El valor de la acupuntura en la práctica de la medicina tradicional complementaria en el sector salud de México / The value of acupuncture in the practice of complementary traditional medicine in Mexico's health sector

Introduction: Complementary traditional medicine acquires an essential value from the diversity and pluralism of care and therapy. In this logic, it is up to people to search for alternatives when it comes to caring for and improving their own health. Specifically, acupuncture has had rapid growth, largely due to processes derived from globalization, migration and cultural exchange, which in some way force countries to modify their health system towards one that takes into account the transculturality of its population and treatment preferences. Development: With the establishment of a comprehensive health model, physicians can assess the person as a homeodynamic process (information exchange process between environment and man, to keep an internal and external homeostasis to the individual) and pandimensional (spiritual and energetic care) that allows to identify the health problem's origin and thus determine an intervention more in line with the person's needs during the health-disease, life-death processes, with the corresponding conventional or non-conventional therapy. Conclusions: The value and interest of acupuncture in the population derives from the degree of development of a country, its origin and the incorporation of the West as part of the diagnostic and therapeutic arsenal, in order to respond to the population needs by incorporating low-cost complementary treatments with proven effectiveness, without ceasing to consider its unquestionable cultural heritage.

Introducción: la medicina tradicional complementaria adquiere un valor imprescindible desde la diversidad y el pluralismo de la asistencia y la terapéutica. En esa lógica, corresponde a las personas la búsqueda social de alternativas cuando se trata de atender y mejorar la propia salud. En específico la acupuntura ha tenido un rápido crecimiento, en gran parte debido a la globalización, la migración y el intercambio cultural, que de alguna forma obligan a los países a modificar su sistema de salud hacia uno que tome en cuenta la transculturalidad de su población y las preferencias de tratamiento. Desarrollo: con el establecimiento de un modelo de salud integral, los médicos pueden valorar a la persona como un proceso homeodinámico (intercambio de información entre el ambiente y el hombre para mantener una homeostasis interna y externa del individuo) y pandimensional (cuidado espiritual y energético) que permita identificar el origen real del problema de salud y determinar una intervención más acorde a las necesidades de la persona durante los procesos de salud-enfermedad, de vida-muerte, con la terapia convencional o no convencional que corresponda. Conclusiones: el valor e interés de la acupuntura en la población se deriva del grado de desarrollo de un país, de su origen y de la incorporación de occidente como parte del arsenal diagnóstico y terapéutico, para responder a las necesidades de la población al incorporar tratamientos complementarios de bajo costo y con efectividad demostrada, y sin dejar de considerar su herencia cultural incuestionable.

Treating Alcohol Use Disorder in U.S. Veterans: The Role of Traumatic Brain Injury.

OBJECTIVE: The authors examined the efficacy of valproate to reduce relapse to heavy drinking among veterans with alcohol use disorder (AUD) and neuropsychiatric comorbidities and whether antecedent traumatic brain injury (TBI) or posttraumatic stress disorder (PTSD) affected treatment response. METHODS: Participants were male veterans 18-60 years old with an AUD and no other substance use besides nicotine or cannabis. Sixty-two patients were randomly assigned to receive either valproate or naltrexone. Participants were evaluated at baseline and followed weekly for 24 weeks. All participants received standardized psychosocial interventions as well as treatment for coexistent psychiatric conditions. RESULTS: During the follow-up period, nine study subjects in the naltrexone group and 14 in the valproate group relapsed to heavy drinking, but the difference did not reach statistical significance. Participants with a history of moderate to severe TBI were more likely to relapse to heavy drinking compared with those with no TBI (hazard ratio=4.834, 95% CI=1.103-21.194, p=0.033). PTSD status did not significantly affect outcome. CONCLUSIONS: Intensive outpatient programs are efficacious alternatives to treat AUD in veterans, although the role of pharmacological treatment is not completely elucidated. Glutamatergic agents appear to be less effective than opiate antagonists to prevent relapse to heavy drinking and to increase cumulative abstinence. Future studies should examine novel pharmacological and nonpharmacological options.

The Effect of Bioinduced Increased pH on the Enrichment of Calcium Phosphate in Granules during Anaerobic Treatment of Black Water.

