Acupuncture in Patients with Diabetic Peripheral Neuropathy-Related Complaints: A Randomized Controlled Clinical Trial

Background: Diabetic polyneuropathy (DPN) is a common complication of diabetes, which presents with a loss of sensorimotor function or pain. This study assessed the effectiveness and safety of acupuncture as a treatment for DPN-related complaints. Methods: In this randomized controlled trial, patients with type II diabetes and symptoms of neuropathy in the lower limbs were included. A total of 12 acupuncture treatments were administered over 8 weeks. The waitlist control group received the same acupuncture treatment starting at week 16 (after baseline). Results: A total of 62 patients were randomized (acupuncture group n = 31; control group n = 31). The primary outcome was overall complaints, and it was reduced with a significant difference of 24.7 on a VAS (CI 95% 14.8;34.7, p < 0.001) between both groups in favor of acupuncture. Reductions were recorded for the secondary outcomes VAS pain, neuropathic pain symptom inventory (NPSI), emotional dimensions of pain, SF-12, and diabetic peripheral neuropathic pain impact (DPNPI) after the intervention and at the follow-ups in the acupuncture group. Adverse reactions were minor and transient. Conclusions: Acupuncture leads to a significant and lasting reduction in DPN-related complaints when compared to routine care and is well tolerated, with minor side effects

Acupuncture in diabetic peripheral neuropathy—protocol for the randomized, multicenter ACUDPN trial

Background: Acupuncture is used to treat patients with diabetic peripheral neuropathy; however, the evidence is unclear. We present the design and methodology of the ACUDPN (ACUpuncture in Diabetic Peripheral Neuropathy) trial, which investigates the effectiveness of acupuncture for the treatment of diabetic peripheral neuropathy (DPN) symptoms. Methods: The aim of this study is to investigate whether acupuncture is effective for the treatment of DPN symptoms.MethodsThis study is a two-armed, randomized, controlled, parallel group, open-label, confirmatory, multicenter trial (8-week intervention period plus 16weeks of follow-up). Physicians in outpatient units in Germany who specialize in acupuncture treatment will treat 110 diabetes type II patients with clinical symptoms of peripheral neuropathy in the feet and legs with signs of neuropathy according to nerve conduction testing. The patients will be randomized in a 1:1 ratio to one of the following two groups: (a) semi-standardized acupuncture plus routine care or (b) routine care alone. Acupuncture will consist of 12 treatments per patient over 8weeks. The primary outcome will be the overall DPN-related complaints in the extremities after 8weeks as measured by the Visual Analog Scale (VAS). Further outcome measures will include DPN-related pain, the Neuropathic Pain Symptom Inventory (NPSI), Diabetic Peripheral Neuropathic Pain Impact (DPNPI) scores, and nerve conduction parameters of the sural nerve at weeks 8, 16, and 24. Discussion: The results of this trial will be available in 2021 and will help clarify whether acupuncture can be considered effective for the treatment of DPN with regard to the subdimensions of the neuropathic clinical picture

Wissenschaftliche Aufbereitung des geburtshilflichen Instrumentariums der geburtshilflich-gynäkologischen Sammlung an der Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Ernst-Moritz-Arndt-Universität Greifswald

