Dextrose Prolotherapy for Symptomatic Grade IV Knee Osteoarthritis: A Pilot Study of Early and Longer-Term Analgesia and Pain-Specific Cytokine Concentrations.

Background: Neurocytokines may upregulate or downregulate neuropathic pain. We hypothesized that dextrose (D-glucose) injections for therapeutic purposes (dextrose prolotherapy: DPT) in painful knee osteoarthritis (KOA) would favorably affect synovial-fluid neurocytokine concentrations. Methods: Twenty participants with grade IV symptomatic KOA received synovial-fluid aspiration followed by dextrose or simulated dextrose injections, followed by the reverse after one week. All participants then received open-label dextrose injections monthly for 6 months, with serial assessments of walking pain at 20 min for 9 months, as well as synovial-neurocytokine-concentration measurements (calcitonin gene-related peptide, substance P (SP), and neuropeptide Y (NPY)) at one week and three months. Results: Clinically important analgesia was observed at 20 min and for 9 months post dextrose injection. One -week synovial-fluid SP concentration rose by 111% (p = 0.028 within groups and p = 0.07 between groups) in the dextrose-injected knees compared to synovial-fluid aspiration only. Three-month synovial-fluid NPY concentration dropped substantially (65%; p < 0.001) after open-label dextrose injection in all knees. Conclusions: Prompt and medium-term analgesia after intra-articular dextrose injection in KOA was accompanied by potentially favorable changes in synovial-fluid neurocytokines SP and NPY, respectively, although these changes were isolated. Including neurocytokines in future assessments of DPT to elucidate mechanisms of action is recommended.

Dextrose Prolotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial.

Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).

Systematic integration of GATA transcription factors and epigenomes via IDEAS paints the regulatory landscape of hematopoietic cells.

Members of the GATA family of transcription factors play key roles in the differentiation of specific cell lineages by regulating the expression of target genes. Three GATA factors play distinct roles in hematopoietic differentiation. In order to better understand how these GATA factors function to regulate genes throughout the genome, we are studying the epigenomic and transcriptional landscapes of hematopoietic cells in a model-driven, integrative fashion. We have formed the collaborative multi-lab VISION project to conduct ValIdated Systematic IntegratiON of epigenomic data in mouse and human hematopoiesis. The epigenomic data included nuclease accessibility in chromatin, CTCF occupancy, and histone H3 modifications for 20 cell types covering hematopoietic stem cells, multilineage progenitor cells, and mature cells across the blood cell lineages of mouse. The analysis used the Integrative and Discriminative Epigenome Annotation System (IDEAS), which learns all common combinations of features (epigenetic states) simultaneously in two dimensions-along chromosomes and across cell types. The result is a segmentation that effectively paints the regulatory landscape in readily interpretable views, revealing constitutively active or silent loci as well as the loci specifically induced or repressed in each stage and lineage. Nuclease accessible DNA segments in active chromatin states were designated candidate cis-regulatory elements in each cell type, providing one of the most comprehensive registries of candidate hematopoietic regulatory elements to date. Applications of VISION resources are illustrated for the regulation of genes encoding GATA1, GATA2, GATA3, and Ikaros. VISION resources are freely available from our website http://usevision.org.

The Jonas Hypertension Program: An Academic-Community Partnership to Address Hypertension in Four Dominican Bateyes.

INTRODUCTION: Adults living in bateyes (i.e., sugarcane plantation villages) in the Dominican Republic have minimal access to health care services. Hypertension (HTN) is a serious and often unrecognized health problem among batey residents. The Jonas Batey Hypertension Program was built on existing social networks to address the detection and treatment of HTN. METHODS: An ongoing community-based participatory research endeavor involves a partnership among three organizations and collaboration with promotoras who engage their batey communities in a mobile HTN screening and treatment program. Adults are screened and, if indicated, are treated with antihypertensive medications. Data collection includes project documentation, participant observation, demographic data, blood pressure (BP) measurements, and pill counts. RESULTS: To date, 243 adults have received HTN treatment in four batey communities. A within-group, as-treated, repeated-measures, pre-/postanalysis showed that among participants who had been receiving antihypertensive treatment for 12 months ( n = 70), there was a significant decrease in BP ( p < .005). CONCLUSION: Results of an interim data analysis indicate that the program model has been implemented successfully and is making a positive impact on BP control. Evaluation is ongoing with regard to the long-term HTN-related health outcomes of batey residents. Ensuring program sustainability is an important consideration for the future.

