bluuebunny/crossref_metadata_2025 huggingface dataset:
The Programme for the Evaluation of Patient Care with Acupuncture (Pep-Ac) – a Project Sponsored by Ten German Social Health Insurance Funds
Authors: Linde Klaus , Streng Andrea , Hoppe Andrea , Jürgens Susanne , Weidenhammer Wolfgang , Melchart Dieter
Published: April 2009

Objective

The aim of the Programme for the Evaluation of Patient care with Acupuncture (PEP-Ac) was to investigate the efficacy, effectiveness and safety of acupuncture in patients with the following three indications: chronic headache, chronic low back pain and chronic osteoarthritic pain. This article provides an overview of the results of the whole programme.

Methods

The programme included five randomised trials, a large observational study, a survey of physicians providing acupuncture, and three systematic reviews.

Results

The results show that, for all three indications, acupuncture, when compared to no treatment, produces a clear benefit that lasts for at least several months. However the effects of point-specific acupuncture only offered a significant advantage over minimal acupuncture in the treatment of OA knee.

Conclusions

The evidence from these trials – on the one hand, a clear overall effect of acupuncture and on the other hand, the lack of evidence supporting its superiority over sham acupuncture for all indications except osteoarthritis of the knee – leaves a considerable amount of room for interpretation.
Some of the Effects of Acupuncture in Knee Pain May be Due to Activation of the Reward System
Authors: Lundeberg Thomas
Published: April 2009

Acupuncture is an ancient therapy with a variety of different explanatory models. A cascade of physiologic effects has been reported, both in the peripheral and the central nervous system, following the insertion of a needle. Clinical trials testing the specific claims of acupuncture have generally tried to focus on testing the efficacy of applying specific techniques and/or specified points. However, different conditions may respond differently to different modes of stimulation. Also, insertion of needles into the body can stimulate effects not dependent on the locations of stimulation. Recently, it was demonstrated that both superficial and deep needling (with de qi/Hibiki) resulted in amelioration of patellofemoral pain and an increased feeling of wellbeing. One area in the brain that is affected by acupuncture stimulation is the limbic system. The limbic system consists of a group of brain structures, including the hippocampus, amygdala, and their interconnections, and connections with the hypothalamus, septal area, and portions of the tegmentum. It contains many of the centres related to emotion and reward.

The pleasurable aspect of the acupuncture experience has largely been ignored as it has been considered to be part of its antinociceptive effects. It has previously been reported that physical exercise and electroacupuncture in animals result in modulation of the peptidergic content in limbic structures. These results are supported by recent animal studies in Japan that have clearly demonstrated that acupuncture results in the activation of the reward system. These findings are supported by positron emission tomography studies in patients, which showed that the insula ipsilateral to the site of needling was activated, as well as the dorsolateral prefrontal cortex, the anterior cingulate and the midbrain.

Taken together, these results suggest that acupuncture, as well as the patient's expectation and belief regarding a potentially beneficial treatment, modulate activity in the reward system.
Acupuncture for Anxiety and Anxiety Disorders – a Systematic Literature Review
Authors: Pilkington Karen , Kirkwood Graham , Rampes Hagen , Cummings Mike , Richardson Janet
Published: April 2009

Introduction

The aim of this study was to evaluate the evidence for the efficacy of acupuncture in the treatment of anxiety and anxiety disorders by systematic review of the relevant research.

Methods

Searches of the major biomedical databases (MEDLINE, EMBASE, ClNAHL, PsycINFO, Cochrane Library) were conducted between February and July 2004. Specialist complementary medicine databases were also searched and efforts made to identify unpublished research. No language restrictions were imposed and translations were obtained where necessary. Study methodology was appraised and clinical commentaries obtained for studies reporting clinical outcomes.

Results

Twelve controlled trials were located, of which 10 were randomised controlled trials (RCTs). Four RCTs focused on acupuncture in generalised anxiety disorder or anxiety neurosis, while six focused on anxiety in the perioperative period. No studies were located on the use of acupuncture specifically for panic disorder, phobias or obsessive-compulsive disorder. In generalised anxiety disorder or anxiety neurosis, it is difficult to interpret the findings of the studies of acupuncture because of the range of interventions against which acupuncture was compared. All trials reported positive findings but the reports lacked many basic methodological details. Reporting of the studies of perioperative anxiety was generally better and the initial indications are that acupuncture, specifically auricular acupuncture, is more effective than acupuncture at sham points and may be as effective as drug therapy in this situation. The results were, however, based on subjective measures and blinding could not be guaranteed.

Conclusions

Positive findings are reported for acupuncture in the treatment of generalised anxiety disorder or anxiety neurosis but there is currently insufficient research evidence for firm conclusions to be drawn. No trials of acupuncture for other anxiety disorders were located. There is some limited evidence in favour of auricular acupuncture in perioperative anxiety. Overall, the promising findings indicate that further research is warranted in the form of well designed, adequately powered studies.
Two Styles of Acupuncture for Treating Painful Diabetic Neuropathy – a Pilot Randomised Control Trial
Authors: Ahn Andrew C , Bennani Taher , Freeman Roy , Hamdy Osama , Kaptchuk Ted J
Published: April 2009

