Pit picking vs. Limberg flap vs. primary open method to treat pilonidal sinus disease - A cohort of 327 consecutive patients.

Background: Minimally invasive methods in pilonidal sinus disease (PSD) surgery are becoming standard. Although long-term results are available for some techniques, long-term outcome data of patients after pit picking is lacking. We aimed at investigating perioperative and long-term outcomes of patients undergoing pit picking, Limberg flap or primary open surgery to treat PSD. Methods: In a single-centre observational study, we evaluated the outcomes of 327 consecutive patients undergoing PSD surgery between 2011 and 2020. Results: PSD had recurred in 22% of Limberg flap patients and 62% of pit picking patients at 5 years (p=0.0078; log rank test). Previous pilonidal surgeries, smoking, body mass index, immunodeficiency, and diabetes did not significantly influence the long-term recurrence rate. Primary open treatment was performed for 72% of female patients presenting with primary disease. Conclusions: Due to its especially dismal long-term results, pit picking should be abandoned, and Limberg flap should be promoted instead, even for primary disease and in females.

Slow motion in films and video clips: Music influences perceived duration and emotion, autonomic physiological activation and pupillary responses.

Slow motion scenes are ubiquitous in screen-based audiovisual media and are typically accompanied by emotional music. The strong effects of slow motion on observers are hypothetically related to heightened emotional states in which time seems to pass more slowly. These states are simulated in films and video clips, and seem to resemble such experiences in daily life. The current study investigated time perception and emotional response to media clips containing decelerated human motion, with or without music using psychometric and psychophysiological testing methods. Participants were presented with slow-motion scenes taken from commercial films, ballet and sports footage, as well as the same scenes converted to real-time. Results reveal that slow-motion scenes, compared to adapted real-time scenes, led to systematic underestimations of duration, lower perceived arousal but higher valence, lower respiration rates and smaller pupillary diameters. The presence of music compared to visual-only presentations strongly affected results in terms of higher accuracy in duration estimates, higher perceived arousal and valence, higher physiological activation and larger pupillary diameters, indicating higher arousal. Video genre affected responses in addition. These findings suggest that perceiving slow motion is not related to states of high arousal, but rather affects cognitive dimensions of perceived time and valence. Music influences these experiences profoundly, thus strengthening the impact of stretched time in audiovisual media.

CORE-Hom: a powerful and exhaustive database of clinical trials in homeopathy.

The CORE-Hom database was created to answer the need for a reliable and publicly available source of information in the field of clinical research in homeopathy. As of May 2014 it held 1048 entries of clinical trials, observational studies and surveys in the field of homeopathy, including second publications and re-analyses. 352 of the trials referenced in the database were published in peer reviewed journals, 198 of which were randomised controlled trials. The most often used remedies were Arnica montana (n = 103) and Traumeel(®) (n = 40). The most studied medical conditions were respiratory tract infections (n = 126) and traumatic injuries (n = 110). The aim of this article is to introduce the database to the public, describing and explaining the interface, features and content of the CORE-Hom database.

Geographical and temporal distribution of basic research experiments in homeopathy.

The database HomBRex (Homeopathy Basic Research experiments) was established in 2002 to provide an overview of the basic research already done on homeopathy (http://www.carstens-stiftung.de/hombrex). By this means, it facilitates the exploration of the Similia Principle and the working mechanism of homeopathy. Since 2002, the total number of experiments listed has almost doubled. The current review reports the history of basic research in homeopathy as evidenced by publication dates and origin of publications. In July 2013, the database held 1868 entries. Most publications were reported from France (n = 267), followed by Germany (n = 246) and India (n = 237). In the last ten years, the number of publications from Brazil dramatically increased from n = 13 (before 2004) to n = 164 (compared to n = 251 published in France before 2004, and n = 16 between 2004 and 2013). The oldest database entry was from Germany (1832).

[The situation of complementary medicine in Germany]. / Zur lage der komplementärmedizin in Deutschland.