Development and feasibility of a community-partnered nutrition intervention targeting rural migrant communities in the Dominican Republic.

OBJECTIVE: Research on health initiatives for rural batey communities in the Dominican Republic is needed. DESIGN AND SAMPLE: This study utilized a pretest-posttest design to examine the feasibility and acceptability of a nutritional intervention targeting rural migrant sugarcane families. Participants (N = 310) were primarily female (61%) and ranged in age from 13 to 64 years (M = 25.9; SD = 10.4). A convenience sample was recruited from six rural bateyes in the southern region of the Dominican Republic. INTERVENTION: The intervention was developed for the target population in partnership with a grass-roots organization. The intervention consisted of a short video in the participant's preferred language (Spanish or Creole) describing the importance of consuming a diverse diet. Participants then completed an interactive meal-planning activity to enhance skills learned in the video. The main outcome variable was knowledge and a secondary outcome was participants' performance on the interactive activity. RESULTS: Results showed that the intervention was well received by the target population and participants demonstrated a significant increase in nutrition knowledge (p < .001). Higher postintervention knowledge scores were positively correlated with higher activity skills scores. CONCLUSION: This novel intervention may have promise as a practical program to enhance the nutritional status of a vulnerable population of migrant sugarcane workers.

Optical Coherence Tomography Angiography of Asymptomatic Neovascularization in Intermediate Age-Related Macular Degeneration.

PURPOSE: To determine whether angiography with swept-source (SS) optical coherence tomography (OCT) identifies subclinical type 1 neovascularization in asymptomatic eyes with intermediate age-related macular degeneration (iAMD). DESIGN: Prospective, observational, consecutive case series. PARTICIPANTS: Patients with asymptomatic iAMD in one eye and neovascular age-related macular degeneration (AMD) in their fellow eye. METHODS: The patients underwent SS OCT angiography (OCTA), fluorescein angiography (FA), and indocyanine green angiography (ICGA), and the images from these 3 angiographic techniques were compared. MAIN OUTCOME MEASURES: Identification of subclinical type 1 neovascularization with SS OCTA in asymptomatic eyes with iAMD. RESULTS: Eleven consecutive patients with iAMD in one eye and neovascular AMD in their fellow eye were imaged with FA, ICGA, and SS OCTA between August 2014 and September 2015. Clinical examination of the 11 eyes revealed drusen and pigmentary abnormalities in the central macula and no evidence of macular fluid on routine OCT imaging. Ten of the 11 eyes had no evidence of leakage on FA and 1 eye had questionable fluorescein leakage. Indocyanine green angiography revealed the presence of central macular plaques in 3 of the 11 asymptomatic eyes with iAMD, and SS OCTA revealed unambiguous type 1 neovascularization corresponding to the plaques in all 3 eyes. Optical coherence tomography angiography did not identify neovascularization in the remaining 8 eyes. CONCLUSIONS: Swept-source OCTA identified type 1 neovascularization corresponding to ICGA plaques in asymptomatic eyes with iAMD. The ability of OCTA to provide noninvasive, fast, detailed, depth-resolved identification of nonexudative neovascular lesions in eyes with iAMD suggests the need for a new classification system that distinguishes between neovascular and nonneovascular iAMD.

A prospective randomized controlled trial of an interpersonal violence prevention program with a Mexican American community.

Using methods of community-based participatory research, a prospective randomized controlled trial of a violence prevention program based on Latino cultural values was implemented with elementary school children in a Mexican American community. Community members participated in intervention program selection, implementation, and data collection. High-risk students who participated in the program had greater nonviolent self-efficacy and demonstrated greater endorsement of program values than did high-risk students in the control group. This collaborative partnership was able to combine community-based participatory research with a rigorous study design and provide sustained benefit to community partners.

Acupuntura: prática baseada em evidências / Acupuncture: evidence-based practice

A acupuntura está cada vez mais em evidência, além de ser uma especialidade em ascensão tanto entre os estudantes de medicina, como entre os médicos que buscam a sua especialização, ganhou destaque da Associação Médica Britânica que advogou a sua aprovação perante a comunidade...