In a pilot study, we evaluated the clinical and mechanistic effects of two styles of acupuncture, Traditional Chinese Medicine (TCM) and Japanese acupuncture, for the treatment of painful diabetic neuropathy. Out of seven patients enrolled, three received Traditional Chinese acupuncture while four received Japanese style acupuncture. Treatments were delivered once a week for 10 weeks. Acupuncturists were permitted to select the needle interventions. Substantial differences in diagnostic techniques, choice of acupuncture points, and needle manipulation were observed between TCM and Japanese acupuncturists. Clinically, patients allocated to Japanese acupuncture reported decreased neuropathy-associated pain according to the daily pain severity score, while the group allocated to the TCM acupuncture reported minimal effects. Both acupuncture styles, however, lowered pain according to the McGill Short Form Pain Score. The TCM style improved nerve sensation according to quantitative sensory testing while the Japanese style had a more equivocal effect. No evident changes were observed in glucose control or heart rate variability in either group.
Acupuncture as a Potential Treatment for Non-Cardiac Chest Pain – a Survey
Authors: MacPherson Hugh , Dumville Jo C
Published: April 2009

Objective

To establish the level of interest in acupuncture as a treatment option for non-cardiac chest pain and to identify the factors associated with this interest.

Background

Non-cardiac chest pain is known to be a prevalent condition in the general population. Treatment options are limited. Given that acupuncture has a potential role in the treatment of chronic pain, this study was designed to establish the levels of interest in acupuncture among people with continuing non-cardiac chest pain.

Methods

This small study formed part of a larger retrospective cohort study, and was conducted with all 235 people who were given a diagnosis of non-cardiac chest pain at the Rapid Access Chest Pain Unit in York within a 14 month period. We collected data on whether people continued to experience chest pain, and if so, whether they had considered, or would consider, acupuncture as a treatment. We used ordinal logistic regression to investigate potential covariates, including sex and age, that might be associated with this interest.

Results

In total, 161 (69%) participants returned questionnaires, 75 (47%) of whom were experiencing continued chest pain with a median duration of 5.4 months. Of these participants, 42% reported that they would consider acupuncture, 36% reported that they would not, and 22% did not know. In the ordinal regression model, we found no covariates significantly associated with the strength of participants’ interest in acupuncture.

Conclusion

People with continuing non-cardiac chest pain after attending a Rapid Access Chest Pain Unit have shown considerable interest in acupuncture as a primary care treatment option.
Evidence from Rcts on Optimal Acupuncture Treatment for Knee Osteoarthritis – An Exploratory Review
Authors: Vas Jorge , White Adrian
Published: April 2009

There are many differing opinions on what constitutes an optimal acupuncture dose for treating any particular patient with any particular condition, and only direct comparisons of different methods in a clinical trial will provide information on which reliable decisions can be made. This article reviews the recent research into acupuncture treatment for osteoarthritis of the knee, to explore whether any aspects of treatment seem more likely to be associated with good outcome of treatment. Among four recent, high quality RCTs, one showed a much greater treatment response than the other three, and the possible factors are discussed. A recent systematic review included 13 RCTs, and this article discusses the possible explanations for differences in their outcomes. It is speculated that optimal results from acupuncture treatment for osteoarthritis of the knee may involve: climatic factors, particularly high temperature; high expectations of patients; minimum of four needles; electroacupuncture rather than manual acupuncture, and particularly, strong electrical stimulation to needles placed in muscle; and a course of at least 10 treatments. These factors offer some support to criteria for adequate acupuncture used in the recent review. In addition, ethnic and cultural factors may influence patients’ reporting of their symptoms, and different versions of an outcome measure are likely to differ in their sensitivity – both factors which may lead to apparent rather than real differences between studies. The many variables in a study are likely to be more tightly controlled in a single centre study than in multicentre studies.
Sham Acupuncture Devices – Practical Advice for Researchers
Authors: McManus Claire A , Schnyer Rosa N , Kong Jian , Nguyen Long T , Nam Bong Hyun , Goldman Rose , Stason William B , Kaptchuk Ted J
Published: April 2009

Several validated sham acupuncture devices have recently become available. While some debate exists on whether such needles are the best placebo control for an RCT of acupuncture, practical advice based on research experience is missing from the literature. This paper shares our concrete experience using the most commonly used such sham needle (the ‘Streitberger needle’ and its paired verum needle) in a large RCT (n=135) which included a two-week run-in period. The placebo run-in gave us an opportunity to use the sham device on all participants, who were then re-randomised to receive genuine acupuncture or to continue treatment with the device. The blinding was successful both at the end of the run-in and at the conclusion of the trial despite the re-randomisation. We also report our experience with the sham needle in neuroimaging experiments where the magnetic machinery poses considerable challenges for acupuncture research.
Effectiveness of Acupuncture and Related Techniques in Treating Non-Oncological Pain in Primary Healthcare – An Audit
Authors: Vas Jorge , Aguilar Inmaculada , Perea-Milla Emilio , Méndez Camila
Published: April 2009

Background

Pain is one of the principal symptoms for which the general public seeks medical attention, and it is frequently treated by GPs. Although acupuncture is mainly practised in the private field, it enjoys growing acceptance in the public system too, which helps bring down the high cost of its use. The aim of the present study is to evaluate the effectiveness of acupuncture and related techniques in treating non-oncological pain during nine years of activity at the Pain Treatment Unit (PTU) within the Andalusian Public Health System (Spain) in the field of primary healthcare.

