• Energy Research
• clinical medicine close
• US close
• GB close
• AU close
• CA close

Objective: To evaluate the effectiveness of extracorporeal shockwave therapy compared with other interventions on pain, grip strength and disability in patients with lateral elbow tendinopathy. Data Sources: MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, Cochrane Library and clinical trial registries. Review methods: We included randomized controlled trials assessing the effectiveness of extracorporeal shockwave therapy alone or as an additive intervention compared with sham or other interventions. Pain intensity, grip strength and elbow disability were used as primary outcome measures. We assessed methodological quality with the PEDro score and quality of evidence with the GRADE approach. Results: Twenty-seven studies with 1871 patients were finally included. Extracorporeal shockwave therapy reduced pain intensity at mid-term follow-up (standardized mean difference: −1.21, 95% confidence interval:−1.53, −0.89, P < 0.001) and improved grip strength at very short- (mean difference:3.92, 95% confidence interval: 0.91, 6.94, P = 0.01) and short-term follow-up (mean difference:4.87, 95% confidence interval:2.24, 7.50, P < 0.001) compared with sham treatment. However, no clinically significant results were found between comparators in all outcomes and follow-up times. Extracorporeal shockwave therapy presented clinically better compared to Laser in grip strength at short-term (mean difference:3.50, 95% confidence interval:2.40, 4.60, P < 0.001) and ultrasound in pain intensity at very-short-term follow-up (standardized mean difference: −1.54, 95% confidence interval: −2.60, −0.48, P = 0.005). Conclusion: Low to moderate certainty of evidence suggests that there are no clinical benefits of extracorporeal shockwave therapy compared to sham interventions or corticosteroid injections. Based on very-low and moderate certainty of evidence, extracorporeal shockwave therapy outperforms against Laser and ultrasound, respectively. Level of Evidence: Therapy, level 1a.

A retrospective analysis of a large database of maternal and litter variables in rats collected over several years evaluated the robustness of fetal alcohol effects on birthweight. Pregnant rats were fed a liquid diet in which 35% of the calories were derived from alcohol. Control dams were pairfed an isocaloric liquid diet or were fed lab chow ad lib. Alcohol exposure produced large, highly significant, and reliable decreases in birthweight of male and female pups. Multiple regression analyses indicated that alcohol exposure per se, much more than restricted caloric intake alone, caused these effects. Litters of pairfed dams weighed less than chowfed controls but the effects were less consistent, varying with season and requiring more litters to discriminate the effects of restricted caloric intake. Power analyses indicated that 7 to 12 litters per group are needed for detecting a statistically significant reduction in birthweight due to prenatal alcohol exposure, even with single pups selected at random from each litter. Alcohol-exposed pups also weighed consistently and significantly less than both the chowfed and pairfed pups, whereas differences between chowfed and pairfed groups were much smaller and inconsistent. The results imply that decreased birthweight is a consistent characteristic of prenatal alcohol exposure.

Impairment of motor coordination, or ataxia, is a prominent effect of alcohol ingestion in humans. To date, many models have been created to examine this phenomenon in animals. Evidence suggests that the tasks thought to measure this behavior in mice actually measure different components of this complex trait. We have characterized the parallel rod floor apparatus to quantify ethanol‐induced motor incoordination. Using genetically heterogeneous mice, we evaluated the influence of rod diameter and inter‐rod distance on dose‐related ethanol‐induced motor incoordination to select parameters that optimized testing procedures. We then used the DBA/2J and C57BL/6J inbred strains of mice to examine the effect of 2 g/kg of ethanol, by serially testing mice on two floor types, separated by 1 week. Finally, we tested eight inbred strains of mice on four floor types to examine patterns of strain sensitivity to 2 g/kg of intraperitoneal ethanol and determined the test parameters that maximized strain effect size. Motor incoordination varied depending on the floor type and strain. When data from strain 129S1/SvlmJ were removed from the analyses because of their extreme behavior, the greatest strain effect size was observed on one floor type during the first 10 min of testing after 2 g/kg of intraperitoneal ethanol. These findings suggest that the parallel rod floor apparatus provides a useful means for examining ethanol‐induced motor incoordination in mice but that specific testing procedures are important for optimizing detection of motor incoordination and genetic influences.

The influence of the physical characteristics and biological effectiveness of pion and other charged heavy particle beams on treatment techniques is reviewed. Of major importance are the expected differences in the biological effects of variable star dose to total dose ratios (star fractions) with pion beams and with high LET to low LET dose ratios with other charged particles. Special consideration is given to the multiport irradiation configuration of the Stanford Medical Pion Generator.

The mechanism of veisalgia cephalgia or hangover headache is unknown. Despite a lack of mechanistic studies, there are a number of theories positing congeners, dehydration, or the ethanol metabolite acetaldehyde as causes of hangover headache.We used a chronic headache model to examine how pure ethanol produces increased sensitivity for nociceptive behaviors in normally hydrated rats.Ethanol initially decreased sensitivity to mechanical stimuli on the face (analgesia), followed 4 to 6 hours later by inflammatory pain. Inhibiting alcohol dehydrogenase extended the analgesia whereas inhibiting aldehyde dehydrogenase decreased analgesia. Neither treatment had nociceptive effects. Direct administration of acetate increased nociceptive behaviors suggesting that acetate, not acetaldehyde, accumulation results in hangover-like hypersensitivity in our model. Since adenosine accumulation is a result of acetate formation, we administered an adenosine antagonist that blocked hypersensitivity.Our study shows that acetate contributes to hangover headache. These findings provide insight into the mechanism of hangover headache and the mechanism of headache induction.

Decreases in birth weight are among the most commonly reported effects of prenatal alcohol exposure in animals. However, these decreases are typically associated with relatively high doses of alcohol. Two studies were conducted. The first evaluated the effects of low doses of alcohol (0.15 and 0.30 g/kg) on birth weight and other measures. A second study examined the effects of a relatively high dose of alcohol (3.0 g/kg). The two low doses of alcohol produced a slight, but not significant, increase in birth weight relative to vehicle controls whereas the high dose of alcohol produced a significant decrease in birth weight relative to its controls. When the data for the two studies were combined, the relationship between alcohol and birth weight assumed an inverted U-shaped function. There was no effect of prenatal alcohol exposure on weights at weaning, passive avoidance learning, or ambulation. In the context of birth weight, slight increases may be related to increased protein synthesis associated with low doses of alcohol.

Even after they cease drinking, many alcoholics show continued impairment of cognitive functioning on both intelligence and neuropsychological tests, with deficits being apparent in visual perception, learning and memory, and the use of problem-solving strategies. Neuropsychological investigations have suggested that these deficits reflect premature aging, a direct dose response relationship, or localized brain damage. However, studies have shown that a considerable recovery of cognitive functioning occurs, most dramatically after drinking cessation and more slowly thereafter. Tasks that require novel, complex, and rapid information processing require longer to recover, and persistent impairments in visual-spatial abilities, abstraction and problem solving, and short-term memory are common, particularly in older alcoholics. Practical applications of this research are discussed in terms of the possibility of reducing cognitive dysfunction and improving treatment outcome in alcoholics.