Diagnosis and Treatment of Patients Utilizing Complementary Medicine at a Tertiary Referral Hospital in Eastern Switzerland.

BACKGROUND: In 2012, the Cantonal Hospital of St. Gallen, a tertiary referral hospital in Eastern Switzerland, opened its Center for Integrative Medicine (ZIM). This study aims to characterize disease and treatment characteristics of adult patients treated at the ZIM. PATIENTS AND METHODS: For all new patients, physicians at the ZIM completed questionnaires on patients' diagnoses and treatments. Descriptive statistics for categorical variables were reported as percentages. Univariable logistic regression analysis was used to assess the data. The analysis was performed with the statistical software package SPSS (IBM). RESULTS: From 2015 to 2020, 4,592 new patients were seen at the ZIM. The most common diagnosis in the supergroups was cancer (48%), followed by pain diagnoses (33%). Chronic pain as a subgroup was represented the most in patients (29%). Anthroposophical medication was the most commonly prescribed therapy, in 74% of patients with cancer and 73% with pain diagnosis. The latter was associated with the prescription of eurythmy therapy (OR: 3.80, p < 0.001), traditional Chinese medicine (OR: 3.34, p < 0.001), or art therapy (OR: 5.15, p < 0.001), whereas mistletoe therapy was the preferred treatment option (OR: 59.0, p < 0.001) for a cancer diagnosis. CONCLUSION AND OUTLOOK: The results will help adapt CM services to patients' needs and provide a good basis for the planning of future services in CM in major hospitals. Further research should be conducted focusing on specific health outcomes.

Heart rate variability decreases after 3 months of sustained treatment with fingolimod.

The objective is to prospectively investigate short- and mid-term changes of heart rate variability (HRV) in patients with relapsing-remitting multiple sclerosis (RRMS), being started on fingolimod. In this prospective clinical trial, patient (n = 33) with RRMS starting treatment with fingolimod underwent a time-domain-based analysis of HRV (breathing at rest, deep breath, and in response to the Valsalva maneuver) shortly before, 4.5 h and 3 months after first intake. Blood pressure changes after the Valsalva maneuver were used as a marker of the sympathetic noradrenergic system. We used a non-invasive continuous beat-to-beat heart rate and blood pressure monitoring. In addition, the Fatigue Severity Scale and the refined and abbreviated Composite Autonomic Symptom Score were applied. Significant changes in HRV in RRMS patients, following treatment with fingolimod, were detected. After an initial increase in HRV, measured 4.5 h after the first intake of fingolimod, a substantial decrease in HRV occurred within 3 months on continuous treatment. There is a growing body of evidence for short-term cardiovascular side effects in continuous treatment with fingolimod, driven by the ANS. The mechanisms and the clinical relevance of the observed changes in HRV need further evaluation, especially in longer and larger prospective studies.

Autonomic dysfunction in cancer cachexia coincides with large fiber polyneuropathy.

CONTEXT: Cancer cachexia occurs in most patients suffering from solid malignancies. Recent works suggest paraneoplastic mechanisms. Empirical studies also found autonomic dysfunction in cancer patients, but comprehensive evaluation of the peripheral nervous system is lacking. OBJECTIVES: To further understand the role of the autonomic and peripheral nervous system in cancer cachexia to guide treatment. METHODS: We prospectively investigated cachectic cancer patients for parasympathetic autonomic dysfunction with a time-domain-based analysis of heart rate variability (breathing at rest, deep breath, and in response to the Valsalva maneuver). Blood pressure changes after the Valsalva maneuver were used as a marker of the sympathetic noradrenergic system. Orthostatic hypertension was investigated in response to active standing. We used a noninvasive continuous beat-to-beat heart rate assessment and blood pressure monitoring. The sympathetic cholinergic nervous system was evaluated with the sympathetic skin response. A detailed neurological examination, nerve conduction studies, and electromyography also were conducted. RESULTS: A total of 13 patients were enrolled (median age 66 years). Median time from inclusion until death was 3.5 months. About 12 of the 13 patients showed abnormal results in at least one autonomic test. Sympathetic noradrenergic and cholinergic abnormalities were discovered in six patients each and five patients had orthostatic hypotension. Only one patient showed abnormal results in parasympathetic cholinergic tests. Asymptomatic large fiber polyneuropathy was detected in eight patients. CONCLUSION: Large fiber polyneuropathy coincides with autonomic dysfunction in cachectic cancer patients. Our findings suggest a relevant role of sympathetic impairment in cancer cachexia.

Noninvasive functional neurosurgery using transcranial MR imaging-guided focused ultrasound.

UNLABELLED: Transcranial magnetic resonance imaging-guided focused ultrasound (tcMRgFUS) is a novel technique to supplement the spectrum of established neurosurgical interventions. In contrast to traditional ablative procedures, tcMRgFUS is noninvasive and entirely imaging-guided with continuous temperature measurements at and around the target in real time. It has no trajectory restrictions and does not involve ionizing radiation. Since no device is implanted into the brain or the body, there is no restriction to future diagnostic work-up with MR imaging. The ability to treat a variety of chronic, therapy-resistant neurological diseases by precisely focusing ultrasound energy to desired targets in the thalamus, subthalamus and basal ganglia while avoiding collateral tissue damage is certainly attractive. Ongoing clinical studies on over 130 patients with neuropathic pain, essential tremor, Parkinson's disease and obsessive-compulsive disorder are very promising and demonstrate that ultrasound energy can precisely be focused through the intact skull, without overheating it. Varying the ultrasound parameters allows not only to ablate pathological tissue, or silence dysfunctional neuronal circuits, but also to modulate neural functions, as shown in preclinical studies. CONCLUSION: Transcranial magnetic resonance imaging-guided focused ultrasound is a novel, noninvasive, alternative treatment option for patients with therapy-resistant movement disorders, such as essential tremor and Parkinson's disease.