The response-time relationship and covariate effects of acupuncture for chronic pain: A systematic review and model-based longitudinal meta-analysis.

BACKGROUND AND OBJECTIVE: Critical clinical questions regarding how soon and how long the analgesic effect will be achieved by acupuncture, as well as who will be responsive to acupuncture, need further address. The aim of the study was to investigate the response-time relationship and covariate effects of acupuncture. DATABASES AND DATA TREATMENT: PubMed and EMBASE were searched up to December 2018 for randomized controlled trials that involved sham acupuncture, true acupuncture and conventional therapy. We used a model-based longitudinal meta-analysis to characterize the response-time profile of these treatments. RESULTS: Seventy-seven randomized clinical trials involved chronic shoulder, neck, knee and low back pain were included. The response-time analysis suggested that the treatment duration of acupuncture will be 5 weeks or more to achieve 80% of maximum analgesic effect. Moreover a lower baseline pain intensity and the location of low back pain resulted in a lower pain relief of acupuncture intervention. The absolute maximum analgesic effects of sham acupuncture and conventional therapy were 22.6 and 15.8 points at a 0-100 NRS scale. The absolute effect of true acupuncture was 26.1 points for low back pain (relative effect of 3.5 and 9.4 points to sham and conventional therapy), 34.9 points for other pain body locations (relative effect of 12.3 and 19.1 points to sham and conventional therapy), in patients with a baseline pain intensity of 60 points. CONCLUSION: The treatment duration of acupuncture will not be less than 5 weeks to achieve 80% maximum analgesic effect. Higher analgesic effect was related to higher baseline pain intensity and pain location of neck, shoulder and knee. SIGNIFICANCE: Our systematic review and meta-analysis provides the clear evidence for the treatment duration and significant related covariates of acupuncture intervention for chronic pain. These results provide useful suggestion for acupuncture intervention in clinical pain management.

Hybrid PET/MRI enables high-spatial resolution, quantitative imaging of amyloid plaques in an Alzheimer's disease mouse model.

The emergence of PET probes for amyloid plaques and neurofibrillary tangles, hallmarks of Alzheimer disease (AD), enables monitoring of pathology in AD mouse models. However, small-animal PET imaging is limited by coarse spatial resolution. We have installed a custom-fabricated PET insert into our small-animal MRI instrument and used PET/MRI hybrid imaging to define regions of amyloid vulnerability in 5xFAD mice. We compared fluorine-18 [18F]-Florbetapir uptake in the 5xFAD brain by dedicated small-animal PET/MRI and PET/CT to validate the quantitative measurement of PET/MRI. Next, we used PET/MRI to define uptake in six brain regions. As expected, uptake was comparable to wild-type in the cerebellum and elevated in the cortex and hippocampus, regions implicated in AD. Interestingly, uptake was highest in the thalamus, a region often overlooked in AD studies. Development of small-animal PET/MRI enables tracking of brain region-specific pathology in mouse models, which may prove invaluable to understanding AD progression and therapeutic development.

Psychodynamic aspects of psychopharmacology.

This paper presents a framework for understanding the psychodynamic issues pertaining to psychopharmacology. It examines the treatment situation from three perspectives: the self-in-relation-to-others, the patient-prescriber relationship, and cultural attitudes. It discusses psychodynamic factors involved in clinical improvement and deterioration. The relevance of these issues is discussed and contrasted with the biomedical model of mental illness. It concludes by advocating the mindfulness of psychodynamic factors and the maintenance of dialectics in clinical practice.

The use of lipiodol in spiral tomography for dental implant imaging.

Preoperative radiographic assessment is mandatory for the meticulous treatment planning and successful placement of implants. The precise topographical evaluation of selected implant sites, apart from the most straightforward cases, requires tomographic examination with the use of diagnostic radiographic templates. The incorporation of various radiopaque materials such as barium sulphate and lead foil as radiographic markers had not been entirely satisfactory. A new contrast medium, Lipiodol ethiodized oil (Laboratoire Guerbet, Paris, France), can easily be mixed with the monomer of autopolymerizing acrylic resin. The resultant acrylic template has several advantages. The tomographic images (Scanora; Soredex Orion Corporation, Helsinki, Finland) are radiographically homogenous and show the contour of the future prosthesis, the angulation of the planned implant, and the thickness of the soft tissue. In addition, the radiopaque template is optically transparent (with a slight yellow tint), which facilitates good visibility of surgical sites when the template is modified to become the surgical guide for implant placement. This transparent template can be further modified for implant position registration at the time of surgery. Because this multipurpose template is simple to construct and inexpensive, it can be recommended for routine use in implant dentistry.

Phytosterol content in American ginseng seed oil.

North American ginseng (Panax quinquefolium L.) oil was saponifed and the unsaponifiable matter trimethylsilylated. The phytosterol fraction of hexane-extracted, air-dried seed was quantified and identified by GC and GC-MS. Phytosterol contents (milligrams per 100 g of oil) were as follows: squalene (514-569), oxidosqualene (8.97-48.2), campesterol (9.96-12.4), stigmasterol (93.2-113), clerosterol (1.91-2.14), beta-sitosterol (153-186), beta-amyrin (11.7-19.5), delta(5)-avenasterol (12.4-20.5), delta(5,24(25))-stigmasterol (3.70-.76), lupeol (14.4-15.2), delta(7)-sitosterol (12.5-14.6), delta(7)-avenasterol (4.11-8.09), 24-methylenecycloartanol (1.94-4.76), and citrostadienol (2.50-3.81). Seed stratification lowered the phytosterol levels. Oven-drying gave mixed results, and phytosterols varied slightly between the 1999 and 2000 harvests.