Methods

Retrospective review of 5981 electronically stored case histories of patients who sought treatment for non-oncological pain and were seen at the PTU between June 1997 and July 2006. We excluded from this review those patients who had on any occasion been recruited for clinical trials at the PTU. The primary result measure applied was the success rate, defined as an improvement of least 50% on the Global Assessment Index, which is made up of five variables: pain intensity, as measured on a numerical scale of 0–10, pain frequency, consumption of analgesics, level of incapacity and sleep disorders caused by pain (the latter four variables were measured on a 5-point Likert scale of 0–4).

Results

The majority (84.5%) of the patients treated were women, with a mean age of 58.8 years (range 8–93), and they attended the healthcare clinic because of pain present for over three months (88.8%) and mainly affecting the lower back (58.8%). In the 5690 patients who completed treatment, the mean success rate was 79.7%, with highest rates (93%) being achieved in patients with cephalalgia. The mean reduction in pain intensity was 5.5 (SD 2.5) points amounting to 67% fall from the baseline. There was a reduction of ¢7.1 in the mean weekly expenditure on analgesics per patient. From the regression model, we conclude that the patients who suffered acute or sub-acute pain presented higher success rates than did those with chronic pain (OR, 1.94; 95% CI, 1.53–2.48).

Conclusions

Acupuncture seems to be effective in treating musculoskeletal pain, and presents no severe adverse events. With acupuncture treatment, the consumption of analgesic and anti-inflammatory drugs is considerably reduced.
Acupuncture in the Treatment of Fibromyalgia in Tertiary Care – a Case Series
Authors: Duncan Barbara , White Adrian , Rahman Anisur
Published: April 2009

Aims

Fibromyalgia is a common cause of chronic widespread pain. The benefit of medication is often limited by its side effects, and the improvements obtained with exercise and education are inconsistent. Many patients seek acupuncture treatment, which is reported to be helpful in some cases. This study aimed to explore the acceptability and benefits of acupuncture offered in the setting of a tertiary referral clinic.

Methods

An open, uncontrolled observational study was conducted among patients who met the usual fibromyalgia criteria and who had a pain score of at least 30 on a 100mm Visual Analogue Scale (VAS). Patients were allowed to continue other treatments but not to introduce new ones. Acupuncture was given using a Western approach according to a protocol developed by consensus. Patients were offered eight treatments in eight weeks. Outcome measures included VAS of pain intensity and Fibromyalgia Impact Questionnaire (range 0 – 100), and were taken before and after treatment, and at 14, 20 and 34 weeks from enrolment.

Results

Twenty four eligible patients were enrolled in a 12 month period. Baseline mean pain VAS score for these 24 patients was 74 (SD 18) and mean Fibromyalgia Impact Questionnaire score 78 (SD 12.4). Only 14 patients completed the course of treatment within about 10 weeks. Compliance was poor in the remaining patients because of difficulty attending clinic, and in two cases because of exacerbation of pain. Completion of outcome measures was variable and therefore the analysis of data is limited. Five patients scored at least 20% reduction in Fibromyalgia Impact Questionnaire score which is a clinically relevant improvement. Two of these scored at least 50% reduction.

Conclusion

Acupuncture appears to offer symptomatic improvement to some patients with fibromyalgia in a tertiary clinic who have failed to respond to other treatments. In view of its safety, further acupuncture research is justified in this population.
De Qi: Chinese Acupuncture Patients' Experiences and Beliefs regarding Acupuncture Needling Sensation – An Exploratory Survey
Authors: Mao Jun J , Farrar John T , Armstrong Katrina , Donahue Alethea , Ngo Jessica , Bowman Marjorie A
Published: April 2009

Introduction

While de qi, the acupuncture needling sensation, has been considered as an important component of acupuncture, little is known of the acupuncture patient's experience and beliefs about de qi in clinical settings. The aim of this study was to describe Chinese acupuncture patients’ perceived sensations of, and beliefs about, acupuncture needling.

Methods

We developed a questionnaire and conducted a survey study at two time periods among 200 subjects at six outpatient acupuncture clinics in Beijing, China.

Results

Respondents were 55% female and had a mean age of 41 years. The most common types of needling sensations reported by subjects were the terms ‘distended’(94%), ‘sore’(81%), ‘electric’(81%) and ‘numb’ (78%). Eighty-nine percent of subjects reported that the needling sensation travelled away from the puncturing points or travelled among the needling points. Eighty-two percent of subjects believed that the needling sensation was very important for acupuncture treatment, and 68% further indicated that the stronger the needling sensation, the more effective the therapy. Eighty-one percent of subjects found the acupuncture process to be very comfortable and relaxing.

Conclusion

Chinese acupuncture patients described the common characteristics of de qi and its migratory nature. The sensations were believed to be important in producing clinical efficacy by most patients. Measuring the sensations described as de qi in future prospective studies will help us understand the degree to which this phenomenon has an effect on the physiological outcome and clinical response to acupuncture. There appears to be a limit to the number of sensations that can be discriminated by each individual patient, and further development of the questionnaire is planned.
Analgesic Effects of Indirect Moxibustion on An Experimental Rat Model of Osteoarthritis in the Knee
Authors: Uryu Noriko , Okada Kaoru , Kawakita Kenji
Published: April 2009

Aims

The analgesic effects of moxibustion on an experimental model of osteoarthritis of the knee were investigated.

