Analgesic effects of a capacitive-resistive monopolar radiofrequency in patients with myofascial chronic neck pain: a pilot randomized controlled trial

SUMMARY BACKGROUND: To date, there is a lack of prior studies on the use of capacitive resistive monopolar radiofrequency (RF) to treat neck pain. The objective of this study was to investigate the immediate effect of capacitive resistive monopolar radiofrequency (RF=448 kHz), in comparison with a placebo, on (1) reducing neck pain intensity at myofascial trigger points (MTrP), (2) decreasing neck disability and (3) improving cervical range of motion (CROM). METHODS: A randomized, double-blind, placebo-controlled trial (NCT02353195) was carried out. Patients with myofascial chronic neck pain (N=24) with active MTrP in one upper trapezius muscle were randomly divided into two groups: a radio-frequency group, which received eight sessions of a monopolar capacitive resistive radio-frequency application over the upper trapezius muscle, and a placebo group (PG), which received eight sessions of placebo radio-frequency over the same muscle. Visual analog scale (VAS), CROM and Neck Disability Index (NDI) were evaluated after the first session and after the eight sessions. RESULTS: The Wilcoxon test for VAS showed statistically significant differences between baseline, immediately after the first session and after eight sessions (p<.001). No significant differences for PG were found. No differences were observed between groups. NDI improved in both groups after eight sessions, but no differences were found between groups (p<.05). ANOVA for time factor showed statistically significant changes in the right cervical rotation in both groups (F=4.112; p=.026) after eight sessions. CONCLUSIONS: Even though there were no differences between both groups, the monopolar capacitive, resistive RF could have a potential effect on pain intensity.

RESUMO ANTECEDENTES: Até a data, há uma falta de estudos prévios para tratar a dor no pescoço por radiofrequência (RF) monopolar capacitiva resistiva. O objetivo deste estudo foi investigar o efeito imediato da radiofrequência monopolar capacitiva resistiva (RF = 448 kHz) versus placebo em (1) redução da intensidade da dor no pescoço em pontos de gatilho miofascial (MTrP), (2) diminuição da incapacidade do pescoço e (3) melhorando a amplitude de movimento cervical (Crom). MÉTODOS: Foi realizado um ensaio randomizado, duplo-cego, controlado por placebo (NCT02353195). Os pacientes com dor no pescoço crônica miofascial (N = 24) com MTrP ativo em um músculo trapézio superior foram divididos aleatoriamente em dois grupos: um grupo de radiofrequência, que recebeu oito sessões com uma aplicação de radiofrequência resistiva capacitiva monopolar sobre o músculo trapézio superior, e um grupo de placebo (PG), que recebeu oito sessões de radiofrequência de placebo no mesmo músculo. A escala analógica visual (VAS), Crom e Índice de incapacidade do pescoço (NDI) foram avaliadas após a primeira sessão e após as oito sessões. RESULTADOS: O teste de Wilcoxon para VAS mostrou diferenças estatisticamente significativas entre a linha de base e imediatamente após a primeira sessão e após oito sessões (p < 0,001). Não foram encontradas diferenças significativas para PG. Não foram observadas diferenças entre os grupos. O NDI melhorou em ambos os grupos após oito sessões, mas não foram encontradas diferenças entre os grupos (p < 0,05). A Anova para o fator de tempo mostrou mudanças estatisticamente significativas na rotação direita cervical em ambos os grupos (F = 4,12; p = 0,26) após oito sessões. CONCLUSÕES: Apesar de não haver diferenças entre os dois grupos, o RF resistivo capacitivo monopolar pode ter um efeito potencial sobre a intensidade da dor.

Estudio de la compulsión glucídica y su relación con el perfil antropométrico y metabólico en un grupo de mujeres adultas argentinas / Carbohydrate compulsion study and its relationship with anthropometric