Simultaneous recovery of calcium phosphate granules (CaP granules) and methane in anaerobic treatment of source separated black water (BW) has been previously demonstrated. The exact mechanism behind the accumulation of calcium phosphate (Ca x(PO4) y) in CaP granules during black water treatment was investigated in this study by examination of the interface between the outer anaerobic biofilm and the core of CaP granules. A key factor in this process is the pH profile in CaP granules, which increases from the edge (7.4) to the center (7.9). The pH increase enhances supersaturation for Ca x(PO4) y phases, creating internal conditions preferable for Ca x(PO4) y precipitation. The pH profile can be explained by measured bioconversion of acetate and H2, HCO3- and H+ into CH4 in the outer biofilm and eventual stripping of CO2 and CH4 (biogas) from the granule. Phosphorus content and Ca x(PO4) y crystal mass quantity in the granules positively correlated with the granule size, in the reactor without Ca2+ addition, indicating that the phosphorus rich core matures with the granule growth. Adding Ca2+ increased the overall phosphorus content in granules >0.4 mm diameter, but not in fine particles (<0.4 mm). Additionally, H+ released from aqueous phosphate species during Ca x(PO4) y crystallization were buffered by internal hydrogenotrophic methanogenesis and stripping of biogas from the granule. These insights into the formation and growth of CaP granules are important for process optimization, enabling simultaneous Ca x(PO4) y and CH4 recovery in a single reactor. Moreover, the biological induction of Ca x(PO4) y crystallization resulting from biological increase of pH is relevant for stimulation and control of (bio)crystallization and (bio)mineralization in real environmental conditions.

Calcium addition to increase the production of phosphate granules in anaerobic treatment of black water.

Simultaneous recovery of calcium phosphate granules (CaP granules) and methane from vacuum collected black water (BW), using an upflow anaerobic sludge blanket (UASB) reactor was previously investigated. It was calculated that only 2% of the total phosphorus (P) fed was present as CaP granules whereas 51% of the P accumulated dispersed in the reactor, limiting the applicability of this process for recovery of phosphate. This study proposes adding calcium to increase the P accumulation in the reactor and the production of CaP granules. Calcium was added in a lab-scale UASB reactor fed with BW. An identical UASB reactor was used as reference, to which no calcium was added. The treatment performance was evaluated by weekly monitoring of influent, effluent and produced biogas. Sludge bed development and CaP granulation were assessed through particle size analysis. The composition and structure of CaP granules were chemically and optically assessed. Calcium addition increased accumulation of P in the reactor and formation and growth of granules with size > 0.4 mm diameter (CaP granules). Moreover, with calcium addition, CaP granules contained 5.6 ± 1.5 wt% of P, while without calcium a lower P content was observed (3.7 ± 0.3 wt%). By adding Ca, 89% of the incoming P from BW accumulated in the reactor and 31% was sampled as CaP granules (> 0.4 mm diameter). Addition of 250 mgCa L-1 of BW was the optimum loading found in this study. Furthermore, no significant reduction in CODTotal removal (> 80%) and CH4 production (0.47 ± 0.10 gCOD-CH4 g-1CODTotal-BW) was observed. Therefore, adding calcium can significantly increase the CaP granulation without inhibiting the simultaneous CH4 recovery. This further indicates the potential of this process for phosphate recovery.

Abnormal cortical asymmetry as a target for neuromodulation in neuropsychiatric disorders: A narrative review and concept proposal.

Recent advances in knowledge relating to the organization of neural circuitry in the human brain have increased understanding of disorders involving brain circuit asymmetry. These asymmetries, which can be measured and identified utilizing EEG and LORETA analysis techniques, may be a factor in mental disorders. New treatments involving non-invasive brain stimulation (NIBS), including trans-cranial magnetic stimulation, direct current stimulation and vagal nerve stimulation, have emerged in recent years. We propose that EEG identification of circuit asymmetry geometries can direct non-invasive brain stimulation more specifically for treatments of mental disorders. We describe as a narrative review new NIBS therapies that have been developed and delivered, and suggest that they are proving effective in certain patient groups. A brief narrative of influence of classical and operant conditioning of neurofeedback on EEG coherence, phase, abnormalities and Loreta's significance is provided. We also discuss the role of Heart rate variability and biofeedback in influencing EEG co-relates. Clinical evidence is at an early stage, but the basic science evidence and early case studies suggest that this may be a promising new modality for treating mental disorders and merits further research.

