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

Determinants for receiving acupuncture for LBP and associated treatments: a prospective cohort study

BACKGROUND: Acupuncture is a frequently used but controversial adjunct to the treatment of chronic low back pain (LBP). Acupuncture is now considered to be effective for chronic LBP and health care systems are pressured to make a decision whether or not acupuncture should be covered. It has been suggested that providing such services might reduce the use of other health care services. Therefore, we explored factors associated with acupuncture treatment for LBP and the relation of acupuncture with other health care services. METHODS: This is a post hoc analysis of a longitudinal prospective cohort study. General practitioners (GPs) recruited consecutive adult patients with LBP. Data on physical function, subjective mood and utilization of health care services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months. RESULTS: A total of 179 (13 %) out of 1,345 patients received acupuncture treatment. The majority of those (59 %) had chronic LBP. Women and elderly patients were more likely to be given acupuncture. Additional determinants of acupuncture therapy were low functional capacity and chronicity of pain. Chronic (vs. acute) back pain OR 1.6 (CL 1.4–2.9) was the only significant disease-related factor associated with the treatment. The strongest predictors for receiving acupuncture were consultation with a GP who offers acupuncture OR 3.5 (CL 2.9–4.1) and consultation with a specialist OR 2.1 (CL 1.9–2.3). After adjustment for patient characteristics, acupuncture remained associated with higher consultation rates and an increased use of other health care services like physiotherapy. CONCLUSION: Receiving acupuncture for LBP depends mostly on the availability of the treatment. It is associated with increased use of other health services even after adjustment for patient characteristics. In our study, we found that receiving acupuncture does not offset the use of other health care resources. A significant proportion of patients who received did not meet the so far only known selection criterion (chonicity). Acupuncture therapy might be a reflection of helplessness in both patients and health care providers

The genomic and transcriptional landscape of primary central nervous system lymphoma

Primary lymphomas of the central nervous system (PCNSL) are mainly diffuse large B-cell lymphomas (DLBCLs) confined to the central nervous system (CNS). Molecular drivers of PCNSL have not been fully elucidated. Here, we profile and compare the whole-genome and transcriptome landscape of 51 CNS lymphomas (CNSL) to 39 follicular lymphoma and 36 DLBCL cases outside the CNS. We find recurrent mutations in JAK-STAT, NFkB, and B-cell receptor signaling pathways, including hallmark mutations in MYD88 L265P (67%) and CD79B (63%), and CDKN2A deletions (83%). PCNSLs exhibit significantly more focal deletions of HLA-D (6p21) locus as a potential mechanism of immune evasion. Mutational signatures correlating with DNA replication and mitosis are significantly enriched in PCNSL. TERT gene expression is significantly higher in PCNSL compared to activated B-cell (ABC)-DLBCL. Transcriptome analysis clearly distinguishes PCNSL and systemic DLBCL into distinct molecular subtypes. Epstein-Barr virus (EBV)+ CNSL cases lack recurrent mutational hotspots apart from IG and HLA-DRB loci. We show that PCNSL can be clearly distinguished from DLBCL, having distinct expression profiles, IG expression and translocation patterns, as well as specific combinations of genetic alterations

Genomic and transcriptomic changes complement each other in the pathogenesis of sporadic Burkitt lymphoma

Burkitt lymphoma (BL) is the most common B-cell lymphoma in children. Within the International Cancer Genome Consortium (ICGC), we performed whole genome and transcriptome sequencing of 39 sporadic BL. Here, we unravel interaction of structural, mutational, and transcriptional changes, which contribute to MYC oncogene dysregulation together with the pathognomonic IG-MYC translocation. Moreover, by mapping IGH translocation breakpoints, we provide evidence that the precursor of at least a subset of BL is a B-cell poised to express IGHA. We describe the landscape of mutations, structural variants, and mutational processes, and identified a series of driver genes in the pathogenesis of BL, which can be targeted by various mechanisms, including IG-non MYC translocations, germline and somatic mutations, fusion transcripts, and alternative splicing

Identification of Disparities in Personalized Cancer Care—A Joint Approach of the German WERA Consortium

