[Are SPA therapy and pulsed electromagnetic field therapy effective for chronic neck pain? Randomised clinical trial. Second part: medicoeconomic approach]. / Y a-t-il un effet des soins thermaux et des champs électromagnétiques pulsés sur la cervicalgie chronique? Essai clinique randomisé. Deuxième partie: approche médicoéconomique.

UNLABELLED: We report the results of a cost-effectiveness evaluation of pulsed electromagnetic field (PEMF) therapy and spa therapy (ST) versus usual care (control) for chronic neck pain. MATERIALS AND METHODS: Inclusion criteria were age 18 to 80 years with pain in the neck area of more than 3 months' duration and no contraindications for PEMF therapy and ST. Randomization to the ST (n=25) and PEMF groups (n=26) was blinded, as was collection of data. Non-included subjects (n=29) underwent usual care. The trial respected the Helsinki declaration, and informed consent was obtained from subjects. The analysis was intent to treat; the main outcome measure was increase in health dimension scores on the MOS SF-36 in terms of increase in French health care costs from 6 months preceding to 6 months after the start of the study. RESULTS: The increase in health care costs was less for the PEMF group (+68 euro+/-539 [95% confidence interval (CI)]: -145.0+281) than the ST and control groups. The increase tended to be less, but not significantly, for the ST group (+373+/-938 euro [95% CI, -14.0+76.0]) than for controls (+618+/-2715 euro [95% CI, -434.0+167.0]). The gain of one physical MOS SF-36 unit during one year cost 3400 euro [95% CI, -6759+13 100] for the PEMF group, 29,000 euro [95% CI, -1093+59 375] for the ST group and 95076 euro [95% CI, -66 769+256 923] for the control group, but the differences were not significant. COMMENTARY: These results suggest a potential cost-effectiveness for ST and particularly PEMF as compared to usual care in chronic cervical pain. Our results perhaps lack significance probably because of lack of statistical power and do not distinguish costs related or not to chronic cervical pain.

[Are SPA therapy and pulsed electromagnetic field therapy effective for chronic neck pain? Randomised clinical trial First part: clinical evaluation]. / Y a-t-il un effet des soins thermaux et des champs électromagnétiques pulsés sur la cervicalgie chronique? Essai clinique randomisé. Première partie: étude clinique.

OBJECTIVES: The purpose of this study was to compare SPA therapy (ST) with pulsed electromagnetic field (PEMF) therapy in chronic neck pain. MATERIALS AND METHODS: Inclusion criteria were age between 18 and 80 years, neck pain of more than 3 months' duration and pain score>30 mm on a visual analog scale (VAS). Exclusion criteria were contraindication to ST or PEMF. The protocol was approved by the ethics committee of Grenoble Hospital. Randomisation to the ST (n=44) and PEMF groups (n=42) was blinded. The main outcome measure was number of improved patients at 6 months in each group. A patient was considered improved if pain score decreased by more than 20%. Secondary measures were score on the Copenhagen and MOS SF-36 scales. Evaluation and intent-to-treat analysis were also blinded. RESULTS: Patients' preferences were for PEMF. At 6 months, in the PEMF group, 33 patients were improved, 5 not improved and 4 lost to follow-up. In the ST group, 24 patients were improved, 14 not improved and 6 lost to follow-up, for significantly greater improvement in the PEMF than ST group (p=0.02). Significant improvement was seen in both groups in terms of pain score, Copenhagen scale score and score on some dimensions of the MOS SF-36 survey. CONCLUSION: PEMF seems to be superior to standard ST without massage in control of neck pain. The difference between groups, although perhaps biased, seem to suggest the importance of our conclusions.

Arterial hypertension as risk factor for spontaneous cervical artery dissection. A case-control study.