Acupuncture has been put in evidence more recently. It represents an ascending practice among under-graduated medical students, as well as among graduated physicians in search for their specialization. Recently, acupuncture won BMA approval, which not only recommended NHS to accept acupuncture to the chronic...

Acupuntura: uma modalidade terapêutica validada no arsenal terapêutico do médico atual / Acupuncture: a validated therapeutic modality in updated physician therapeutic arsenal

Uma das mais antigas modalidades de terapêutica, acupuntura faz parte da Medicina Tradicional Chinesa. Baseada principalmente em um antigo pensamento filosófico chinês e na observação da ocorrência de fenômenos da natureza. Medicina Tradicional Chinesa possui uma fisiopatologia peculiar, um sistema de diagnóstico complicado baseado em exame de uma fisiopatologia peculiar...

One of the most ancient therapeutic maneuvers, acupuncture is part of Traditional Chinese Medicine. Based in ancient philosophic thinking and observation of naturally complicated diagnosis system based on examination of pulse, tongue and observation of patients'behavior and attitudes...

Homeopathy and acupuncture teaching at Faculdade de Medicina da Universidade de São Paulo: the undergraduates' attitudes

CONTEXTO E OBJETIVO: Apesar de a homeopatia e a acupuntura serem reconhecidas como especialidades médicas no Brasil, não são ensinadas na maioria das escolas médicas. O objetivo foi avaliar as atitudes dos acadêmicos perante estas práticas, após sua inserção como disciplinas eletivas no currículo da Faculdade de Medicina da Universidade de São Paulo (FMUSP) em 2002.TIPO DE ESTUDO E LOCAL: Questionário, na FMUSP. MÉTODOS: 484 estudantes responderam um questionário auto-aplicável sobre interesse no aprendizado, forma de ensino, nível de conhecimento e forma de aquisição, experiência da terapêutica em si próprios ou pessoas próximas, principais indicações e eficácia geral, e possibilidade de oferecimento e integração junto aos serviços públicos de saúde. RESULTADOS: Acima de 85% dos estudantes considerou que a homeopatia e a acupuntura deveriam estar inseridas no currículo, de forma opcional (72%) ou obrigatória (19%); 56% mostraram-se muito interessados no aprendizado. Apesar de 76% terem nenhum ou pouco conhecimento, 67% creditavam algum grau de eficácia às terapêuticas, tendo como principais indicações as doenças crônicas, isoladamente (37%) ou englobando também as doenças agudas (29%). Em torno de 35% foram favoráveis ao oferecimento ambulatorial nos serviços públicos de saúde, enquanto que 34% defenderam a disponibilização também em hospitais, com 60% acreditando na possibilidade de integração com a prática médica convencional. CONCLUSÕES: A maioria dos estudantes de medicina entrevistados mostrou-se bastante interessada em aprender os fundamentos da homeopatia e da acupuntura durante a graduação, foi capaz de observar e reportar a eficácia e defendeu a incorporação nos serviços públicos de saúde.

Environmental epidemiology applied to urban atmospheric pollution: a contribution from the Experimental Air Pollution Laboratory (LPAE)

A investigaçäo sobre os efeitos da exposiçäo humana à poluiçäo ambiental iniciou de maneira sistemática, com abordagem científica, apenas no século XX, como conseqüência de uma série de acidentes ambientais percebidos por um significativo aumento na mortalidade e com a realizaçäo de estudos epidemiológicos observacionais e toxicológicos em animais. Tais estudos têm se concentrado nos países considerados desenvolvidos. Relata a experiência do Laboratório de Poluiçäo Atmosférica Experimental (LPAE), da Faculdade de Medicina da Universidade de Säo Paulo, no estudo dos mecanismos fisiopatológicos do sistema respiratório em face da exposiçäo aos poluentes, utilizando abordagens experimentais e toxicológicas, complementadas com estudos epidemiológicos observacionais na cidade de Säo Paulo. Descreve como esses estudos se inserem no panorama mundial, convergindo para um consenso de que a poluiçäo do ar é prejudicial à saúde pública, e que esses efeitos säo observados inclusive em concentraçöes de poluentes abaixo dos limites estabelecidos pela legislaçäo ambiental em vigor, fornecendo dados valiosos para subsidiar a tomada de decisöes políticas e econômicas para a melhoria do meio ambiente.