Auriculotherapy in prevention of migraine attacks: an open randomized trial.

Use of auriculotherapy to prevent episodic migraine pain has seldom been reported. The aim of this open study was to show that three sessions of auriculotherapy, 1 month apart, using semi-permanent needles decrease frequency and intensity of an attack in patients presenting episodic migraine. A total of 90 patients were randomized to the treatment group (AUR group, n = 58) or the control group (C group, n = 32). Four patients dropped out during the study (three in the AUR group and one in the C group). The number of days with migraine and non-migraine headache was similar when the analysis focused on the 3 months of the study or on the difference in each group of this number between the 3 months preceding the inclusion and the 3 months of the study (p = 0.123). AUR group patients had fewer days with non-migraine headache (p = 0.011) and took less Triptans (p = 0.045) than group C. Number of days with migraine, sum of the pain intensities of all migraines and non-migraine headaches, and total number of analgesics taken, other than triptan, were similar between groups. MIDAS score decreased with time in the AUR group while it increased in the C group whether in absolute values (p = 0.035) or as categories (p = 0.037). These contrasted results should lead to further study of the effectiveness of auriculotherapy for the prevention of migraine. Clinical trail registration: Protocol registered on the Clinicaltrials.gov, website (January 30, 2017, NCT03036761).

Nebulized versus intravenous morphine titration for the initial treatment of severe acute pain in the emergency department: study protocol for a multicenter, prospective randomized and controlled trial, CLIN-AEROMORPH.

BACKGROUND: Intravenous morphine titration (IVMT) is the French gold standard for opioid treatment in the emergency department (ED). Nebulized morphine titration (NMT) may represent an alternative without venous access, but it has not been adequately studied in adults. We test the hypothesis that NMT is at least as effective as IVMT to initially manage severe acute pain in the ED. METHODS/DESIGN: We designed a multicenter (10 French EDs), single-blind, randomized and controlled trial. Adults between 18 and 75 years with visual analog scale (VAS) ≥ 70/100 or numeric rating scale (NRS) ≥ 7/10 will be enrolled. We will randomize 850 patients into two groups to compare two routes of MT as long as VAS >  30 or NRS >  3. In group A (425), patients will receive an initial NMT for 5-25 min associated with titration of an intravenously (IV) administered placebo of physiologic serum (PS). In group B (425), patients will receive IVMT plus nebulized PS placebo. NMT is defined as a minimum of 1 and a maximum of 3 5-min nebulized boluses of 10 mg or 15 mg (weight ≥ 60 kg), at 10-min fixed intervals. IVMT is defined as a minimum of 1 and a maximum of 6 boluses of 2 mg or 3 mg (weight ≥ 60 kg), at 5-min fixed intervals. Nebulized placebo titration will be performed every 10 min. IV titration of PS will be performed every 5 min. In both groups, after 25 min, if VAS > 30/100 or NRS > 3/10, routine IVMT will be continued until pain relief. Pain severity, vital signs, bronchospasm, and Ramsay score will be recorded every 5 min. The primary outcome is the rate of relief obtained 1 h from the start of drug administration. Complete pain relief in both groups will be compared with a non-inferiority design. Secondary outcomes are pain relief at 30 min (the end of NMT) and at 2 h and median pain relief. We will compare final doses, and study the feasibility and tolerance of NMT (protocol deviations, respiratory or hemodynamic depression, sedation, and minor vegetative side effects). Co-analgesia will be recorded. Discharge criteria from the ED and hospital are defined. DISCUSSION: This trial is the first multicenter randomized and controlled NMT protocol for severe pain in the ED using the titration concept. We propose an original approach of combined titration with an endpoint at 1 h and a non-inferiority design. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03257319 . Registered on 22 August 2017.

First record of the green microalgae Coccomyxa sp. in blue mussel Mytilus edulis (L.) from the Lower St. Lawrence Estuary (Québec, Canada).

During autumn 2012 and spring 2013, blue mussels Mytilus edulis (L.) with strongly deformed (L-shaped) posterior shell margins and green spots in soft tissue (microalgae) were collected from intertidal zone along the south shore of the Lower St. Lawrence Estuary near Rimouski (Québec, Canada). Identification of algal cells infesting mussels as Coccomyxa sp. was confirmed by rRNA sequencing and HPLC pigment analysis. Flow cytometric analysis revealed the presence of algal cells in the hemolymph and extrapallial fluid in mussels with deformed and non-deformed shells; concentrations of algal cells were ranged from about 200mL(-1) in mussels with actually non-deformed shells to concentrations reaching up to 3.8×10(7)mL(-1) in mussels with heavily deformed ones. Chemical analyses of soft tissues led us to conclude that butyltin compounds and trace metals cannot be considered among factors responsible for the shell deformity observed. Using scanning electron microscopy, the biogenic nature of the erosion on the external shell surface and aragonitic lenses of prisms in the curvature zone of deformed shells (in sections) were recorded. The sequence of the green algae from M. edulis of the Lower St. Lawrence Estuary was closely related to Coccomyxa sp. infecting M. edulis from the Flensburg Fjord (North Sea) and Modiolus modiolus (L.) from the Vityaz Bay (Sea of Japan).

Chemical and microbial contamination baseline in the Saguenay-St. Lawrence Marine Park (Eastern Canada): concentrations and fluxes from land-based sources.

Stretching halfway between the Canadian Great Lakes and the Atlantic Ocean, the Saguenay-St. Lawrence Marine Park is subject to environmental issues being exposed to untreated or uncontrolled point and non-point sources of anthropogenic contamination. This article provides a first estimation of chemical and microbial contamination entering the marine park from the discharges of local municipal effluents and the inputs of tributaries in the summer period. Suspended particulate matter (SPM), nutrients, particulate carbon (PC) and nitrogen, trace metals, and fecal coliform bacteria were determined in surface brackish waters at upstream boundaries, in freshwater of 11 tributaries, and in nine sewage effluents from small communities settled along the marine park. Most tributaries have SPM < 10 mg L(-1) and contributed to a total of ~47 tons day(-1), thus representing a small proportion of daily SPM transported by Saguenay River (200 tons day(-1)) and St. Lawrence River (6.3 × 10(3) tons day(-1)). As expected, untreated sewage effluents showed high fecal contamination (0.2-6.0 × 10(6) CFU 100 mL(-1)), high NO x levels (4-33 µmol L(-1)) and high concentrations of particulate organic carbon (7-62 mg L(-1)). However, all tributaries had low coliforms (<230 CFU 100 mL(-1)), low PC (0.3-1.1 mg L(-1)), and low nutrients (NO(x) < 3.3 µmol L(-1)), with the exception of the Moulin-à-Baude River, a small tributary (2.3 × 10(5) m(3) day(-1)) clearly contaminated by human activities. Detailed analysis of 14 metals and metalloids in SPM did not show any clear contamination trend between sewage effluents and tributaries, except for Grandes-Bergeronnes River, where most trace metals appeared to be greater than for other rivers. Regarding global inputs, results showed that despite their relatively high pollutants load, inputs from local sewages and small tributaries remained minor contributors compared with upstream inputs, i.e., Saguenay River and St. Lawrence River. However, we illustrate that some local hydrodynamic factors in bays and inlets must be taken into account when evaluating risks associated with sewage discharges.

Acute respiratory illness as a trigger for detecting chronic bronchitis in adults at risk of COPD: a primary care survey.

AIM: To evaluate the impact of chronic bronchitis in patients identified among subjects at risk of chronic obstructive pulmonary disease (COPD) but currently free from any known chronic respiratory disorder, visiting a general practitioner for an acute respiratory episode. METHOD: A multicentre, cross-sectional survey carried out in primary care. RESULTS: Primary care practitioners (n = 772) examined 14,030 patients with acute cough (male: 56.9%, age 50.6 ± 16.5 years). Of these, 3,615 were at risk of COPD (> 40 years and tobacco use > 10 pack-years) and constituted the study population: 79.8% reported current symptoms of chronic bronchitis. Compared to patients without chronic bronchitis, they were older, more frequently exposed to occupational pollutants or to passive smoking, had more tobacco use (p < 0.001), reported dyspnoea > Grade 2 more frequently, and had poorer quality of life as assessed by the EuroQOL-5D questionnaire. CONCLUSIONS: In this survey, previously unrecognised chronic bronchitis was diagnosed in a high proportion of at-risk patients with acute respiratory episodes. Chronic bronchitis was associated with significantly poorer health status. Acute respiratory illness could be an appropriate opportunity for screening those patients at risk of COPD with lung function testing.