Acupuntura en la recuperación de la anestesia general en pacientes intervenidas quirúrgicamente de nódulo de mama / Acupuncture in the recovery from general anesthesia in patients who underwent a breast nodule surgery

RESUMEN Introducción: en el período de recuperación de la anestesia general se deben metabolizar los medicamentos empleados y restablecer las alteraciones fisiológicas. La acupuntura es un método de tratamiento que ha sido estudiado en el período perioperatorio con diferentes fines; sin embargo, es menos conocido su efecto en la recuperación de la anestesia general. Objetivo: describir el efecto de la estimulación con Acupuntura en la recuperación de la anestesia general balanceada en pacientes intervenidas quirúrgicamente por nódulo de mama. Materiales y métodos: se realizó un estudio observacional prospectivo, en 60 pacientes intervenidas quirúrgicamente de nódulo de mama con anestesia general endotraqueal balanceada, de enero de 2014 a enero de 2016, en el Hospital Provincial Docente José Ramón López Tabrane, de Matanzas. Se conformaron dos grupos: grupo I, al que al finalizar la cirugía se le colocaron agujas de acupuntura en los puntos R1, Du26 y P9; y grupo II, al que no se le realizó acupuntura. El efecto de la acupuntura en la recuperación anestésica se midió a través de la Escala de Aldrete. Resultados: la edad de mayor incidencia fue de 40 a 49 años. El estado físico de las pacientes, según la Sociedad Americana de Anestesiología, es I. Prevaleció un tiempo anestésico de 61 a 90 minutos. Más del 75 % de las féminas tuvieron un tiempo de recuperación anestésica entre 31 y 60 minutos. Se presentaron dos complicaciones leves atribuibles a la acupuntura. Conclusiones: la aplicación de la acupuntura acortó el tiempo de recuperación anestésica en las pacientes estudiadas (AU).

ABSTRACT Introduction: in the recovery period from general anesthesia the used drugs should be metabolized and the physiological alterations restored. Acupuncture is a treatment method that has been studied in the perioperative period with different aims; nevertheless its effect on the recovery from general anesthesia is less well known. Objective: to describe the acupuncture stimulation effect on the recovery from general balanced anesthesia in patients who underwent a breast nodule surgery. Materials and methods: a prospective, observational study was performed in 60 patients who underwent a surgery of breast nodule with balanced endotracheal general anesthesia, from January 2014 to January 2016, at the Provincial Teaching Hospital "Jose Ramon Lopez Tabrane" of Matanzas. Two groups were formed: group I included patients to whom acupuncture needles were placed in R1, Du 26 and P9 acupoints after surgery, and Group II patients to whom acupuncture was not performed. The acupuncture effect on anesthetic recovery was assessed using the Aldrete Scale. Two groups were formed: group I, whose members at the end of the surgery were placed acupuncture needles to in the points R1, Du26 and P9; and group II, whose members did not receive acupuncture. The effect of acupuncture on anesthetic recovery was measured through the Aldrete Scale. Results: the highest incidence age was 40 to 49 years. The physical condition of the patients, according to the American Society of Anesthesiology, was I. An anesthetic time of 61 to 90 minutes prevailed. More than 75% of the women had an anesthetic recovery time between 31 and 60 minutes. There were two minor complications attributable to acupuncture. Conclusions: acupuncture application shortened the anesthetic recovery time in the studied patients (AU).

Comparative efficacy and safety of NSAIDs-controlled acupuncture in the treatment of patients with primary dysmenorrhoea: a Bayesian network meta-analysis.