Methods

Male Wistar rats (n= 36,296–421g) were used. Intra-articular injection of mono-iodoacetic acid (MIA) was performed to induce knee osteoarthritis. Indirect moxibustion was applied to the lateral aspect of the knee joint every other day for 28 days (14 treatments). Weight bearing of the hind legs was measured directly by the downward pressure applied to footplates, using an Incapacitance Tester. Morphine was injected for testing the validity of weight bearing as a pain measure, and naloxone was used to examine the participation of endogenous opioids in the mechanism of moxibustion analgesia. Data were analysed by calculating the area under the curve.

Results

Injection of MIA significantly reduced weight bearing. No analgesic effects of moxibustion were observed during the initial 7 days (unpaired t test, P=0.83). Continued moxibustion treatments increased weight bearing at the 14th day significantly, and this effect continued until the end of the experiment on the 28th day (P<0.05). A single moxibustion treatment had no immediate effect on weight bearing. The analgesia due to the cumulative effect of moxibustion was antagonised by naloxone injection. Morphine injection in control MIA injected rats increased weight bearing to the normal range, confirming the validity of the measurements.

Conclusion

These results highlight the importance of repeated moxibustion treatments for pain relief in experimental knee osteoarthritis and suggest the existence of sustained inhibitory modulation by endogenous opioids in the moxibustion group.
Did ‘the Princess on the Pea— Suffer from Fibromyalgia Syndrome?
Authors: Lundeberg Thomas , Lund Iréne
Published: April 2009

Fibromyalgia syndrome (FMS) is a chronic pain syndrome characterised by central sensitisation resulting in hypersentivity of the skin and deeper tissues as well as fatigue. Possibly the princess in Hans Christian Andersen's ‘The Princess and the Pea’ suffered from FMS since chronic sleep disturbances are typical in FMS. These sleep disturbances have been attributed to a dysfunction in the systems regulating sleep and wakefulness resulting in loss of deep sleep. In addition, many patients with FMS experience cognitive dysfunction, characterised by impaired concentration and short term memory consolidation, a complaint also commonly reported in other sleep disorders.

In recent reviews evaluating the efficacy of acupuncture in FMS it has been concluded that acupuncture has no specific effect. A prerequisite for this conclusion is that all the major symptoms in the syndrome have been assessed. However, previous studies have generally focused on the pain alleviating effect of acupuncture in FMS. We have observed that not only pain but also sleep and cognitive dysfunction may be ameliorated in response to acupuncture, suggesting that these variables should be taken into account when evaluating the effects of acupuncture in FMS. Furthermore, the results demonstrated great individual variability apart from the systematic effects related to the group, indicating that individually performed treatment strategies are required. Our suggestion is supported by experimental and clinical studies showing that acupuncture may affect in somnia and alertness, and that there may be neurophysiologic bases for these specific effects.
Surface Electrostimulation of Acupuncture Points for Sedation of Critically Ill Patients in the Intensive Care Unit – a Pilot Study
Authors: Nayak Sandeep , Wenstone Richard , Jones Andy , Nolan Jill , Strong Ann , Carson Jeff
Published: April 2009

Background

This is a pilot study to investigate the effects of electrostimulation of acupuncture points on sedation and the dose of sedatives in the Intensive Care Unit.

Methods

Electrostimulation of acupuncture points was performed on 12 critically ill patients requiring sedation for mechanical ventilation. Electrostimulation was applied by point surface electrodes at LI4, ST36, HT7 and LR3 points for 20 minutes every hour for 12 hours using dense dispersed mode with a current frequency of 10–100Hz and maximum intensity of 10mA. All patients were sedated with propofol and alfentanil as required. The dose of propofol was reduced by 10mg/hour provided the patient remained sedated according to our guidelines. Sedation and analgesia scores, dose of sedative and analgesics drugs, respiratory rate, heart rate, mean arterial blood pressure and compliance with the ventilator were recorded before electrostimulation of acupuncture points, and hourly thereafter for 12 hours.

Results

There was significant reduction in the median propofol consumption from 145mg/hour (range 30–250) to 15mg/hour (range 0–250) (P<0.05), without any significant change in sedation scores or analgesia scores. The haemodynamic and respiratory variables remained stable. All patients were compliant with the ventilator.

Conclusion

This pilot study showed significant reduction in the dose of propofol required for sedation in critically ill patients following surface electrostimulation of acupuncture points, without any adverse effects. A randomised controlled trial is warranted.
Possible Effects of Acupuncture on Atrial Fibrillation and Post-Herpetic Neuralgia – a Case Report
Authors: Valaskatgis Peter , Macklin Eric A , Schachter Steven C , Wayne Peter M
Published: April 2009