Cirugía incompleta del carcinoma adenoide quístico bronquial: una alternativa terapéutica / Incomplete surgery for bronchial cystic adenoid carcinoma: A therapeutic alternative

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The NIHSS supplementary motor scale: a valid tool for multidisciplinary recovery trials.

BACKGROUND: There is a growing interest in therapies that may augment motor recovery that could be initiated in the acute stroke unit and maintained through the rehabilitation period. Homogenization of the currently fragmented stroke clinicometrics is necessary before such multidisciplinary trials can be conducted. The supplementary motor scale of the NIH Stroke Scale (SMS-NIHSS) is a simple and reliable scale for assessing proximal and distal motor function in the upper and lower extremities. We hypothesized that the currently underutilized SMS-NIHSS is a valid tool for assessing motor recovery with prognosticative value. METHODS: We performed an analysis of SMS-NIHSS scores recorded in 1,281 patients enrolled in the Trial of ORG 10172 in Acute Stroke Treatment (TOAST). We plotted the probability of a favorable outcome (FO) and very favorable outcome (VFO) at 3 months based on the baseline SMS-NIHSS scores. In order to better study the relationship between SMS-NIHSS and 3-month functional outcome, we performed multivariate logistic regression analyses using both FO and VFO as outcome measures. Analyses were adjusted for potential confounders such as age, sex, side of the lesion, time from symptom onset to emergency room arrival, temperature, systolic blood pressure, blood glucose level and treatment group assignment (ORG 10172 vs. placebo). We also calculated the Spearman correlation coefficient between the SMS-NIHSS, Barthel Index (BI) and Glasgow Outcome Score (GOS) obtained at the 3-month visit. RESULTS: The mean SMS-NIHSS scores were 8.18 at baseline and 4.68 at 3 months. The SMS-NIHSS scores showed a gradual improvement during the first 3 months after stroke. There was a linear relationship between the baseline SMS-NIHSS scores and the probability of an FO or VFO at 3 months. The SMS-NIHSS baseline score was an independent predictor of FO (OR = 0.86; 95% CI 0.84-0.87; p < 0.0001) and VFO (OR = 0.85; 95% CI 0.84-0.87; p < 0.0001) at 3 months after adjusting for confounders. The degree of improvement in the SMS-NIHSS scores from baseline to 3 months was also independently associated with FO and VFO (p < 0.0001). At 3 months, SMS-NIHSS scores showed a strong correlation with the BI (r = -0.70; p < 0.0001) and GOS (r = 0.73; p < 0.0001). CONCLUSIONS: The SMS-NIHSS is a valid scale for assessing motor recovery with prognosticative value, and may be sensitive to changes during recovery. Given that the SMS-NIHSS is an extension of the widely accepted NIHSS, it could be easily implemented in trials conducted in a variety of clinical research settings, including acute stroke hospitals and rehabilitation units.

The frequency, clinical correlates, and mechanism of anosognosia after stroke.

OBJECTIVE: To review the frequency, clinical correlates, and mechanism of anosognosia after stroke. METHODS: We searched the most recent relevant literature on anosognosia after stroke and carried out a critical analysis of the main findings. RESULTS: Anosognosia is present in about 10% of acute stroke patients and its diagnosis is relatively simple. Nevertheless, a valid and reliable standardization of diagnostic instruments and criteria for research purposes is more difficult to achieve. This limitation may partially account for various instruments available to assess anosognosia and the different strategies used to diagnose this phenomenon. Anosognosia is a fleeting phenomenon and chronic cases are infrequent. There is a robust association between anosognosia and right-hemisphere lesions involving cortical (insular, temporal, and parietal lobes) and subcortical structures (thalamus and basal ganglia). The main clinical correlates of anosognosia are the presence of neglect, cognitive deficits, previous strokes, and older age. Anosognosia has a negative impact on the rehabilitation of stroke patients. The mechanism of anosognosia remains unknown but was explained as owing to psychological denial, disconnection between left and right hemispheres, and dysfunction of a system that monitors the intention to move and actual movements. CONCLUSION: Anosognosia is a relatively frequent complication of acute stroke and may become an excellent model to understand the mechanism of human awareness.

In vivo proton magnetic resonance spectroscopy in patients with mood disorders: a technically oriented review.

