentials. Monitoring these potentials allows to prevent an injury to the long pathways within the brainstem. In addition, mapping techniques provide functional identification of critical anatomical landmarks, whenever their visual identification is ambiguous, to select the safest entry route to the brainstem. In this chapter we critically review the various intyraoperative mapping and monitoring techniques that can be used during surgery for lesions in the midbrain, pons, and medulla oblongata
Revue sommaire : histoire, concept et discussion de la détermination neurologique de la mort
Anatomical location of the abducens nerves (VI) in the ventral approach of clival tumors
Modelo de carcinogĂȘnese gĂĄstrica utilizando piloroplastia de Finney: estudo experimental em ratos Gastric carcinogenesis model using Finney pyloroplasty: experimental study in rats
RACIONAL: O refluxo duodenogĂĄstrico tem sido implicado como potencial carcinĂłgeno para o estĂŽmago e esĂŽfago e Ă© um dos fatores que podem explicar o desenvolvimento de cĂąncer no coto gĂĄstrico. Modelos experimentais de carcinogĂȘnese no estĂŽmago ressecado ou nas gastrojejunoanastomoses estĂŁo bem definidos. OBJETIVOS: Desenvolver um modelo experimental de carcinogĂȘnese gĂĄstrica atravĂ©s de piloroplastia Ă Finney, avaliar a influĂȘncia da ingestĂŁo de nitrito de sĂłdio nesse modelo, analisar as concentraçÔes de ĂĄcidos biliares e o valor do pH gĂĄstrico. MĂTODOS: Foram operados 110 ratos Wistar divididos em quatro grupos: Grupo I (15 ratos) submetidos Ă laparotomia (grupo Sham); Grupo II (15 ratos) submetidos Ă laparotomia (Sham) e Ă ingestĂŁo de nitrito de sĂłdio na ĂĄgua de beber; Grupo III (40 ratos) submetidos Ă piloroplastia Ă Finney; Grupo IV (40 ratos) submetidos Ă piloroplastia Ă Finney e Ă ingestĂŁo de nitrito de sĂłdio na ĂĄgua de beber. ApĂłs 50 semanas da operação, os ratos foram sacrificados, coletadas amostras de suco gĂĄstrico para anĂĄlise do pH, dosagem dos ĂĄcidos biliares, e realizada anĂĄlise histolĂłgica. RESULTADOS: A mortalidade pĂłs-operatĂłria imediata foi de 9% e, ao longo do experimento, 10 ratos morreram. O grupo controle (I) nĂŁo apresentou lesĂ”es gĂĄstricas; o grupo controle com nitrito de sĂłdio (II) desenvolveu papilomas no prĂ©-estĂŽmago em 16.6%; os grupos operados com piloroplastia apresentaram adenomas em 10,3% no Grupo III e 14,2% no Grupo IV, e adenocarcinoma em 55,1%, no grupo III e 14,2% no Grupo IV. A implantação de glĂąndulas para dentro da submucosa e muscular, na zona de anastomose (implantação mucosa), nĂŁo foi critĂ©rio suficiente para decidir sobre a malignidade das lesĂ”es, sendo necessĂĄria a presença simultĂąnea de atipias celulares. A concentração de ĂĄcidos biliares do suco gĂĄstrico foi maior nos Grupos III e IV. A medida do pH gĂĄstrico nĂŁo foi diferente nos grupos estudados. CONCLUSĂO: 1) A piloroplastia Ă Finney Ă© modelo experimental adequado de carcinogĂȘnese gĂĄstrica; 2) ela induziu refluxo duodenogĂĄstrico; 3) o refluxo duodenogĂĄstrico atuou como carcinĂłgeno para o estĂŽmago; 4) nĂŁo houve relação entre o pH gĂĄstrico e o desenvolvimento de carcinoma; 5) o nitrito de sĂłdio nĂŁo atuou como carcinĂłgeno para o estĂŽmago dos ratos.<br>BACKGROUND: The duodenogastric reflux has been implicated as a potential carcinogen for the stomach and esophagus and is one of the factors that may explain the development of gastric stump cancer. Experimental models of carcinogenesis in the stomach stump or in the duodenogastric anastomosis are well defined. AIM: To develop an experimental model of gastric carcinogenesis through the Finney pyloroplasty, evaluate the influence of ingestion of sodium nitrite in this model, analyze the concentrations of bile acids and the pH of the stomach. METHODS: A hundred and ten Wistar rats were operated and divided into four groups: Group I (15 rats) underwent laparotomy (Sham group); Group II (15 rats) underwent laparotomy (Sham) and ingestion of sodium nitrite in drinking water; Group III (40 rats) submitted to the Finney pyloroplasty and Group IV (40 rats) submitted to the Finney pyloroplasty and ingestion of sodium nitrite in drinking water. After 50 weeks of surgery, the rats were sacrificed and samples collected for analysis of gastric pH, dosing of bile acids and histological analysis. RESULTS: The immediate postoperative mortality was 9%, and during the experiment, 10 rats died. The control group (I) did not show gastric lesions; the control group with sodium nitrite (II) developed papillomas in the pre-stomach in 16.6%; the operated groups with pyloroplasty had adenomas in 10.3% in Group III and 14.2 % in Group IV, and adenocarcinoma in 55.1% in group III and 14.2% in Group IV. The implementation of glands into the submucosa and muscle in the area of anastomosis (mucosa deployment) was not sufficient criterion for deciding on the malignancy of the lesions, requiring the simultaneous presence of atypical cells. The concentration of bile acids in gastric juice was higher in Groups III and IV. The measurement of gastric pH was not different in both groups. CONCLUSION: 1) The Finney pyloroplasty is suitable experimental model of gastric carcinogenesis; 2) it induced duodenogastric reflux; 3) the duodenogastric reflux served as a carcinogen for the stomach; 4) there was no relationship between pH and the development of gastric carcinoma; 5 ) sodium nitrite did not act as a carcinogen for the stomach of rats