A 72 year old female with a main complaint of severe post-herpetic neuralgia and a secondary complaint of atrial fibrillation (AF) received two series of acupuncture treatments totalling 20 treatments over a four month period. Her standard medical treatment remained unchanged. The primary focus of the acupuncture was pain relief; however, two acupuncture points (PC6, SP4) were included in both treatment series because of possible effects on both costal or chest pain and cardiac arrhythmias, according to Traditional Chinese Medicine (TCM) teaching and limited research. As recorded by her pacemaker, estimated weekly episodes of AF in the patient decreased significantly, and percentage time in AF decreased with borderline statistical significance, from the pretreatment estimates during the second series of treatments (weekly AF episode estimates: pretreatment =71.4; second series =16.5, difference estimates =−54.9, 95% CI −6.5 to −103.3, P=0.02; percentage time in AF estimates: pretreatment =30.6; 2 second series =18.0, difference estimates = −12.6, 95% CI 0.9 to −26.0, P=0.08). The pain levels were also significantly reduced following the acupuncture treatment series by more than 67%. Further studies are warranted to further explore these observations of a possible effect of acupuncture on both atrial fibrillation and post-herpetic neuralgia.
Acupuncture in the Rehabilitation of Women after Breast Cancer Surgery – a Case Series
Authors: Alem Michele , Gurgel Maria Salete Costa
Published: April 2009

Objective

To evaluate the effect of acupuncture on rehabilitation of motor function, reduction in lymphoedema and improvement in perceived heaviness and tightness in the arms of women who had undergone breast cancer surgery.

Subjects and Methods

Twenty nine women who had had mastectomy or segmentectomy with axillary dissection, presenting with lymphoedema and/or a decrease in movement amplitude of the upper limb ipsilateral to surgery were studied. The patients underwent 24 acupuncture sessions once a week from February to December 2004. The movement amplitude of shoulder flexion and abduction and circumferential measurements of the arm, forearm and wrist were evaluated before and after one, three and six months of treatment. Statistical analysis was performed by Friedman's test.

Results

Significant improvements in range of movement of shoulder flexion and abduction (P<0.001), degree of lymphoedema (P=0.016), and sense of heaviness and tightening (P<0.001) in the affected limb after six months of therapy were observed. For circumferential measurements of the arm, forearm and wrist, no significant improvement between the different periods of treatment was observed.

Conclusions

Acupuncture in rehabilitation after breast cancer surgery was shown to be associated with improvements in movement amplitude of the shoulder, symptoms of heaviness and tightness in the arm, and the degree of lymphoedema. However, controlled trials should be performed to ascertain whether the results were due to the natural history of the complaint or the acupuncture treatment.
Acupuncture for Back Pain, Knee Pain and Insomnia in Transverse Myelitis – a Case Report
Authors: Vaghela Sonia A , Donnellan Clare P
Published: April 2009

This case report describes the use of acupuncture for back pain, knee pain and insomnia in a 49 year old woman with a recent diagnosis of transverse myelitis with paraplegia, sensory disturbance, and bladder and bowel dysfunction. She was receiving intensive in-patient multi-disciplinary rehabilitation but was struggling to participate fully due to pain and poor sleep quality. She received a course of acupuncture in addition to standard care and reported substantial benefits including reduction in pain, improved sleep and mood, and reduction in daytime fatigue. Effective symptom control allowed this patient to participate more fully in her rehabilitation programme. Reduction of knee pain and sleep disturbance was maintained until discharge, 15 weeks after the last acupuncture treatment. This case report suggests that acupuncture may be an option to consider for other patients with pain or sleep disturbance that is interfering with their rehabilitation programme.
A Placebo Acupuncture Needle with Potential for Double Blinding – a Validation Study
Authors: Takakura Nobuari , Yajima Hiroyoshi
Published: April 2009

Background

The double blind, non-penetrating placebo needle is effective in masking patients who are not informed that they may receive a placebo needle. In this study, we aimed to examine whether such needles are effective in masking subjects who have been so informed.

Methods

One hundred and fourteen informed, consenting, healthy volunteers were recruited. An experienced acupuncturist applied one of the following needle pairs – penetrating/non-penetrating, non-penetrating/non-penetrating, penetrating/penetrating – randomly at bilateral TE5 points in subjects who were informed that they would receive either a non-penetrating or a penetrating needle. After the application of a pair of needles, the subjects reported for each arm on whether they identified the needle as non-penetrating or penetrating. The patients also rated skin penetration/penetration-like pain and the deep dull pain ( de qi) associated with the needle application on a visual analogue scale (VAS). The chi squared goodness of fit test was used to determine the probability of the number of correctly and incorrectly identified needles. Statistical comparisons for VAS scores for skin penetration pain and de qi were made using Mann-Whitney's U test.

Results

Of the 114 non-penetrating needle applications, the subjects identified 64 incorrectly and 50 correctly, fitting a probability of 0.5 (χ2=1.72, P=0.19). Most interestingly, the subjects identified 36 (32%) of 114 penetrating needle applications incorrectly. Skin penetration/penetration-like pain and de qi scores did not differ significantly (P=0.87 and P=0.17, respectively) between the 114 non-penetrating and 114 penetrating needles.

Conclusions

The non-penetrating placebo needle was effective in masking fully informed subjects. When used together with the matched penetrating needle, it has potential for use in double blind (patient and practitioner blind) studies.
The Role of Acupuncture in Western Medicine
Authors: Thompson John
Published: April 2009

Acupuncture has three main roles in western medicine (i) therapeutic, (ii) research, (iii) cultural and political.

(i) Therapeutic: There has been a steady increase in the use of acupuncture in western medicine, both as complementary to orthodox medicine and also on its own.

(ii) Research: Basic research is steadily defining the mechanism of action of acupuncture. Controlled clinical research is slowly substantiating the clinical efficacy of acupuncture.