BACKGROUND: Acupuncture and non-steroidal anti-inflammatory drugs (NSAIDs) are used frequently to treat primary dysmenorrhoea. However, it is unclear whether this treatment greatly reduces the risk of primary dysmenorrhoea. METHODS: Eight databases were searched up to January 2018. Pair-wise and network meta-analyses were conducted to synthesize data from eligible studies. RESULTS: Seventeen randomized controlled trials were included. The following acupuncture types showed more efficacy than NSAIDs in reducing primary dysmenorrhoea risk: traditional acupuncture (odds ratio [OR] = 6.70, 95% confidence interval [CI] 2.60-20.0), eye acupuncture (OR = 3.50, 95% CI 1.40-8.90), wrist-ankle acupuncture (OR = 6.00, 95% CI 1.30-32.0), superficial acupuncture (OR= 5.10, 95% CI 1.20-26.0), moxibustion (OR = 7.70, 95% CI 2.90-25.0), electroacupuncture (OR = 23.0, 95% CI 4.80-130), ear acupuncture (OR = 13.0, 95% CI 2.80-100) and abdominal acupuncture (OR = 5.30, 95% CI 2.10-16.0). Surface under the cumulative ranking curve values were traditional acupuncture (53.0%), eye acupuncture (22.0%), wrist-ankle acupuncture (81.5%), superficial acupuncture (50.0%), moxibustion (57.8%), electroacupuncture (99.9%), ear acupuncture (41.6%) and abdominal acupuncture (44.1%). CONCLUSION: Acupuncture is more efficacious than NSAIDs in reducing primary dysmenorrhoea risk. Acupuncture, particularly electroacupuncture, can decrease the risk of primary dysmenorrhoea.

Tratamiento inicial de la enfermedad de Parkinson clínicamente establecida / Initial treatment of clinically established Parkinson's disease

Introducción. La enfermedad de Parkinson es una enfermedad cuyo diagnóstico continúa siendo clínico y aunque en la actualidad no existe una solución definitiva para la misma, se dispone de diversos fármacos para su tratamiento. Desarrollo. Se repasan los distintos fármacos que pueden tener su utilidad en la fase inicial de la enfermedad: L-dopa, inhibidores de la catecol-o-metil-transferasa, agonistas dopaminérgicos, inhibidores de la monoamino-oxidasa tipo B, amantadina, zonisamida y anticolinérgicos; así como terapias no farmacológicas. Asimismo se dan unas pautas sobre cómo emplear estos fármacos de una forma racional. Conclusiones. Actualmente sólo rasagilina ha cumplido los requisitos para poder ser considerada como tratamiento modificador de la enfermedad. L-dopa sigue siendo el mejor tratamiento sintomático, pero su utilización se asocia a aparición de complicaciones motoras. Los agonistas dopaminérgicos o los inhibidores de la monoamino-oxidasa tipo B pueden ser alternativas para retrasar el uso de la L-dopa. Zonisamida puede ser útil de inicio en pacientes jóvenes con cuadros de predominio tremórico. Los anticolinérgicos pueden ser empleados de forma excepcional para control de temblor parkinsoniano intenso no controlable con otros fármacos en pacientes jóvenes. El ejercicio físico, la hidroterapia y la terapia de la voz también pueden aportar beneficios (AU)

ntroduction. The diagnosis of Parkinson's disease continues to be clinically-based and although there is currently no definitive solution for it, a number of drugs are available to treat it. Development. Here we review the different drugs that can be useful in the early phases of the disease. These include: L-dopa, catechol-O-methyl transferase inhibitors, dopamine agonists, monoamine oxidase type B inhibitors, amantadine, zonisamide and anticholinergic agents, as well as non-pharmacological therapies. Likewise, guidelines are also provided on how to use these drugs in a rational way. Conclusions. At present, only rasagiline complies with the requirements to be considered a disease-modifying treatment. L-dopa continues to be the best symptomatic treatment, but its use is associated with the appearance of motor complications. Dopamine agonists or monoamine oxidase type B inhibitors can be employed as alternatives to delay the use of L-dopa. Zonisamide can be useful in the early phases in young patients with clinical pictures in which tremor predominates. The anticholinergics can be employed exceptionally to control intense parkinsonian tremor in young patients that cannot be controlled with other drugs. Physical exercise, hydrotherapy and voice therapy can also be beneficial (AU)