With the amendment of the German Medicinal Products Act in 1976 and the inclusion of naturopathy and homeopathy into the German Medical Licensure Act from 1988, the German government set up a comparatively favorable framework for Complementary and Alternative Medicine (CAM). But no comprehensive integration into the academic operating systems followed, because the universities as well as the legislative body seemed to have no further interest in CAM. Therefore, research projects in the field and suitable professorships had and still have to be financed by third-party funds. Notwithstanding the success of several CAM-projects, no sustainable development could be established: When the third-party funding runs off and the protagonists retire the institutional structures are supposed to vanish as well. Although the public demand for CAM is high in Germany, the administration detached homeopathy as a compulsory subject from the German Medical Licensure Act in 2002 and restricted severely the refunding of naturopathic medicines by the statutory health insurance in 2004. Moreover, the trend for CAM bashing takes root in the media. Unfortunately the CAM scene does not close ranks and is incapable to implement fundamental data collection processes into daily clinical routine: A wide range of data could justify further efforts to the government as well as to the scientific community. To say something positive, it must be mentioned that the scientific standard of CAM research is high for the most part and that third-party funded projects deliver remarkable results ever and on.

Homeopathic drug proving of Okoubaka aubrevillei: a randomised placebo-controlled trial.

BACKGROUND: Homeopathic drug proving is a basic concept in homeopathy. This study aimed to record symptoms produced by a homeopathic drug compared with placebo. METHODS: This multicentre, randomised, double-blind, placebo-controlled phase 1 trial consisted of a 7-day run-in period, a 5-day intervention period and a 16-day post-intervention observation period. Subjects, investigators and statisticians were blinded for intervention groups and identity of the homeopathic drug. Subjects in the intervention group received Okoubaka aubrevillei (potency C12) and subjects in the placebo group received the optically identical sucrose globules. Dosage in both groups was five globules taken five times per day over a maximum period of 5 days. Subjects documented the symptoms they experienced in a semistructured online diary. The primary outcome parameter was the number of characteristic proving symptoms compared with placebo after a period of 3 weeks. Characteristic symptoms were categorised using content analysis. Secondary outcome parameters were the qualitative differences in profiles of characteristic and proving symptoms and the total number of all proving symptoms. The number of symptoms was quantitatively analysed on an intention-to-treat basis using analyses of covariance with the subject's expectation and baseline values as covariates. RESULTS: Thirty-one subjects were included (19 Okoubaka and 12 placebo). Data for 29 participants could be analysed. No significant differences in number of characteristic symptoms in both groups were observed between Okoubaka (mean±standard deviation 5.4±6.0) and placebo (4.9±5.6). The odds ratio for observation of a characteristic symptom was 1.11 (95% confidence interval 0.4 to 3.05, P=0.843). Females and subjects expecting a higher number of symptoms at baseline or feeling more sensitive to homeopathic drugs experienced more characteristic symptoms regardless of allocation. The qualitative analysis showed an inter-coder reliability of 0.69 (95% confidence interval 0.62 to 0.76). The qualitative comparison of symptom profiles was inconclusive. CONCLUSIONS: Combined results of qualitative and quantitative methods did not result in a significant difference of characteristic proving symptoms between O. aubrevillei C12 and placebo. The qualitative comparison of the symptom profiles leaves some open questions. The nocebo effect might be a plausible explanation for most of the phenomena observed in this trial. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01061229.

Weakly electric fish for biomonitoring water quality.

Environmental pollution is a major issue that calls for suitable monitoring systems. The number of possible pollutants of municipal and industrial water grows annually as new chemicals are developed. Technical devices for pollutant detection are constructed in a way to detect a specific and known array of pollutants. Biological systems react to lethal or non-lethal environmental changes without pre-adjustment, and a wide variety have been employed as broad-range monitors for water quality. Weakly electric fish have proven particularly useful for the purpose of biomonitoring municipal and industrial waters. The frequency of their electric organ discharges directly correlates with the quality of the surrounding water and, in this way, concentrations of toxicants down to the nanomolar range have been successfully detected by these organisms. We have reviewed the literature on biomonitoring studies to date, comparing advantages and disadvantages of this test system and summarizing the lowest concentrations of various toxicants tested. Eighteen publications were identified investigating 35 different chemical substances and using six different species of weakly electric fish.

