[Is the analgesic effect of acupuncture a placebo effect?]. / Ist die analgetische Wirkung der Akupunktur ein Placeboeffekt?

The German acupuncture trials ART and GERAC have shown that acupuncture and sham or minimal acupuncture were equally effective in the reduction of chronic pain symptoms. These results have prompted an ongoing discussion as to whether acupuncture exerts its effects through a placebo response. Increasing knowledge about the neurobiology of pain and its intrinsic control suggests a combination of acupuncture-specific neurophysiologic effects combined with effects that match those of expectation-induced placebo analgesia.

[Acupuncture: quo vadis?]. / Akupunktur -- quo vadis? Zur aktuellen Diskussion um Wirksamkeit und "Punktspezifität" der Nadeltherapie.

On the current discussion about efficacy and "point-specificity" of the needle therapy To improve the evidence base for acupuncture in pain treatment the German health insurance initiated the so called "Acupuncture randomised trials (ART)" and "German Acupuncture Trials" (GERAC) with a sample size of 300 (ART) and 1000 (GERAC) patients, providing a new dimension in acupuncture research. These studies have yielded data, which indicate that acupuncture is effective in the treatment of migraine, tension type headache, osteoarthritis of the knee and chronic low back pain. For the two latter indications acupuncture showed an even higher therapeutic response rate than conventional standard treatment. In migraine acupuncture showed an effect comparable to pharmacological treatment. The studies moreover indicate that the relevance of point-specific effects may have been overestimated concerning some indications. This article discusses the results of ART and GERAC, based on differentiating the mechanisms of action in acupuncture therapy. It is shown that the current data neither support the postulate of a "no-matter-where acupuncture" nor the irrefutability of the theorems of Chinese Medicine. Future studies will have to determine more precisely the mechanism by which the therapeutic effect of acupuncture is mediated. Furthermore, it will be necessary to find out more clearly in what diseases the location of needling represents the crucial part of the treatment and in what diseases rather different factors, like the intensity of stimulation or the doctor-patient interaction, are more relevant for the therapeutic effect. Research into acupuncture is still at the beginning. For this reason it should be avoided to draw premature and untenable conclusions from the current data.

Total synthesis of 1,11- and 3,11-diazasteroids.

The 2- and 6-methoxy derivatives of 8-aminoquinoline, as well as 5-aminoisoquinoline, condensed with 2-ethoxycarbonylcyclopentanone to give tricyclic intermediates in 86-90% yield. These secosteroids were cyclized in 35-69% yield with polyphosphoric acid to 2-methoxy-1,11-diaza-, 7-methoxy-1,11-diaza-, and 3,11-diaza-1,3,5,7,9,13-gonahexaen-12-ones, respectively. The latter exhibits slight antileukemic activity.

Total synthesis of diazasteroids (1).

Contrary to previous reports, the condensation product of 8-aminoquinoline (1) and 2-carbethoxycyclopentanone (2) undergoes ring closure with polyphosphoric acid to give the 1, 11-diazasteroid 5. Catalytic hydrogenation reduced the A ring and the double bond to produce 6. 8-Aminotetrahydroquinoline (7) and 3-carbethoxy-2-piperidone condense to a tricyclic intermediate (11), which could not be cyclized to a steroid, however.