En el acto de comer, además de numerosas hormonas y sistemas, participa un mecanismo de placer/recompensa que obedece a estímulos específicos y naturales. Objetivos: Asociar la compulsión glucídica con perfil antropométrico y metabólico en mujeres adultas argentinas. Metodología: Diseño descriptivo transversal en muestra voluntaria no probabilística de mujeres mayores de 20 años, asistentes por primera vez a Consulta Nutricional de Fundación para la Investigación de Enfermedades Endocrino Metabólicas durante 2011-2012. Variable dependiente: Compulsión Glucídica (deseo irresistible consumo carbohidratos y sensación de calma posterior). Variables independientes: Edad y etapa biológica: edad fértil, pre y postmenopausia, estilo de vida (hábito tabáquico, consumo alcohol y sedentarismo), perfil antropométrico (IMC>25 kg/m2 y circunferencia de cintura: CC>88cm), perfil metabólico (HDL-C, insulinemia y TG expresados en mg/dl y a través de HOMA-R>2,5 y TG/HDL-C>3,0), perfil tiroideo (eutiroideas/hipotiroideas). Análisis estadístico por SPSS 15.0 calculando, Odds Ratio (OR), intervalo de confianza (IC) del 95%, X2, prueba de Fisher y correlación de Pearson con nivel de significación estadística p< 0,05. Resultados: Muestra de 164 mujeres 50,5 ± 10,7 años. El 49,4% fueron postmenopáusicas. El 87,7% presentó sobrepeso u obesidad y 67,1% CC aumentada. El 47% presentó HOMA-R aumentada y el 22,6% TG/HDL elevada. El 59,1% prefirió sabor dulce, 73,8% picotea entre comidas y 81,7% compulsión glucídica. Se encontró asociación significativa entre compulsión glucídica y sobrepeso u obesidad (OR: 0,29; IC95%: 0,10-0,79; p=0,01) y circunferencia de cintura aumentada (OR: 0,34; IC95%: 0,15-0,77; p=0,009). Conclusiones: Las mujeres con CC aumentada, y sobrepeso u obesidad, presentaron significativamente más riesgo de compulsiones glucídicas que aquellas con perfil antropométrico normal...

Subclavian artery angioplasty in elderly patients with coronary-subclavian steal syndrome: preliminary comparison between a modified brachial technique and the standard femoral approach / 老年心脏病学杂志（英文版）

Background and Objective Elderly patients who have been submitted to coronary bypass grafting with the left internal mammary artery (LIMA) may develop a coronary-subclavian steal syndrome because of a left subclavian artery (LSA) stenosis. Usually stenting of LSA is performed by the standard femoral route with guiding catheter technique, but this technique can be particularly difficult in elderly patients who often have iliac-femoral kinking and aortic tortuosity. We compared a new ad hoc brachial artery approach technique with the standard guiding catheter technique through the femoral access. Methods Between January 2005 and September 2006, four patients underwent LSA stenting using the left brachial artery access obtained with a 6F or 7F 45-cm-long valved anti-kinking sheath as the Super Arrow Flex sheath (Arrow International, PA, USA). The sheath was positioned just before the LIMA graft ostium and a 0.035 inch 260-cm-long Storq guidewire (Cordis Inc., Johnson & Johnson, Warren, NJ) was advanced across the lesion to the descending aorta. A balloon-expandable Genesis (Cordis Inc., Johnson & Johnson, Warren, NJ) endovascular stent was easily deployed, and the correct position was checked by direct contrast injection through the long sheath. This small group of patients has been compared to a group of 5 age-matched patients with coronary steal syndrome in whom the procedure has been performed with standard technique including femoral approach and guide catheter. Results The procedure was successful in all patients; vertebral and LIMA ostia remained patent in all cases. In the control group, cannulation of the subclavian artery was difficult in two cases, while one patient developed a groin hematoma. Mean pretreatment gradient was 32 mm Hg with a range of 25 to 40 mm Hg (34 mmHg, range 26-43, in the control group, P=0.87) and fell to 2 mm Hg with a range of 0 to 4 mm Hg (3.1 mmHg, range 0 to 5, P=0.89) posttreatment. Mean contrast dose was 60±16 ml (138±26 ml in the control group, P＞0.01), whereas mean fluoroscopy and procedural time were 5.7±1.6 minutes (10.8±1.0 minutes in the control group, P＞0.01) and 15.7±6.3 minutes (28±7.1 minutes in the control group, P＞0.01). At a mean follow-up of 10±3.2 months all patients are alive and free from angina and residual induced ischemia. Conclusions Our brief study suggested that brachial artery access be considered the optimal route to treat coronary-subclavian steal syndrome in elderly patients because of clear advantages; these included no manipulation of catheter to cannulate the artery, perfect coaxial position of the catheter at the site of LSA stenosis, clear visualization of the LIMA and vertebral ostia, and easy access to these vessels in case of plaque shifting or embolic protection device deployment.