Review of the use of high potencies in basic research on homeopathy.

The HomBRex database includes details of about 1500 basic research experiments in homeopathy. A general overview on the experiments listed in the HomBRex database is presented, focusing on high dilutions and the different settings in which those were used. Though often criticised, many experiments with remedies diluted beyond Avogadro's number demonstrate specific effects. A total of 830 experiments employing high potencies was found; in 745 experiments of these (90%), at least one positive result was reported. Animals represent the most often used model system (n=371), followed by plants (n=201), human material (n=92), bacteria and viruses (n=37) and fungi (n=32). Arsenicum album (Ars.) is the substance most often applied (n=101), followed by Sulphur (Sulph.) and Thuja (Thuj.) (n=65 and 48, respectively). Proving, prophylactic and therapeutic study designs have all been used and appear appropriate for homeopathy basic research using high dilutions. The basic research data set to support specific effects unique to high dilutions and opposite to those observed with low dilutions is, to date, insufficient.

[Legal status and organization of homeopathic drug testing in Germany]. / Arzneirechtlicher Status und Organisation homöopathischer Arzneimittelprüfungen in Deutschland.

For more than 200 years, homeopathic doctors have been carrying out homeopathic drug provings (HDPs),which embodies the traditional self drug testing, an integral part of the homeopathic medical profession. However,according to national authorities, testing homeopathic drugs is a phase I clinical trial for which the German Federal Drug Law applies. Adapting a 200-year-old primary qualitative study design to modern drug law and Good Clinical Practice Guidelines generates several difficulties, in particular, blinding, informed consent and the classification of adverse events. In addition, in Germany naturopaths (German: 'Heilpraktiker') are excluded from leading HDP trials. The costs are climbing, and the organizational over heads for a HDP are enormous. Implications for the future are discussed.

Infection models in basic research on homeopathy.

INTRODUCTION: The objective of this study was to search for effective agents for the treatment of infections in animals or infected cell lines. METHODS: The Homeopathic Basic Research experiments (HomBRex) database (http://www.carstens-stiftung.de/hombrex) on model biological systems in homeopathic research was searched. Eligible experiments were reviewed and analysed. RESULTS: The database contains 48 eligible experiments published from 1832 to 2009. Causative pathogens were bacteria, fungi, viruses, proto- and metazoa. In the experiments, various parameters were observed and a large set of medicines was investigated. In eight of the 48 experiments, at least one of the investigated medicines was selected according to the similia principle. Nosodes and homeopathic complexes were investigated in 8 and 14 experiments respectively. Mice were the most often used host organisms (13 experiments). In 31 experiments at least one homeopathic medicine was found effective for treatment. CONCLUSION: The results of basic research experiments may invigorate new clinical trials that investigate complementary treatments for infectious diseases. However, all experiments reviewed here await replication and no clear-cut conclusion can be drawn regarding the transferability of in vitro results to in vivo outcomes.

Database on veterinary clinical research in homeopathy.

OBJECTIVE: The aim of the present report is to provide an overview of the first database on clinical research in veterinary homeopathy. PROCEDURES: Detailed searches in the database 'Veterinary Clinical Research-Database in Homeopathy' (http://www.carstens-stiftung.de/clinresvet/index.php). RESULTS: The database contains about 200 entries of randomised clinical trials, non-randomised clinical trials, observational studies, drug provings, case reports and case series. Twenty-two clinical fields are covered and eight different groups of species are included. The database is free of charge and open to all interested veterinarians and researchers. CONCLUSION: The database enables researchers and veterinarians, sceptics and supporters to get a quick overview of the status of veterinary clinical research in homeopathy and alleviates the preparation of systematical reviews or may stimulate reproductions or even new studies.

Protocol for a phase 1 homeopathic drug proving trial.