Proton MR spectroscopy (1HMRS) has been extensively used among mood disorders patients. A review of the published literature in 1HMRS studies of mood disorders was carried out for the period 1991 to July 2006. Of 71 1HMRS studies, 77.5% were done at 1.5T and 66.2% used single voxel sequences (SVS), implying limitations of spectral resolution and anatomic coverage, respectively. In all, 47.9% of studies relied on creatine (Cr) as internal signal standard, although Cr changes were reported in major depression (MD). Most reported metabolic alterations related to mood state affected the left frontal lobe. Depressed adult and pediatric MD patients had reduced glutamate (Glu) in frontal lobe regions, which reversed with successful treatment. A consistent reduction of N-acetyl-aspartate (NAA) was reported in the hippocampal formation among bipolar disorder (BD) patients, along with an increment in frontal Glu. The differences in results of 1HMRS studies in mood disorders reflect heterogeneity of technical factors and subject selection. Future studies should benefit from higher spectral resolution and more extensive anatomic coverage as well as standardized data-processing protocols and subject selection criteria.

Producción científica sobre aplicaciones terapéuticas del ozono en el Web of Science / Scientific production on the therapeutic applications of ozone at the Web of Science

Uno de los descubrimientos más notables durante los últimos años en el campo de la medicina alternativa es el empleo del ozono como agente terapéutico. No obstante, a pesar de la práctica cada vez más extendida de la ozonoterapia en el mundo, existen todavía aspectos contradictorios alrededor de su aceptación como técnica terapéutica, y algunos medios de comunicación han afirmado que no existe evidencia científica que acredite sus supuestas ventajas. El presente trabajo constituye un estudio bibliométrico con el objetivo de identificar y analizar la producción científica sobre aplicaciones terapéuticas del ozono existente en el Web of Science. Se recuperaron 117 artículos sobre le temática. Se identificó el índice de asociación de los autores; los autores, revistas y países más productivos; los artículos más citados; las redes de colaboración internacionales; las especialidades más beneficiadas; y los padecimientos más tratados con la ozonoterapia. A pesar de la escasa producción científica sobre las aplicaciones terapéuticas del ozono recogida en el Web of Science, se observó un crecimiento exponencial de esta durante la última década, así como una amplia gama de patologías que registraron sus efectos positivos. Ello confirmó la existencia de una evidencia científicamente válida que acredita su uso como técnica terapéutica en la práctica clínica(AU)

Evaluation of the GTRACT diffusion tensor tractography algorithm: a validation and reliability study.

Fiber tracking, based on diffusion tensor imaging (DTI), is the only approach available to non-invasively study the three-dimensional structure of white matter tracts. Two major obstacles to this technique are partial volume artifacts and tracking errors caused by image noise. In this paper, a novel fiber tracking algorithm called Guided Tensor Restore Anatomical Connectivity Tractography (GTRACT) is presented. This algorithm utilizes a multi-pass approach to fiber tracking. In the first pass, a 3D graph search algorithm is utilized. The second pass incorporates anatomical connectivity information generated in the first pass to guide the tracking in this stage. This approach improves the ability to reconstruct complex fiber paths as well as the tracking accuracy. Validation and reliability studies using this algorithm were performed on both synthetic phantom data and clinical human brain data. A method is also proposed for the evaluating reliability of fiber tract generation based both on the position of the fiber tracts, as well the anisotropy values along the path. The results demonstrate that the GTRACT algorithm is less sensitive to image noise and more capable of handling areas of complex fiber crossing, compared to conventional streamline methods.

Producción científica sobre aplicaciones terapéuticas del ozono en el Web of Science / Scientific production on the therapeutic applications of ozone at the Web of Science

Uno de los descubrimientos más notables durante los últimos años en el campo de la medicina alternativa es el empleo del ozono como agente terapéutico. No obstante, a pesar de la práctica cada vez más extendida de la ozonoterapia en el mundo, existen todavía aspectos contradictorios alrededor de su aceptación como técnica terapéutica, y algunos medios de comunicación han afirmado que no existe evidencia científica que acredite sus supuestas ventajas. El presente trabajo constituye un estudio bibliométrico con el objetivo de identificar y analizar la producción científica sobre aplicaciones terapéuticas del ozono existente en el Web of Science. Se recuperaron 117 artículos sobre le temática. Se identificó el índice de asociación de los autores; los autores, revistas y países más productivos; los artículos más citados; las redes de colaboración internacionales; las especialidades más beneficiadas; y los padecimientos más tratados con la ozonoterapia. A pesar de la escasa producción científica sobre las aplicaciones terapéuticas del ozono recogida en el Web of Science, se observó un crecimiento exponencial de esta durante la última década, así como una amplia gama de patologías que registraron sus efectos positivos. Ello confirmó la existencia de una evidencia científicamente válida que acredita su uso como técnica terapéutica en la práctica clínica

White matter volume and cognitive dysfunction in early Huntington's disease.