(iii) Cultural/political: There is a steady increase in the availability of information about, and training in acupuncture by way of books, Journals and training courses. Acupuncture has been a potent stimulus to cultural exchanges and has thus encouraged peaceful collaboration between East and West.
Codetron in Rehabilitation of Chronic Pain Patients
Authors: Fargas-Babjak Angelica
Published: April 2009

Acupuncture is one of the oldest healing methods which is used in traditional medicine. in modern medicine we are witnessing a renaissance of this ancient treatment applied mainly in the management of chronic pain. A number of modern technological changes are being applied to replace, or modify, the classical needle treatment Among many of the modalities used at present are light, in the form of laser, and electrical stimulation. CODETRON TENS, the novel addition to Transcutaneous Electrical Nerve Stimulation (TENS), has been evaluated in a clinical trial, over a two year period, in a multidisciplinary pain clinic on patients who came for acupuncture therapy. Indications, effectiveness and experiences with this form of treatment are presented.
Scientific Observations on the Antiemetic Action of Stimulation of the P6 Acupuncture Point
Authors: Dundee J.W. , Ghaly R.G. , Yang J.
Published: April 2009

There would seem to be circumstances where there is some psychological element in P6 acupuncture antiemesis, but there is definite evidence that stimulation of the point alone has a clinically useful therapeutic action.
Analgesic Effects of Electroacupuncture in Extracorporeal Shock-Wave Treatment of Gallstone Disease
Authors: Iliev E. , Deredjan S.
Published: April 2009

Thirty-four patients with gallstone disease were treated with extracorporeal shock-wave lithotripsy (E.S.W.L.). Analgesia was provided by means of electroacupuncture in ear and body acupuncture points. Electrostimulation was begun about 30 minutes before the start of shock-wave lithotripsy and continued until the end of treatment. The number of shock waves varied between 400 and 1200 per patient. The favourable results obtained with the above method may be compared with those obtained with classical epidural anaesthesia as well as with drug premedication with Droperidol, Fentanyl, and Diazepam. The good sedative and analgesic effect which was obtained by acupuncture widens its field of application.
Use of Acupuncture in a General Practice: The First Two Years
Authors: Selly Eryl
Published: April 2009

The integration of acupuncture into a National Health Service (NHS) group practice is described, and its advantages and problems are discussed.
AN ESTIMATION OF THE ALTERNATION NUMBER OF A TORUS KNOT
Authors: ABE TETSUYA
Published: April 2009

We give a lower bound for the alternation number of a knot by using the Rasmussen s-invariant and the signature of a knot. Then, we determine the torus knots with alternation number one and show that many torus knots are "far" from the alternating knots. As an application, we determine the almost alternating torus knots, solving a conjecture due to Adams et al.
A GENERALIZED MULTISCALE ANALYSIS OF THE PREDICTIVE CONTENT OF EURODOLLAR IMPLIED VOLATILITIES
Authors: CARDINALI ALESSANDRO
Published: April 2009

It is widely believed that implied volatilities contains information that would enable prediction of spot volatility for a wide range of financial assets. Lead-lag analysis based on the Discrete Wavelet Transform has been proposed as one method for identifying and extracting that predictive information. Unfortunately this approach can fail to identify periodic components that are not proportional to an increasing dyadic scale. We propose a multiscale analysis of the Eurodollar realized volatility and at-the-money (ATM) implied volatilities. After filtering the long memory components we produce a decomposition of cross-correlation by using wavelet packet methods. A threshold cost functional based on asymptotic confidence intervals was used along with the best basis algorithm in order to select an adaptive frequency partition of the sample cross-correlation. We found substantial evidence that Eurodollar implied volatilities contain predictive information about realized volatilities. Moreover, in our analysis the new technique outperforms the lead-lag analysis based on the nondecimated Discrete Wavelet Transform. Therefore we contend that the proposed technique will improve detection of predictive information and recommend further testing in a range of applied contexts.
MINIMUM CONNECTED r-HOP k-DOMINATING SET IN WIRELESS NETWORKS
Authors: LI DEYING , LIU LIN , YANG HUIQIANG
Published: April 2009

In this paper, we study the connected r-hop k-dominating set problem in wireless networks. We propose two algorithms for the problem. We prove that algorithm I for UDG has (2r + 1)3 approximate ratio for k ≤ (2r + 1)2 and (2r + 1)((2r + 1)2 + 1)-approximate ratio for k > (2r + 1)2. And algorithm II for any undirected graph has (2r + 1) ln (Δr) approximation ratio, where Δr is the largest cardinality among all r-hop neighborhoods in the network. The simulation results show that our algorithms are efficient.
ON THE LONGEST RNG EDGE OF WIRELESS AD HOC NETWORKS
Authors: WAN PENG-JUN , WANG LIXIN , YAO FRANCES , YI CHIH-WEI
Published: April 2009

Relative neighborhood graph (RNG) has been widely used in topology control and geographic routing in wireless ad hoc networks. Its maximum edge length is the minimum requirement on the maximum transmission radius by those applications of RNG. In this paper, we derive the precise asymptotic probability distribution of the maximum edge length of the RNG on a Poisson point process over a unit-area disk. Since the maximum RNG edge length is a lower bound on the critical transmission radius for greedy forward routing, our result also leads to an improved asymptotic almost sure lower bound on the critical transmission radius for greedy forward routing.
Dynamics of Input Patterns Modulate the Behavior of a Model of Olfactory Bulb Function
Authors: Künsting Thomas , Spors Hartwig
Published: April 2009