BACKGROUND: This study protocol adapts the traditional homeopathic drug proving methodology to a modern clinical trial design. METHOD: Multi-centre, randomised, double-blind, placebo-controlled phase 1 trial with 30 healthy volunteers. The study consists of a seven day run-in period, a five day intervention period and a 16 day post-intervention observation period. Subjects, investigators and the statisticians are blinded from the allocation to the study arm and from the identity of the homeopathic drug. The intervention is a highly diluted homeopathic drug (potency C12 = 1024), Dose: 5 globules taken 5 times per day over a maximum period of 5 days. The placebo consists of an optically identical carrier substance (sucrose globules). Subjects document the symptoms they experience in a semi-structured online diary. The primary outcome parameter is the number of specific symptoms that characterise the intervention compared to the placebo after a period of three weeks. Secondary outcome parameters are qualitative differences in profiles of characteristic and proving symptoms and the total number of all proving symptoms. The number of symptoms will be quantitatively analysed on an intention-to-treat basis using ANCOVA with the subject's expectation and baseline values as covariates. Content analysis according to Mayring is adapted to suit the homeopathic qualitative analysis procedure. DISCUSSION: Homeopathic drug proving trials using the terminology of clinical trials according GCP and fulfilling current requirements for research under the current drug regulations is feasible. However, within the current regulations, homeopathic drug proving trials are classified as phase 1 trials, although their aim is not to explore the safety and pharmacological dynamics of the drug, but rather to find clinical indications according to the theory of homeopathy. To avoid bias, it is necessary that neither the subjects nor the investigators know the identity of the drug. This requires a modification to the informed consent process and blinded study materials. Because it is impossible to distinguish between adverse events and proving symptoms, both must be documented together. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01061229.

The in vitro evidence for an effect of high homeopathic potencies--a systematic review of the literature.

OBJECTIVE: Systematic assessment of the in vitro research on high potency effects. METHOD: Publications of experiments were collected through databases, experts, previous reviews, citation tracking. INCLUSION CRITERIA: stepwise agitated dilutions <10(-23); cells or molecules from human or animal. Experiments were assessed with the modified SAPEH score. RESULTS: From 75 publications, 67 experiments (1/3 of them replications) were evaluated. Nearly 3/4 of them found a high potency effect, and 2/3 of those 18 that scored 6 points or more and controlled contamination. Nearly 3/4 of all replications were positive. Design and experimental models of the reviewed experiments were inhomogenous, most were performed on basophiles. CONCLUSIONS: Even experiments with a high methodological standard could demonstrate an effect of high potencies. No positive result was stable enough to be reproduced by all investigators. A general adoption of succussed controls, randomization and blinding would strengthen the evidence of future experiments.

Does potentized HgCl2 (Mercurius corrosivus) affect the activity of diastase and alpha-amylase?

BACKGROUND: Homeopathic drugs even with dilutions beyond 10(23) (high potencies) are frequently used, although their working mechanism is still unknown. Curative information preserved in solvent structure is postulated to exert biologic effects. OBJECTIVE: The objective was to test for a stimulating or inhibiting effect of high potencies of the homeopathic remedy HgCl2 (Mercurius corrosivus) on two sugar hydrolases. METHODS: High potencies were produced using stepwise dilution plus shaking. Controls included potentized solvent (aqua bidestillata), equimolar dilutions without shaking, and enzyme-free references. Tested were potencies with dilution factors 1:200 (CC) on diastase extract from winter barley, and 1:100 (C) on alpha-amylase from hog pancreas. Enzyme activity was colorimetrically determined by Lugol's iodine-starch reaction. RESULTS: An inhibiting effect of HgCl2 on enzyme activities was observed only in low potencies and dilutions. Statistically significant differences between potencies and controls were not found in randomized and blinded experiments. CONCLUSIONS: This experimental design provided independent reproducible results of cell-free in vitro assays. However, it did not indicate an effect of potentized HgCl2 on hydrolases. Demonstrating potency effects may require additional experimental features.