Die über einhundert geburtshilflichen Instrumente der Greifswalder Sammlung historischer geburtshilflich-gynäkologischer Instrumente werden ihrem jeweiligen Entwickler und ihrer Entstehungsgeschichte zugeordnet. Indikationen und Anwendungen der häufig seit Jahrzehnten oder Jahrhunderten nicht mehr in Gebrauch befindlichen Geräte werden detailliert beschrieben. Die einzelnen Instrumente werden in einen historischen Entwicklungszusammenhang eingeordnet, so wird unter anderem die Geschichte der Geburtszange ( und Hebel ) inkl. der Kopfschwartenzange an Hand der Greifswalder Exemplare nahezu lückenlos bis hin zu den heute noch eingesetzen Modellen vorgestellt. Die Arbeit vermittelt eine detaillierte Geschichte der zerstückelnden Operationen (Perforation, Kraniotomie, Kranioklasie, Kephalothrypsie, Dekapitation, Embryotomie, (ect...) und der hierzu verwendeten Instrumente, von denen einige unbekannt oder völlig in Vergessenheit geraten waren. Hier werden zusätzlich die mit diesen Eingriffen verbundenen ethischen Fragen im Wechsel der Zeit untersucht. Neben diesen zwei Hauptkapiteln finden sich Abhandlungen über Beckenmesser, Stethoskope und Amnioskope, Dilatatorien, Nabelschnurrepositorien, Instrumente zur Extraktion am Steiß, Abortzangen und Instrumente zur Blutstillung in der Nabelgeburtsperiode. Die Arbeit dokumentiert die geburtshilfliche Instrumentensammlung zudem durch qualitativ hochwertige Fotografien. Im Anhang werden die bedeutendsten Geburtshelfer der letzten zwei Jahrhunderte in Form einer synchronoptischen ausklappbaren Grafik vorgestellt. Hier wird die neuere Geschichte der Gebrutshilfe mit wegweisenden Entdeckungen aus anderen Gebieten der Medizin und mit großen Ereignissen aus Kunst, Kultur, Politik und Gesellschaft korreliert.The vintage obstetrical instruments (>100) of the Greifswald collection of gynecological and obstetrical instruments (which contains in total than 770 items) have been identified and linked inventors and to the time in which they have been developped. Indications and manuals on how to use these long-time out-of-use-instruments are provided. The instruments are being embedded into their historical context. Describing the exemplars of the collection, the thesis for instance shows the complete history of the development of the delivery forceps, including levers and the scalpforceps up to the instruments that are still in use today. Included is a detailed description of the destructive operations (cranial perforation, cephalotripsy, decapitation, embryotomy etc...) an the instruments used for this purpose, some of which had completely been unknown of forgotten. The ethical dilemmas connected to these operations and the way they have been dealt with during the decades is presented as well. Besides these main chapters the thesis contains further treatises on pelvimeters, stethoscopes and amnioscopes, dilators, umbilical cord repostiories, abortion forceps, instruments for rump-extrations for the haemostasis in the afterbirth stage. All instruments have additionally been documented throught high-quality photographs taken by the autors for the dissertation. Finally the most important obstetricians of the past three centuries are presented in a synchronoptical diagram. Here the history of obstetrics becomes correlated with groundbreaking medical inventions and important cultural, political and social events

Akupunktur bei Schmerzerkrankungen und Allergien – von der klinischen Erfahrung zur Evidenz

Background!#!Acupuncture is a traditional Chinese medicine therapy method that is also frequently used in the western world. It has been the subject of intensive scientific research over the past two decades.!##!Aim of the work!#!To describe the efficacy, therapy safety, and health economic relevance of acupuncture for chronic pain disorders and allergic diseases.!##!Material and methods!#!In the context of a review (narrative review) the relevant literature was selected, presented, and interpreted.!##!Results!#!Acupuncture is effective in chronic pain disorders such as chronic knee joint pain in osteoarthritis, migraine, tension headache, chronic lumbar spine pain, chronic cervical spine pain, shoulder pain, dysmenorrhea, and fibromyalgia under routine conditions. In addition, specific efficacy is shown in most chronic pain indications. Acupuncture is also effective in patients with allergic diseases. In large clinical studies, acupuncture has proven to be a relatively safe therapy, but severe complications (e.g. pneumothorax cases, hepatitis B) also occur in rare instances. Acupuncture is usually associated with higher therapy costs, but is considered a cost-effective treatment strategy for pain disorders.!##!Discussion!#!As a nonpharmacological procedure, acupuncture is becoming increasingly important in pain and allergy therapy and is therefore increasingly included in current guidelines. In further studies, the efficacy of acupuncture should be determined in other indications and the mechanisms of action of this therapy method should be investigated