Input patterns to the olfactory bulb are dynamic and change in an odor-specific manner as measured by selective calcium imaging of olfactory bulb input. To our knowledge, none of the published models of olfactory bulb function uses dynamic input patterns. Therefore we tested how dynamic input alters the behavior of a simple model consisting of two layers. The membrane potential of the first-layer neurons, integrate-and-fire neurons corresponding to mitral cells, was modulated with a subthreshold oscillation at respiration frequency. The membrane potential of the second-layer neurons was used to discriminate input patterns. We implemented oscillating input with amplitudes and latencies different for each mitral cell. Not only varying the input amplitudes but also de-synchronizing the input, and varying the relation between latency and input amplitude, individually changed the model's performance significantly. The discrimination time was affected more easily than the number of second-layer neurons that can differentiate an odor pair. Increasing the de-synchronization, i.e., the spread of latency values, reduced the differences in response time between strong and weak stimulus pairs without reducing the number of reacting cells. Input phase relative to the subthreshold oscillation altered the effect of de-synchronization. Thus dynamic input changes performance parameters of models of olfactory information processing that can be verified experimentally.
Influence of fatty acid diets on gene expression in rat mammary epithelial cells
Authors: Medvedovic M. , Gear R. , Freudenberg J. M. , Schneider J. , Bornschein R. , Yan M. , Mistry M. J. , Hendrix H. , Karyala S. , Halbleib D. , Heffelfinger S. , Clegg D. J. , Anderson M. W.
Published: April 2009

Background: This study examines the impact of dietary fatty acids on regulation of gene expression in mammary epithelial cells before and during puberty. Methods: Diets primarily consisted of n-9 monounsaturated fatty acids (olive oil), n-6 polyunsaturated fatty acids (safflower), saturated acids (butter), and the reference AIN-93G diet (soy oil). The dietary regimen mimics the repetitive nature of fatty acid exposure in Western diets. Diet-induced changes in gene expression were examined in laser capture microdissected mammary ductal epithelial cells at day of weaning and end of puberty. PCNA immunohistochemistry analysis compared proliferation rates between diets. Results: Genes differentially expressed between each test diets and the reference diet were significantly enriched by cell cycle genes. Some of these genes were involved in activation of the cell cycle pathway or the G2/M check point pathway. Although there were some differences in the level of differential expression, all diets showed qualitatively the same pattern of differential expression compared to the reference diet. Cluster analysis identified an expanded set of cell cycle as well as immunity and sterol metabolism related clusters of differentially expressed genes. Conclusion: Fatty acid-enriched diets significantly upregulated proliferation above normal physiological levels during puberty. Higher cellular proliferation during puberty caused by enriched fatty acid diets poses a potential increase risk of mammary cancer in later life. The human homologs of 27 of 62 cell cycle rat genes are included in a human breast cancer cluster of 45 cell cycle genes, further emphasizing the importance of our findings in the rat model.
Genetic dissection reveals diabetes loci proximal to thegimap5lymphopenia gene
Authors: Fuller J. M. , Bogdani M. , Tupling T. D. , Jensen R. A. , Pefley R. , Manavi S. , Cort L. , Blankenhorn E. P. , Mordes J. P. , Lernmark Å. , Kwitek A. E.
Published: April 2009

Congenic DRF.f/frats are protected from type 1 diabetes (T1D) by 34 Mb of F344 DNA introgressed proximal to the gimap5 lymphopenia gene. To dissect the genetic factor(s) that confer protection from T1D in the DRF.f/frat line, DRF.f/frats were crossed to inbred BBDR or DR.lyp/lyprats to generate congenic sublines that were genotyped and monitored for T1D, and positional candidate genes were sequenced. All (100%) DR.lyp/lyprats developed T1D by 83 days of age. Reduction of the DRF.f/fF344 DNA fragment by 26 Mb (42.52–68.51 Mb) retained complete T1D protection. Further dissection revealed that a 2 Mb interval of F344 DNA (67.41–70.17 Mb) ( region 1) resulted in 47% protection and significantly delayed onset ( P < 0.001 compared with DR.lyp/lyp). Retaining <1 Mb of F344 DNA at the distal end (76.49–76.83 Mb) ( region 2) resulted in 28% protection and also delayed onset ( P < 0.001 compared with DR.lyp/lyp). Comparative analysis of diabetes frequency in the DRF.f/fcongenic sublines further refined the RNO4 region 1 interval to ∼670 kb and region 2 to the 340 kb proximal to gimap5. All congenic DRF.f/fsublines were prone to low-grade pancreatic mononuclear cell infiltration around ducts and vessels, but <20% of islets in nondiabetic rats showed islet infiltration. Coding sequence analysis revealed TCR Vβ 8E, 12, and 13 as candidate genes in region 1 and znf467 and atp6v0e2 as candidate genes in region 2. Our results show that spontaneous T1D is controlled by at least two genetic loci 7 Mb apart on rat chromosome 4.
Activation of the PI3 Kinase Pathway By Retinoic Acid Mediates Sodium/Iodide Symporter Induction and Iodide Transport in MCF-7 Breast Cancer Cells
Authors: Ohashi Emi , Kogai Takahiko , Kagechika Hiroyuki , Brent Gregory A.
Published: April 2009