BACKGROUND: Structural abnormalities of the striatum and cognitive impairments have consistently been shown in patients with Huntington's disease (HD). Fewer studies have examined other cerebral structures in early HD and potential associations with cognition. METHOD: Ten patients with early HD and 10 matched control subjects underwent magnetic resonance imaging to provide quantitative measures (volumes) of cortical gray and white matter and the caudate, putamen, and thalamus. Patients completed the Unified Huntington's Disease Rating Scale, including three cognitive tasks. RESULTS: Although striatal volumes were clearly reduced, white matter was also morphologically abnormal. Cortical gray matter volume was not significantly correlated with cognitive performance. However, the cognitive tasks were most highly correlated with cerebral white matter and, to a lesser degree, striatal volume. CONCLUSIONS: Cerebral white matter volume may be an important variable to examine in future studies of HD.

Argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias.

BACKGROUND: Angiodysplasia is a frequent cause of GI bleeding. Argon plasma coagulation has been shown to arrest bleeding, but its efficacy for prevention of recurrent bleeding has not been thoroughly evaluated. This study assessed the effectiveness and the safety of argon plasma coagulation for prevention of recurrent bleeding from GI angiodysplasias. METHODS: A total of 60 patients with GI bleeding caused by angiodysplasia were included. The endoscopic intervention was considered successful if there was no further overt bleeding and if the Hb level stabilized. Recurrent bleeding was defined as any detectable bleeding episode (hematemesis, melena, or hematochezia) or a decrease in Hb level. RESULTS: Overt bleeding was resolved, and the Hb level stabilized without transfusion or supplemental iron therapy in 50 of the 60 patients (83%) at a median follow-up of 18 months (range 6-38 months). In the subgroup of patients with anemia, mean Hb level increased from 8.6 g/dL (range 5.1-12.2 g/dL) to 12 g/dL (range 8.0-15.2 g/dL) ( p < 0.01). The estimated probability of remaining free of recurrent bleeding at 1- and 2-year follow-up was 86%: 95% CI [73%, 93%] and 80%: 95% CI [64%, 89%], respectively. Among 72 procedures, only two were associated with a complication (2.8%). CONCLUSIONS: Endoscopic argon plasma coagulation is both effective and safe for prevention of recurrent bleeding from GI angiodysplasia.

Repetitive transcranial magnetic stimulation as treatment of poststroke depression: a preliminary study.

BACKGROUND: Depression has a significant impact on poststroke recovery and mortality. There are a proportion of patients with poststroke depression (PSD) who do not respond to antidepressants. Repetitive Transcranial Magnetic Stimulation (rTMS) might be a safe and effective alternative in these refractory cases. METHODS: We conducted a randomized, parallel, double-blind study of active versus sham left prefrontal rTMS in patients with refractory PSD. After discontinuing antidepressants, patients were randomly assigned to receive 10 sessions of active (10 Hz, 110% of the motor threshold, 20 trains of 5 seconds duration) or sham left prefrontal rTMS. Efficacy measures included HAM-D scores, response and remission rates. Patients completed a neuropsychological battery at baseline and after completing the protocol. RESULTS: When compared with sham stimulation, 10 sessions of active rTMS of the left dorsolateral prefrontal cortex were associated with a significant reduction of depressive symptoms. This reduction was not influenced by patient's age, type or location of stroke, volume of left frontal leukoaraiosis or by the distance of the stimulating coil to the prefrontal cortex. However, there was a significant positive correlation between the percentage of reduction of Ham-D scores and frontal gray and white matter volumes. There were no significant changes in cognitive functioning between the active and the sham stimulation groups. In addition, there were few and mild adverse effects that were equally distributed among groups. CONCLUSIONS: Taken together, these preliminary findings suggest that rTMS may be an effective and safe treatment alternative for patients with refractory depression and stroke.