International research project to devise a protocol to test the effectiveness of acupuncture on painful shoulder.

OBJECTIVES: To describe in detail the questions and deliberations leading to the development of a methodologically rigorous protocol to test the effectiveness of acupuncture on painful shoulder. DESIGN: Randomized controlled trial using three groups, including one control group. SETTINGS/LOCATION: A hospital in the north of Italy treating at least 8-10 painful shoulders a day, with physician/acupuncturists, physiotherapists, and assessors available to participate in the study. SUBJECTS: Sixty patients with monolateral painful shoulder. A list of exclusion criteria is given. INTERVENTIONS: Acupuncture + mobilization; mobilization alone (control); ear acupuncture + mobilization. OUTCOME MEASURES: Severity of pain, scored on a visual analogue scale (VAS) and on the McGill Pain Questionnaire and restriction of range of motion (ROM) of the shoulder joint. Voluntary use of pain medication, Tenoxicam 20 mg, was added to the protocol. RESULTS: The research team developed a protocol and methodology that avoids the common flaws and difficulties of previous clinical trials on acupuncture. CONCLUSIONS: Physicians and acupuncture specialists will benefit from the advice and support of a project group consisting of experienced clinicians, researchers, and statisticians when designing and preparing clinical trials on acupuncture and other complementary and alternative therapies.

Effects of subinhibitory concentrations of ciclopirox on the adherence of Candida albicans to human buccal and vaginal epithelial cells.

At present, only a limited number of studies of the effects of sub-inhibitory antifungal agents on the adherence of Candida to epithelial (buccal and vaginal) host cells are available. The adherence of Candida albicans to the epithelial cell surface is accepted as an important first step in persistent colonization and in the following symptomatic or asymptomatic infection of mucosal surface. Ciclopirox (ciclopiroxolamine, CAS 29342-05-0) is a substituted pyridone antimycotic drug, unrelated to the imidazole derivatives and its topical application ensures maximum local bioavailability. The present study was done to investigate the effects of sub-inhibitory concentrations of ciclopirox on the adherence of Candida albicans to human buccal and vaginal epithelial cells. The findings on the adherence of different strains of Candida indicate that the drug caused a significant reduction in the mean number of Candida adhering to both buccal and vaginal cells. This reduction was maximal at concentration of 1/2 MIC and still significant at 1/4, 1/8, 1/16 MIC, but with progressive return to mean control values at 1/32 MIC. Ciclopirox acts on fungi by inhibiting the intracellular uptake of essential substrates and ions and this probably acts on the Candida ability to express its adherence mechanisms.

[ARDS in MOFS (multiple organ failure syndrome). How to direct the therapy? A case report of MOFS in AIDS]. / ARDS componente della MOFS (multiple organs failure syndrome) come orientare la terapia? Descrizione di MOFS in AIDS.

A young AIDS patient was admitted to the Intensive Therapy ward of our hospital with ARDS. The case raised the question of how medical and nursing personnel should face the problem of "suitable treatment for a terminally ill patient". Therapy was based on invasive methods such as mechanical ventilation and the insertion of catheters to monitor vital parameters. The evolution of ARDS in MOFS revealed the difficulty of sustaining vital parameters and avoiding pluriorganic damage.