IGRAINE IS A COMMON AND disabling condition that typically manifests as attacks of severe, pulsating, 1-sided headaches, often accompanied by nausea, phonophobiaor or photophobia. Population-based studies suggest that 6% to 7% of men and 15% to 18% of women experience migraine headaches. 1,2 Although in most cases it is sufficient to treat acute headaches, many patients require interval treatment as attacks occur often or are insufficiently controlled. Drug treatment with ␤-blockers, calcium antagonists, or other agents has been shown to reduce the frequency of migraine attacks; however, the success of treatment is usually modest and tolerability often suboptimal. 3 Acupuncture is widely used for preventing migraine attacks although its effectiveness has not yet been fully established. 4 Since 2001, German social health insurance companies have reimbursed accredited physicians who provide acupuncture treatment for chronic pain. By December 2004 more than 2 million patients had been treated with acupuncture , about a third of these had migraine or tension-type headaches. In this study, the Acupuncture Randomized Trial (ART-Migraine), we investigated whether acupuncture reduced headache frequency more effectively than sham acupuncture or no acupuncture in patients with migraines.

ISRCTN9737659.

No abstract

Acute respiratory tract infections (ARIs) are leading causes of morbidity and, in developing countries, mortality in children. A multiplex reverse transcription-PCR (RT-PCR) assay was developed to allow in one test the detection of nine different microorganisms (enterovirus, influenza A and B viruses, respiratory syncytial virus [RSV], parainfluenzaviruses type 1 and type 3, adenovirus,Mycoplasma pneumoniae, and Chlamydia pneumoniae) that do not usually colonize the respiratory tracts of humans but, if present, must be assumed to be the cause of respiratory disease. Clinical samples from 1,118 children admitted to the Department of Pediatrics because of an ARI between November 1995 and April 1998 were used for a first clinical evaluation. Detection of one of the microorganisms included in the assay was achieved for 395 of 1,118 (35%) clinical samples, of which 37.5% were RSV, 20% were influenza A virus, 12.9% were adenovirus, 10.6% were enterovirus, 8.1% were M. pneumoniae, 4.3% were parainfluenzavirus type 3, 3.5% were parainfluenzavirus type 1, 2.8% were influenza B virus, and 0.2% were C. pneumoniae. Seasonal variations in the rates of detection of the different organisms were observed, as was expected from the literature. The levels of concordance with the data obtained by commercially available enzyme immunoassays were 95% for RSV and 98% for influenza A. The results show that the multiplex RT-PCR–enzyme-linked immunosorbent assay is a useful and rapid diagnostic tool for the management of children with ARI. Studies of the overall benefit of this method with regard to the use of antibiotics, the use of diagnostic procedures including additional microbiological tests, and hospitalization rate and duration are warranted.

Due to missing the recruitment target (480 patients) and the high drop-out in the metoprolol group the results must be interpreted with caution. Still, they suggest that acupuncture might be an effective and safe treatment option for patients unwilling or unable to use drug prophylaxis.

HOPPE, ANDREA A., AND GALE B. CAREY. Polybrominated diphenyl ethers as endocrine disruptors of adipocyte metabolism. Obesity. 2007;15:2942-2950. Objective: Obesity is thought to result from poor diet and insufficient exercise. An additional factor may be endocrine-disrupting environmental chemicals that contaminate the air, water, and food supply. We tested the hypothesis that a class of lipid-soluble flame retardant chemicals known to accumulate in adipose tissue, polybrominated diphenyl ethers (PBDEs), disrupts insulin and isoproterenol sensitivity of isolated rat adipocytes. Research Methods and Procedures: Six-week-old Sprague-Dawley rats were gavaged daily with 14 mg/kg body weight (BW) pentabrominated diphenyl ether (penta-BDE) in corn oil (n ϭ 24) or corn oil alone (n ϭ 24). At 2 and 4 weeks of treatment, epididymal fat pad adipocytes were isolated, and isoproterenol-stimulated lipolysis, insulin-stimulated glucose oxidation, and adipocyte size were measured. Results: There was no alteration in adipocyte metabolism after 2 weeks of in vivo penta-BDE treatment, but after 4 weeks of treatment, adipocytes averaged a 30% increase in isoproterenol-stimulated lipolysis and a 59% decrease in insulin-stimulated glucose oxidation, compared with control. There were no differences in average rat BW and adipocyte size between treated and control rats, but plasma total thyroxine level in 2-and 4-week treated rats was 30% of control. Discussion: Daily exposure of rats to 14 mg/kg BW penta-BDE for 4 weeks has no effect on animal or adipocyte size but significantly alters insulin and isoproterenol-stimulated metabolism of isolated adipocytes. These alterations, hallmark features of metabolic obesity, suggest the need for further research on the contribution of lipid-soluble, endocrine-disrupting environmental chemicals to the obesity epidemic.

Objective The goal of this paper is to describe the characteristics of physicians and their interventions in a large, multicentre randomised trial of acupuncture for tension-type headache known as ARTTTH, in order to enable acupuncturists to assess the study interventions. Methods Participating physicians were recruited whose qualifications met or surpassed those of physicians currently accredited for providing acupuncture by state health funding agencies in Germany. Semi-standardised treatment strategies for acupuncture and minimal acupuncture were developed in a consensus process with acupuncture experts. Atotal of 270 patients suffering from episodic or chronic tension-type headache were randomised to 12 sessions of semi-standardised acupuncture (three predefined 'basic' points, recommendations for additional points given, but individual choice of additional points possible), standardised minimal acupuncture (superficial needling of at least 5 of 10 predefined, bilateral, distant non-acupuncture points) or a waiting list. Forty two physicians, trained and experienced in acupuncture, from 28 centres in Germany participated in the trial. Results The median duration of acupuncture training of trial physicians was 500 hours (range 140 to 1350 hours). Physicians had 10 (<1 to 25) years acupuncture experience. The three 'basic' points (GB20, GB21 and LR3) were treated in 96%, 82% and 97% of sessions, respectively. Frequently treated optional points included LI4 (67%), SP6 (50%) and ST36 (46%). Ten of the 42 physicians stated that they would have treated patients differently outside the trial. The trial found a significant effect of acupuncture over waiting list but not over minimal acupuncture. Conclusions In general, trial physicians complied well with the predefined interventions. Arelevant minority of participating trial physicians stated that they would have treated patients differently outside the trial.

While CAM usage is agreed upon by many physicians due to the idea that it helps patients to become active and feel more in control of the disease, our data are in favor of the contrary. A strong perception of external locus of control seems to be a driver of CAM usage. Physicians should be aware of this association when counseling on CAM.