Acupuncture for pain and allergic rhinitis—from clinical experience to evidence

Hintergrund Die Akupunktur ist ein Therapieverfahren der Traditionellen Chinesischen Medizin, das inzwischen auch in der westlichen Welt häufig eingesetzt wird. In den letzten beiden Jahrzehnten wurde es intensiv wissenschaftlich untersucht. Ziel der Arbeit Darstellung von Wirksamkeit, Therapiesicherheit und gesundheitsökonomischer Relevanz der Akupunktur bei chronischen Schmerzerkrankungen und Allergien. Material und Methoden Im Rahmen einer Übersichtsarbeit (narratives Review) wird die relevante Literatur ausgesucht, vorgestellt und interpretiert. Ergebnisse Akupunktur hat sich bei vielen chronischen Schmerzerkrankungen unter Routinebedingungen als wirksam erwiesen, so z. B. bei Kniegelenksschmerzen aufgrund von Arthrose, bei Migräne, Spannungskopfschmerz, chronischen Schmerzen der Lenden- und Halswirbelsäule, Schulterschmerzen, Dysmenorrhö und Fibromyalgie. Außerdem zeigt sich bei den meisten Schmerzerkrankungen eine spezifische Wirksamkeit. Auch bei Patienten mit allergischen Erkrankungen ist Akupunktur wirksam. Akupunktur hat sich in den großen klinischen Studien als relativ sicheres Therapieverfahren erwiesen, allerdings kommen in seltenen Fällen auch schwere Komplikationen vor (z. B. Pneumothoraxfälle, Hepatitisinfektionen). In der Regel ist Akupunktur mit zusätzlichen Therapiekosten verbunden, gilt allerdings bei Schmerzerkrankungen als kosteneffektive Therapiestrategie. Diskussion Als nichtpharmakologischem Verfahren kommt Akupunktur eine wachsende Bedeutung bei der Behandlung von chronischen Schmerzerkrankungen und Allergien zu. Sie wird daher zunehmend in aktuelle Therapieleitlinien aufgenommen. In weiteren Studien sollte ihre Wirksamkeit bei weiteren Indikationen bestimmt werden. Die Wirkmechanismen sollten untersucht werden.Background: Acupuncture is a traditional Chinese medicine therapy method that is also frequently used in the western world. It has been the subject of intensive scientific research over the past two decades. Aim of the work: To describe the efficacy, therapy safety, and health economic relevance of acupuncture for chronic pain disorders and allergic diseases. Material and methods: In the context of a review (narrative review) the relevant literature was selected, presented, and interpreted. Results: Acupuncture is effective in chronic pain disorders such as chronic knee joint pain in osteoarthritis, migraine, tension headache, chronic lumbar spine pain, chronic cervical spine pain, shoulder pain, dysmenorrhea, and fibromyalgia under routine conditions. In addition, specific efficacy is shown in most chronic pain indications. Acupuncture is also effective in patients with allergic diseases. In large clinical studies, acupuncture has proven to be a relatively safe therapy, but severe complications (e.g. pneumothorax cases, hepatitis B) also occur in rare instances. Acupuncture is usually associated with higher therapy costs, but is considered a cost-effective treatment strategy for pain disorders. Discussion: As a nonpharmacological procedure, acupuncture is becoming increasingly important in pain and allergy therapy and is therefore increasingly included in current guidelines. In further studies, the efficacy of acupuncture should be determined in other indications and the mechanisms of action of this therapy method should be investigated

Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack

Background and purpose Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction. Methods The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD‐EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m$^{2}$. eGFR dynamics were classified based on two in‐hospital values as “stable normal” (≥60 ml/min/1.73 m$^{2}$), “increasing” (by at least 15% from baseline, second value ≥ 60 ml/min/1.73 m$^{2}$), “decreasing” (by at least 15% from baseline of ≥60 ml/min/1.73 m$^{2}$), and “stable decreased” (<60 ml/min/1.73 m$^{2}$). The composite endpoint (stroke, major bleeding, myocardial infarction, all‐cause death) was assessed after 24 months. We estimated hazard ratios in confounder‐adjusted models. Results Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m$^{2}$ at baseline (hazard ratio [HR] = 2.2, 95% confidence interval [CI] = 1.40–3.54) as well as decreasing (HR = 1.79, 95% CI = 1.07–2.99) and stable decreased eGFR (HR = 1.64, 95% CI = 1.20–2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95% CI = 1.51–6.10) and decreasing eGFR were associated with all‐cause death (HR = 3.12, 95% CI = 1.63–5.98). Conclusions In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction

Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry

Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge