Cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders in Singapore.

BACKGROUND: The study evaluated the cost-effectiveness of hydrotherapy versus land-based therapy in patients with musculoskeletal disorders (MSDs) in Singapore. METHODS: A decision-analytic model was constructed to compare the cost-effectiveness of hydrotherapy to land-based therapy over 3 months from societal perspective. Target population comprised patients with low back pain (LBP), osteoarthritis (OA), rheumatoid arthritis (RA), total hip replacement (THR) and total knee replacement (TKR). Subgroup analyses were carried out to determine the cost-effectiveness of hydrotherapy in individual MSDs. Relative treatment effects were obtained through a systematic review of published data. RESULTS: Compared to land-based therapy, hydrotherapy was associated with an incremental cost-effectiveness ratio (ICER) of SGD 27 471 per quality-adjusted life-year (QALY) gained, which was below the willingness-to-pay threshold of SGD 70 000 per QALY (one gross domestic product per capita in Singapore in 2015). For the respective MSDs, hydrotherapy were dominant (more effective and less costly) in THR and TKR, cost-effective for LBP and RA, and not cost-effective for OA. Treatment adherence and cost of hydrotherapy were key drivers to the ICER values. CONCLUSIONS: Hydrotherapy was a cost-effective rehabilitation compared to land-based therapy for a population with MSDs in Singapore. However, the benefit of hydrotherapy was not observed in patients with OA.

[Effects of moxa-stick ignition locations on temperature of needle body and surrounding environment during warm needling].

OBJECTIVE: To observe the effects of different ignition locations of moxa stick on temperature of needle body and surrounding environment during warm needling, so as to provide experimental references for clinical manipulation. METHODS: A high-accuracy infrared temperature measuring instrument was applied during warm needling to measure the temperature of needle body and surrounding environment at different ignition locations. The ignition method was divided into 2 ignition types with 4 measuring locations. The first method was to ignite moxa stick from upper-end to measure the temperature of needle body and surrounding environment 2 cm and 3 cm away from bottom-end of moxa stick; the second one was to ignite moxa stick from bottom-end to measure the temperature of needle body and surrounding environment 2 cm and 3 cm away bottom-end of moxa stick. Each ignition method was repeatedly measured for 5 times. The averaging values of measurement results which were processed with superposition method at identical time point were used to draw a temperature curve. RESULTS: With any identical ignition method, the maintenance time of moxibustion temperature 2 cm away from bottom-end of moxa stick was longer by 3 min compared with that from 3 cm, for bottom-end ignition and upper-end ignition, in the case of 30 degrees C to 35 degrees, more ignition time could be kept from bottom-end ignition; in the case of more than 35 degrees C, the maximum temperature of needle body by upper-end ignition was higher by 5 degrees C than that by bottom-end ignition. The bottom-end ignition could achieve earlier effective initial time of moxibustion temperature. From the curves, bottom-end ignition was characterized by left-shift peak while upper-end ignition was characterized by right-shift peak. CONCLUSION: The ignition location of warming needling seems to be reasonable if moxa stick is ignited from bottom end which is 2 to 3 cm away from skin.

[Effects of acupuncture at Dazhui (GV 14) on brain stem auditory evoked potentials in the patient with cervical spondylosis of vertebral artery type].

OBJECTIVE: To study on the mechanism of Dazhui (GV 14) in treatment of cervical spondylosis of vertebral artery type, and to explore the feasibility of regarding hrain stem auditory evoked potential (BAEP) as the objective criterion for assessment of the therapeutic effect. METHODS: Fifty-two cases of cervical spondylosis of vertebral artery type were treated with acupuncture at Dazhui (GV 14), their therapeutic effect and changes of BAEP before and after treatment were investigated. RESULTS: Seventeen cases were cured, 26 cases improved and 9 cases were ineffective, with an effective rate of 82.7%. In BAEP, V PL, I-III IPL, III-V IPL had significant changes after treatment (P < 0.05), with a significant difference between the clinically effective group (cured and improved) as compared with the ineffective group (P < 0.05, P < 0.01). CONCLUSION: Acupuncture at Dazhui (GV 14) improves blood supply of the vertebrabssilar artery, eliminates or alleviates clinical symptoms of cervical spondylosis of vertebral artery type. BAEP can be used as the criterion for assessment of the therapeutic effect.

[Astragalus membranaceus promote expression of insulin-like growth factor 1 in rat model of olivo-cerebellar degeneration].

OBJECTIVE: To observe the effect of Astragalus membranaceus (AM) on insulin-like growth factor 1 (IGF-1) expression in a rat model of olivo-cerebellar degeneration and assess the neuroprotective actions of AM meanwhile. METHOD: Rats model of olivo-cerebellar degeneration was established by using 3-acetylpyridine. The effect of AM on the expression of Calbindin D-28K in inferior olive (IO) neurons by immunohistochemistry, the serum IGF-1 level by Elisa, the IGF-1 mRNA level in the cerebellum by RT-PCR were detected respectively. RESULT: AM effectively improve the serum IGF-1 level, Cerebellar IGF-1 mRNA level and the survival of the 10 neurons in a rat model of olivo-cerebellar degeneration, even at a lower dose (9 g x kg(-1)), and the effect was in a dose-dependent manner. CONCLUSION: AM could effectively upregulate the IGF-1 expression in the rat model of olivo-cerebellar degeneration, and have neuroprotective effect on IO neurons.

[Inhibitory effects of artesunate on angiogenesis].

AIM: To investigate the inhibitory effects of artesunate on angiogenesis. METHODS: The in vitro anti-angiogenic effect of artesunate was tested on models of angiogenesis: proliferation, migration and tube formation of human umbilical vein endothelial (HUVE) cells; The anti-angiogenic effect in vivo was evaluated in nude mice by means of human ovarian cancer HO-8910 implantation and immunohistochemical stainings for microvessel (CD31), vascular endothelial growth factor (VEGF) and VEGF receptor KDR/flk-1. RESULTS: Artesunate significantly inhibited angiogenesis in a concentration-dependent form in range of 0.5-50 mumol.L-1. The IC50 of artesunate for HUVE cells was (21 +/- 3) mumol.L-1. Growth of xenograft tumor was decreased and microvessel density was reduced following drug-treatment with no apparent toxicity to the animals. Artesunate also remarkably lowered VEGF expression on tumor cells and KDR/flk-1 expression on endothelial cells as well as tumor cells. CONCLUSION: Artesunate was shown to inhibit angiogenesis in vitro and in vivo. These findings together with the known low toxicity of artesunate are clues that artesunate may be a promising angiogenesis inhibitor.

Apoptosis of human umbilical vein endothelial cells induced by artesunate.

Artesunate (ART), a semi-synthetic derivative of artemisinin isolated from the traditional Chinese herb Artemisia annua, is an effective novel antimalarial drug. The present study investigated the apoptotic activity of artesunate in cultured human umbilical vein endothelial cell (HUVEC) by means of nuclear staining, DNA agarose gel electrophoresis, and flow cytometry. The observations also indicated that artesunate induced apoptosis of HUVEC in a concentration-dependent and time-dependent manner. A Western immunoblot analysis showed down-regulation of the bcl-2 protein and up-regulation of the bax protein in the artesunate-treated HUVEC. Ca2+ in cells was evaluated by fluorescent spectrophotometer using Fura 2-AM as probe. These results suggest that artesunate may be a potential apoptosis-inducing agent for endothelial cells.