(1) Background: molecular tumor boards (MTBs) are crucial instruments for discussing and allocating targeted therapies to suitable cancer patients based on genetic findings. Currently, limited evidence is available regarding the regional impact and the outreach component of MTBs; (2) Methods: we analyzed MTB patient data from four neighboring Bavarian tertiary care oncology centers in Würzburg, Erlangen, Regensburg, and Augsburg, together constituting the WERA Alliance. Absolute patient numbers and regional distribution across the WERA-wide catchment area were weighted with local population densities; (3) Results: the highest MTB patient numbers were found close to the four cancer centers. However, peaks in absolute patient numbers were also detected in more distant and rural areas. Moreover, weighting absolute numbers with local population density allowed for identifying so-called white spots—regions within our catchment that were relatively underrepresented in WERA MTBs; (4) Conclusions: investigating patient data from four neighboring cancer centers, we comprehensively assessed the regional impact of our MTBs. The results confirmed the success of existing collaborative structures with our regional partners. Additionally, our results help identifying potential white spots in providing precision oncology and help establishing a joint WERA-wide outreach strategy

Hypermedia Structures and the Division of Labor in Meeting Room Collaboration

The type of collaboration for a group, whether working in parallel or collectively, is a style for a group influenced by many factors, among them the technology that the group works with. In an empirical study using the DOLPHIN system, we focused on the effect that using hypermedia structures in an electronic meeting room had on collaborative style. We found that groups who cteated documents using hypermedia were: 1) more likely to divide up their labor and work in parallel, and 2) to have a slower frequency of switching between the task phases of planning and developing ideas. We present a model to explain this effect of hypermedia on task division which suggests the involvement of mechanical and semantic components. We also discuss how DOLPHIN supports awareness of others people’s activities for a parallel collaborative style

Hypermedia Use in group Work: Changing the product, Process, and strategy

Abstract. Hypermedia structures have been integrated with CSCW functionality to develop the DOLPHIN system, an electronic meeting room environment. In this paper, a study is reported investigating how the DOLPHIN environment affects group work. Different aspects of group problem solving were examined to understand the effects of working with hypermedia: the group’s product, cognitive factors, and the group process. The results showed that groups can easily work with hypermedia structures, and that these structures influence groups to produce a different product, to use a different strategy, and to use a different collaborative style, namely of dividing up their labor. The experimental results are explained in a model which suggests the involvement of both procedural and semantic components in hypermedia use. We discuss wider implications of hypermedia for CSCW and group work. Key words. Hypermedia, cooperation support, electronic meeting room, electronic whiteboards, group process, division of labor, collaborative style, evaluation, empirical study

Coexistence and Transformation of Informal and Formal Structures: Requirements for More Flexible Hypermedia Systems

In this paper, we argue that some tasks (e.g., meeting support) require more flexible hypermedia systems and we describe a prototype hypermedia system, DOLPHIN, that implements more flexibility. As part of the argument, we present a theoretical design space for information structuring systems and locate existing hypertext systems within it. The dimensions of the space highlight a system's internal representation of structure and the user's actions in creating structure. Second, we describe an empirically derived range of activities connected to conducting group meetings, including the pre- and postpreparation phases, and argue that hypertext systems need to be more flexible in order to support this range of activities. Finally, we describe a hypermedia prototype, DOLPHIN, which implements this kind of flexible support for meetings. DOLPHIN supports different degrees of formality (e.g., handwriting and sketches as well as typed nodes and links are supported), coexistence of different st..

Coexistence and Transformation of Informal and Formal Structures: Requirements for More Flexible Hypermedia Systems

In this paper, we argue that some tasks (e.g., meeting support) require more flexible hypermedia systems and we describe a prototype hypermedia system, DOLPHIN, that implements more flexibility. As part of the argument, we present a theoretical design space for information structuring systems and locate existing hypertext systems within it. The dimensions of the space highlight a system's internal representation of structure and the user's actions in creating structure. Second, we describe an empirically derived range of activities connected to conducting group meetings, including the pre- and postpreparation phases, and argue that hypertext systems need to be more flexible in order to support this range of activities. Finally, we describe a hypermedia prototype, DOLPHIN, which implements this kind of flexible support for meetings. DOLPHIN supports different degrees of formality (e.g., handwriting and sketches as well as typed nodes and links are supported), coexistence of different structures (e.g., handwriting and nodes can exist on the same page) and mutual transformations between them (e.g., handwriting can be turned into nodes and vice versa)