Because of the presumed non-atherosclerotic pathogenesis, the potential link between spontaneous cervical artery dissection (sCAD) and common risk factors for atherosclerosis has never been investigated systematically. Therefore, this prospective, multicentre, case-control study compared the frequency of tobacco use, hypertension, diabetes mellitus, and hypercholesterolaemia among a group of consecutive patients with sCAD (n = 153), a group of patients with ischaemic stroke, not related to CAD (non-CAD), and a group of controls. As opposed to the other variables, a trend towards a significant association was seen when the prevalence of hypertension was compared among patients with sCAD and controls (26.8% v 17.0%; odds ratio (OR) 1.79; 95% confidence interval (CI), 0.98 to 3.27; p = 0.058). Hypertension was also significantly associated with the subgroup of patients with sCAD and cerebral infarction (OR, 1.94; 95% CI, 1.01 to 3.70; p = 0.045), particularly when involving the vertebral arteries (OR, 2.69; 95% CI, 1.20 to 6.04; p = 0.017). These findings might help define the spectrum of pathogenic conditions predisposing to sCAD and provide information to help investigate the combined effect of such susceptibility factors in future studies.

History of migraine and the risk of spontaneous cervical artery dissection.

The pathophysiology of spontaneous cervical artery dissection (sCAD) is largely unknown. An association with migraine has been suggested, but not definitively proven. In the setting of a hospital-based prospective case-control study we assessed personal and family history of migraine in 72 patients with sCAD, 72 patients with cerebral infarct unrelated to a CAD (non-CAD) and 72 control subjects. Personal history of migraine was significantly associated to sCAD compared to non-CAD (59.7% vs. 30.6%; OR 3.14; 95% CI 1.41-7.01) and controls (18.1%; OR 7.41; 95% CI 3.11-17.64). As opposed to migraine with aura, migraine without aura was significantly more frequent among sCAD than among non-CAD (56.9% vs. 25.0%; OR 3.91; 95% CI 1.71-8.90) and controls (12.5%; OR 9.84; 95% CI 3.85-25.16). Similar results were observed when the frequencies of family history of migraine were compared. These findings are consistent with the hypothesis that migraine may represent a predisposing condition for sCAD.

Characterization and optimization of an optical DNA hybridization sensor for the detection of multi-drug resistant tuberculosis.

The development of an optical DNA hybridization biosensor based on ruthenium electrochemiluminescence (ECL) was designed to detect DNA hybridization, using the detection of specific DNA sequences, which are indicative for antibiotic resistant strains of Mycobacterium tuberculosis as a model. The development of the sensor involved the characterization and optimization of the individual elements of the biosensor. Using this approach it was possible to ensure that the complete biosensor system was optimized to its maximum sensitivity for the electrochemiluminescent optical signal, which is produced during the DNA hybridization event. The transduction element used in this work is a solid-state silicon PIN photodiode. The miniaturization of the optical element to 5 mm(2) and smaller has made it possible to integrate the optical element internally as part of the biosensor scheme. Ruthenium ECL is a chemiluminescent reaction that is initiated by electrical stimulation. Photolithographic techniques were used to deposit and pattern gold electrodes directly onto the surface of the PIN photodiodes for the initiation of the ECL reaction. The gold electrodes also act as a biological support layer for DNA immobilization via thiol -gold linkage chemistry. The characterization and optimization of the individual components of this biosensor have allowed us to fabricate a miniaturized and integrated system that is compatible with a flow-through system.

Neurological and cognitive long-term outcome in patients with cerebral venous sinus thrombosis.

OBJECTIVES: The main aim of the present study was to assess long-term neurological and cognitive outcome in patients with cerebral venous sinus thrombosis (CVST). METHODS: We re-investigated by means of a face to face interview all patients with a confirmed diagnosis of CVST, collected at our Department over the years 1990-2000. During the interview the presence of headache, epileptic seizures, visual deficits and a new episode following the first occurrence of CVST were checked. Moreover all patients underwent a neurological examination, a functional evaluation, a cognitive assessment to rule out aphasia, apraxia and working memory deficits. Depression of mood was also investigated. RESULTS: On the whole 34 patients entered the study: 10 patients referred episodic headache following the disease. In three cases epileptic seizures were present. A new event occurred in only one patient. Four patients showed pyramidal signs, in two cases visual deficits were present. All patients had no functional disability. We found a mild non-fluent aphasia in three patients, working memory deficits in six patients and depression of mood in six cases. CONCLUSION: The present study demonstrates a good neurological and cognitive long-term outcome in patients with CVST.