Tratamiento de los trastornos de la marcha en la enfermedad de Parkinson / Treatment of gait disorders in Parkinson's disease

Se observa un interés creciente por el estudio de los síntomas extranígricos de la enfermedad de Parkinson, como las alteraciones de la marcha, que conllevan una importante disminución de la calidad de vida. La marcha es un proceso complejo cuya afectación puede explicarse por la suma de elementos como hipocinesia, asimetría en el movimiento de ambos hemicuerpos, disfunción ejecutiva, alteraciones en la sensibilidad propioceptiva, factores ambientales y emocionales. En la regulación de la marcha y la postura están implicadas diversas estructuras cerebrales y neurotransmisores que en la enfermedad de Parkinson tienen alterada su activación. En las fases iniciales los trastornos de la marcha son controlados aceptablemente con fármacos dopaminérgicos pero la respuesta a estos medicamentos no es satisfactoria en fases avanzadas, lo cual ha llevado a investigar sustancias con otros mecanismos de acción (metilfenidato, dihidroxifenilserina, anticolinesterásicos, memantina, inhibidores selectivos de los receptores de serotonina, entre otros) y tratamientos no farmacológicos como cirugía (estimulación cerebral profunda del núcleo subtalámico y del pedunculopontino), fisioterapia y acupuntura (AU)

There is currently a growing interest in the study of the extra-nigral symptoms of Parkinson's disease, such as gait disorders, which result in an important reduction in quality of life. Walking is a complex process and the problems affecting it can be explained by the sum of elements like hypokinesia, asymmetry in the movement of the two halves of the body, executive dysfunction, alterations affecting proprioceptive sensitivity, and environmental and emotional factors. The activation of a number of different brain structures and neurotransmitters involved in the regulation of gait and posture is altered in Parkinson's disease. In the early phases gait disorders are controlled to an acceptable extent with dopaminergic drugs, but the response to these agents is not satisfactory in advanced phases. This has led researchers to look for substances with other mechanisms of action (methylphenidate, dihydroxyphenylserine, anticholinesterases, memantine and selective serotonin receptor inhibitors, among others) and non-pharmacological treatments such as surgery (deep brain stimulation of the subthalamic nucleus and of the pedunculopontine), physiotherapy and acupuncture (AU)

[Classification and characters of physical parameters of lifting-thrusting and twirling manipulations of acupuncture].

By using "Acupuncture Manipulation Information Analyzing System", the traditional reinforcing and reducing manipulations of acupuncture described in classical Chinese medical books were imitated and their parameters analyzed. It was found that in the oscillogram, the differences between the reinforcing and reducing manipulations (rapid-slow reinforcing-reducing skill, lifting-thrusting reinforcing-reducing skill) are the bigger duration of descending branch (t1) and smaller duration of ascending branch (t2) for the former, and shorter t1 and longer t2 for the later, due to slow insertion and rapid withdrawal of the acupuncture needle for the reinforcing, and rapid insertion and slow withdrawal of needle for the reducing. While for twirling reinforcing, t1 < t2 for predominantly-leftward twirling, and for twirling reducing, t1 > t2 for predominantly-rightward twirling were found. In addition, it is supposed that those parameters as the amplitude (s), frequency (f) and duration of one cycle (t) of the oscillogram may be related to acupuncture stimulating quantity, while t3 (duration of the plateau segment), t4 (duration of the horizontal plane segment) and their variance may be associated with the stability of the acupuncture manipulation. Due to the limited literal recordation, some other traditional acupuncture manipulations can not simulate indeed, because we don't know how to perform those kinds of acupuncture manipulation. This just reflects the importance of objectivity of acupuncture manipulations.

Demographics and patterns of acupuncture use in the Chinese population: the Taiwan experience.

