Acupuncture in the Treatment of Pain in Temporomandibular Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objectives: The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). Methods: By using electronic databases, the goal was to search and evaluate all the randomized controlled trials (RCTs) in which acupuncture was used in the management of pain attributed to these clinical entities. For the meta-analysis, an adequate description of the results' statistical data was required along with a comparison of the treatment with a control group using a placebo or sham. Two independent reviewers evaluated the quality of the studies using the Jadad scale. Results: A total of 8 RCTs were selected, and the quality of only 4 was considered acceptable. These 4 studies showed positive results such as reducing pain, improving masticatory function, and increasing maximum interincisal opening. By combining the studies (n=96) and analyzing the results, it was concluded that acupuncture is more effective than placebo in reducing pain intensity in TMD (standardized mean difference 0.83; 95% confidence interval, 0.41-1.25; P=0.00012). Discussion: The results of this meta-analysis suggest that acupuncture is a reasonable adjunctive treatment for producing a shortterm analgesic effect in patients with painful TMD symptoms. Although the results described are positive, the relevance of these results was limited by the fact that substantial bias was present. These findings must be confirmed by future RCTs that improve the methodologic deficiencies of the studies evaluated in this metaanalysis. Key Words: acupuncture, temporomandibular disorders, orofacial pain, randomized controlled trial, meta-analysis, review (Clin J Pain 2010;26:541-550) T emporomandibular disorders (TMDs) refer to various conditions affecting the temporomandibular joint, masticatory muscles, and contiguous tissues components. 1 Different types of painful TMDs are encountered: myogenous or muscle-generated pain; arthrogenous or joint generated pain; or both. 1-4 According to Stohler, 5 between 90% and 95% of TMD patients have facial pain of muscular origin without identifiable structural causes. Among the painful TMD of muscular origin, the most frequent is myofascial pain (MP). 6 At present, the therapeutic management of TMD is approached using a medical multidisciplinary model, and the treatment options range from conservative, noninvasive therapeutic measures to more aggressive treatment interventions. However, in most of the mild and moderate cases of TMD, a significant clinical improvement can be obtained with conservative therapeutic modalities. Acupuncture is an increasingly used treatment modality for the therapeutic management of pain symptoms. A meta-analysis performed by Ter Riet et al 9 showed that the majority of the studies documented positive results. However, the main conclusion obtained from that meta-analysis was that the methodologic quality of the studies analyzed required more evidence. For this reason, the investigators concluded that the effects of acupuncture for chronic pain are doubtful. In terms of TMD and acupuncture treatment, the results obtained were similar to those obtained in an earlier systematic review published in 1999. It is important to emphasize that in the last 10 years, additional studies have been published using acupuncture to treat TMD. This meta-analysis will review the publications of the last 10 years to include the improved evidence that has accumulated over that time. The aim of this study is to perform an analysis that evaluates the quality of the studies and the effectiveness of acupuncture treatment in relieving painful TMD symptomatology

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Discutindo a educação ambiental no cotidiano escolar: desenvolvimento de projetos na escola formação inicial e continuada de professores

A presente pesquisa buscou discutir como a Educação Ambiental (EA) vem sendo trabalhada, no Ensino Fundamental e como os docentes desta escola compreendem e vem inserindo a EA no cotidiano escolar., em uma escola estadual do município de Tangará da Serra/MT, Brasil. Para tanto, realizou-se entrevistas com os professores que fazem parte de um projeto interdisciplinar de EA na escola pesquisada. Verificou-se que o projeto da escola não vem conseguindo alcançar os objetivos propostos por: desconhecimento do mesmo, pelos professores; formação deficiente dos professores, não entendimento da EA como processo de ensino-aprendizagem, falta de recursos didáticos, planejamento inadequado das atividades. A partir dessa constatação, procurou-se debater a impossibilidade de tratar do tema fora do trabalho interdisciplinar, bem como, e principalmente, a importância de um estudo mais aprofundado de EA, vinculando teoria e prática, tanto na formação docente, como em projetos escolares, a fim de fugir do tradicional vínculo “EA e ecologia, lixo e horta”.Facultad de Humanidades y Ciencias de la Educació

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Rappaport k Godfried Toussaint \Lambda Abstract Consider two orthogonal closed chains on a cylinder. The chains are monotone with respect to the angle \Theta. We wish to rigidly move one chain so that the total area between the two chains is minimized. This is a geometric measure of similarity between two repeating melodies proposed by 'O Maid'in. We present an O(n) time algorithm to compute this measure if \Theta is not allowed to vary, and an O(n 2 log n) time algorithm for unrestricted rigid motions on the surface of the cylinder. 1 Introduction We have all heard numerous melodies, whether they come from commercial jingles, jazz ballads, operatic aria, or any of a variety of different sources. How a human detects similarities in melodies has been studied extensively [11, 7]. There has also been some effort in modeling melodies so that similarities can be detected algorithmically. Some results in this fascinating study of musical perception and computation can be found in a collection edited by Hewlett and Selfridge-Field [6]

Computing a Geometric Measure of the Similarity Between two Melodies

Consider two orthogonal closed chains on a cylinder. The chains are monotone with respect to the angle Θ. We wish to rigidly move one chain so that the total..

Aloupis, G., and others 1 Algorithms for Computing Geometric Measures of Melodic Similarity

We have all heard numerous melodies, whether they come from commercial jingles, jazz ballads, operatic aria, or any of a variety of different sources. How a human detects similarities in melodies has been studied extensively (Martinez 2001; Hofmann-Engl 2002; Müllensiefen 2004). There has also been some effort i

Algorithms for computing geometric measures of melodic similarity

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Acupuncture in the treatment of pain in temporomandibular disorders:a systematic review and meta-analysis of randomized controlled trials

Objectives: The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). Methods: By using electronic databases, the goal was to search and evaluate all the randomized controlled trials (RCTs) in which acupuncture was used in the management of pain attributed to these clinical entities. For the meta-analysis, an adequate description of the results' statistical data was required along with a comparison of the treatment with a control group using a placebo or sham. Two independent reviewers evaluated the quality of the studies using the Jadad scale. Results: A total of 8 RCTs were selected, and the quality of only 4 was considered acceptable. These 4 studies showed positive results such as reducing pain, improving masticatory function, and increasing maximum interincisal opening. By combining the studies (n = 96) and analyzing the results, it was concluded that acupuncture is more effective than placebo in reducing pain intensity in TMD (standardized mean difference 0.83; 95% confidence interval, 0.41-1.25; P = 0.00012). Discussion: The results of this meta-analysis suggest that acupuncture is a reasonable adjunctive treatment for producing a short-term analgesic effect in patients with painful TMD symptoms. Although the results described are positive, the relevance of these results was limited by the fact that substantial bias was present. These findings must be confirmed by future RCTs that improve the methodologic deficiencies of the studies evaluated in this meta-analysis.3.114 JCR (2010) Q1, 6/26 Anesthesiology; Q2, 54/185 Clinical neurolog