Iodide uptake in the thyroid and breast is mediated by the sodium/iodide symporter (NIS). NIS activation is used for radioiodide imaging and therapeutic ablation of thyroid carcinoma. NIS is expressed in >70% of breast cancers but at a level insufficient for radioiodine treatment. All-trans retinoic acid (tRA) induces NIS gene expression and functional iodide uptake in human breast cancer cell lines and mouse breast cancer models. tRA usually regulates gene expression by direct interaction of RA receptor (RAR) with a target gene, but it can also act through nongenomic pathways. We report a direct influence of tRA treatment on the phosphoinositide 3-kinase (PI3K) signal transduction pathway that mediates tRA-induced NIS expression in MCF-7 breast cancer cells. MCF-7 cells express all three RAR isoforms, α, β, and γ, and RXRα. We previously identified RARβ and RXRα as important for NIS induction by tRA. Treatment with LY294002, the PI3K inhibitor, or p85α knockdown with siRNA abolished tRA-induced NIS expression. Immunoprecipitation experiments and glutathione S-transferase pull-down assay showed a direct interaction between RARβ2, RXRα, and p85α. RA also induced rapid activation of Akt in MCF-7 cells. Treatment with an Akt inhibitor or Akt knockdown with siRNA reduced NIS expression. These findings indicate that RA induction of NIS in MCF-7 cells is mediated by rapid activation of the PI3K pathway and involves direct interaction with RAR and retinoid X receptor. Defining these mechanisms should lead to methods to further enhance NIS expression, as well as retinoid targets that influence growth and differentiation of breast cancer. [Cancer Res 2009;69(8):3443–50]
Transcriptional Regulation of Estrogen Receptor-α by p53 in Human Breast Cancer Cells
Authors: Shirley Stephanie Harkey , Rundhaug Joyce E. , Tian Jie , Cullinan-Ammann Noirin , Lambertz Isabel , Conti Claudio J. , Fuchs-Young Robin
Published: April 2009

Estrogen receptor α (ER) and p53 are critical prognostic indicators in breast cancer. Loss of functional p53 is correlated with poor prognosis, ER negativity, and resistance to antiestrogen treatment. Previously, we found that p53 genotype was correlated with ER expression and response to tamoxifen in mammary tumors arising in mouse mammary tumor virus–Wnt-1 transgenic mice. These results lead us to hypothesize that p53 may regulate ER expression. To test this, MCF-7 cells were treated with doxorubicin or ionizing radiation, both of which stimulated a 5-fold increase in p53 expression. ER expression was also increased 4-fold over a 24-h time frame. In cells treated with small interfering RNA (siRNA) targeting p53, expression of both p53 and ER was significantly reduced (>60%) by 24 h. Induction of ER by DNA-damaging agents was p53 dependent as either ionizing radiation or doxorubicin failed to up-regulate ER after treatment with p53-targeting siRNA. To further investigate whether p53 directly regulates transcription of the ER gene promoter, MCF-7 cells were transiently transfected with a wild-type (WT) p53 expression vector along with a luciferase reporter containing the proximal promoter of ER. In cells transfected with WT p53, transcription from the ER promoter was increased 8-fold. Chromatin immunoprecipitation assays showed that p53 was recruited to the ER promoter along with CARM1, CBP, c-Jun, and Sp1 and that this multifactor complex was formed in a p53-dependent manner. These data show that p53 regulates ER expression through transcriptional control of the ER promoter, accounting for their concordant expression in human breast cancer. [Cancer Res 2009;69(8):3405–14]
Functional Role of S100A14 Genetic Variants and Their Association with Esophageal Squamous Cell Carcinoma
Authors: Chen Hongyan , Yu Dianke , Luo Aiping , Tan Wen , Zhang Chunpeng , Zhao Dan , Yang Ming , Liu Junniao , Lin Dongxin , Liu Zhihua
Published: April 2009

S100 proteins have been implicated in various human diseases, including certain types of cancer. Among them, S100A14 is down-regulated in esophageal squamous cell carcinoma (ESCC). In this study, we sought to identify functional genetic variants in the S100A14 locus and assessed their associations with susceptibility to ESCC. Thirty individual DNA samples were sequenced to search for genetic variations in S100A14, and the function of the variants was investigated by a set of biochemical assays. A case-control analysis was performed in 1,021 patients with ESCC and 1,253 control subjects. Odds ratios and 95% confidence intervals (95% CI) were computed by logistic regression model. Four single nucleotide polymorphisms, −43A>G, 461G>A, 1493A>G, and 1545A>T, were identified in the S100A14 locus and they are in absolute linkage disequilibrium. Among them, the 461G>A change was shown to diminish a P53-binding site and is therefore associated with decreased expression of S100A14 in vitro and in vivo in the target tissues. Case-control analysis showed that the 461A allele was associated with susceptibility to ESCC among smokers, with the ORs being 2.01 (95% CI, 1.50–2.69) or 2.10 (95% CI, 1.37–3.22) for the 461GA or 461AA genotype, respectively, compared with the 461GG genotype. These data constitute strong evidence in support of the notion that S100A14 might function as a cancer suppressor working in the P53 pathway and play a role in esophageal carcinogenesis. [Cancer Res 2009;69(8):3451–7]