BACKGROUND: The use of complementary and alternative medicine (CAM), including Traditional Chinese Medicine (TCM) and acupuncture, has substantially increased in western countries in the past decade. However, informative data concerning large-scale investigations of acupuncture used in the Chinese society remain rare so far. DESIGN AND OUTCOME MEASURE: The complete datasets of acupuncture outpatient reimbursement claims from 1996 to 2002 were supplied by the National Health Insurance Research Database, Taiwan, and the usage frequencies and characteristics of the acupuncture users, as well as the disease categories that were treated by acupuncture in Taiwan were analyzed. RESULTS: At the end of 2002, among the 21,869,478 total valid beneficiaries of National Health Insurance (NHI), 1,362,351 subjects (6.2%) used acupuncture during this year, but 4,948,464 subjects (22.6%) had used it for the whole 7-year period since 1996. A mean increment of 1,191,164 (53.6%) new users had been involved yearly. Among all those acupuncture users, a female predominance was observed (female:male = 1.12:1), and the age distribution displayed a peak at around the 40s, followed by the 30s and 50s. Private TCM clinics provided more acupuncture usage (82.0%) than did private TCM hospitals (13.7%). The disease categories treated mostly by acupuncture were diseases of the musculoskeletal system (46.2%); injury (41.8%); diseases of the nervous system (3.5%); and symptoms, signs, and ill-defined conditions (2.7%). CONCLUSIONS: Twenty-three percent (23%) of people in Taiwan had used acupuncture during this 7-year period. Musculoskeletoal and neurologic disorders were two major categories commonly treated with acupuncture.

Randomised control trial of tongue acupuncture versus sham acupuncture in improving functional outcome in cerebral palsy.

BACKGROUND: Traditional Chinese medicine (TCM) has been used historically in the treatment of cerebral palsy (CP). We investigated the efficacy of acupuncture in improving the motor function of children with CP. METHODS: A randomised control trial was conducted to assess the effect of tongue acupuncture (TAC) in 33 CP children. The subjects were randomised to treatment (n = 22) with TAC or control (n = 11). Clinical outcome was evaluated using the gross motor function measure (GMFM) and the pediatric evaluation of disability inventory (PEDI). RESULTS: The increase in mean GMFM score was significantly greater in the treatment than in the control group (p = 0.042). CONCLUSION: An improvement in motor function of CP subjects is seen following a short course of acupuncture.

[Proving the effectiveness of complementary therapy. Analysis of the literature exemplified by acupuncture]. / Wirksamkeitsnachweise komplementärer Therapien. Literaturanalyse am Beispiel der Akupunktur.

At present, acupuncture may be considered one of the most popular forms of complementary medicine worldwide. However, in relation to the number of reviews on the subject, comparatively few controlled clinical trials have been reported so far. An analysis of all the controlled clinical trials listed in MEDLINE between 1987 and March 1994 (n = 39) that met certain basic requirements revealed that they addressed a wide variety of diseases and/or symptoms with no major focus (apart from the symptom of pain, which of course is highly complex in nature). In agreement with the findings of other meta-analyses, most of the more recent papers have been found to be still of indifferent quality. Besides the inherent problem that the term acupuncture subsumes within itself a substantial number of different techniques (and even philosophies), an obvious methodological deficit can be observed. Many groups seem to attach too little importance to choosing an appropriate control model, although seminal papers addressing this problem were already published in the early eighties. Similar remarks apply to inadequacies in study design, which should be at least single-blind. In summary, these findings may well help to explain why the effectiveness of acupuncture has still not been definitively demonstrated.

WHO and the development of acupuncture nomenclature: overcoming a Tower of Babel.

At present, WHO does not have an official policy on acupuncture. The Organization's policies are usually developed after a debate has taken place on a particular health issue. There has not yet been a debate on acupuncture. This paper reviews WHO's efforts to produce a standard acupuncture nomenclature as a first step towards ensuring that a debate on acupuncture takes place in an atmosphere of greater understanding of the contribution that acupuncture can make in the delivery of health care. Activities that the programme for traditional medicine hopes to implement in the coming years are outlined.