Homeopathic Arnica 30x is ineffective for muscle soreness after long-distance running: a randomized, double-blind, placebo-controlled trial

OBJECTIVE

To determine whether homeopathic Arnica 30X can reduce muscle soreness following long-distance running more than a placebo.

DESIGN

Randomized, double-blind placebo-controlled trial.

SETTING

Long-distance runs taking place in the community.

SUBJECTS

A total of 519 runners anticipating delayed-onset muscles soreness after long-distance races.

INTERVENTIONS

A homeopathic medicine (Arnica 30x) and an indistinguishable placebo.

OUTCOME MEASURES

Subjects completed a visual analog scale and Likert scale of muscle soreness every morning and evening for the 5 days following their race. Race time was also recorded. The main outcome measure was mean 2-day visual analog scores.

RESULTS

Results were obtained from 400 subjects. Groups were well matched at baseline. Mean 2-day visual analog soreness scores for Arnica and placebo were 45.2 mm and 41.0 mm, respectively. The 95% confidence interval was between 8.81 mm in favor of placebo and 0.51 mm in favor of Arnica. No differences were found for Likert scores or race time.

CONCLUSION

Homeopathic Arnica 30x is ineffective for muscle soreness following long-distance running.

Do certain countries produce only positive results? A systematic review of controlled trials

OBJECTIVE

To determine whether clinical trials originating in certain countries always have positive results.

DATA SOURCES

Abstracts of trials from Medline (January 1966-June 1995).

STUDY SELECTION

Two separate studies were conducted. The first included trials in which the clinical outcome of a group of subjects receiving acupuncture was compared to that of a group receiving placebo, no treatment, or a nonacupuncture intervention. In the second study, randomized or controlled trials of interventions other than acupuncture that were published in China, Japan, Russia/USSR, or Taiwan were compared to those published in England.

DATA EXTRACTION

Blinded reviewers determined inclusion and outcome and separately classified each trial by country of origin.

DATA SYNTHESIS

In the study of acupuncture trials, 252 of 1085 abstracts met the inclusion criteria. Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR. In studies that examined interventions other than acupuncture, 405 of 1100 abstracts met the inclusion criteria. Of trials published in England, 75% gave the test treatment as superior to control. The results for China, Japan, Russia/USSR, and Taiwan were 99%, 89%, 97%, and 95%, respectively. No trial published in China or Russia/USSR found a test treatment to be ineffective.

CONCLUSIONS

Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.

Consequences of error production in a perceptual-motor task

In 2 experiments, U.S. college students engaged in a computerized version of a tracing task in which a cursor on a monitor screen could be guided through 16 segments of an 8-pointed, star-shaped track into targets at the vertices of the track by moving a joystick handle. The presence or absence of consequences for errors was manipulated. With restricted consequences, the cursor was confined to the track, freezing in position if the joystick handle was moved to an unsuitable position. With unrestricted consequences, the cursor always moved corresponding to the position of the joystick handle, even through and beyond the borders of the track. Time to reach each of the 16 successive targets was recorded on each of 4 training trials, as well as on 2 transfer trials in which consequences were unrestricted, but only the cursor and next target were visible (the contextual cue of the star-shaped track was absent). Times were longer on diagonal segments and when consequences were unrestricted, but there was no consistent carryover to the test trials. The results suggest that feedback, to serve an effective "guidance" function in skill learning, requires production of unrestricted feedback about errors. True guidance, however, prevents response errors, so consequences and feedback about errors are precluded.

Delayed repair: the role of glutathione in a rat incisional wound model

Glutathione is a low molecular weight tripeptide that is a major intracellular antioxidant, modulates DNA synthesis, and may regulate signal transduction mechanisms. Our previous studies in rats suggested that intracellular stores of glutathione were sensitive to skin ischemia and, therefore, may regulate the early temporal course of wound healing. A 4-cm incision was placed on a rat's back and in vivo wound strength was measured over time. Animals were depleted of glutathione using L-buthionine-(S,R)-sulfoximine (BSO), an inhibitor of the enzyme gamma-glutamylcysteine synthetase. Some animals were treated in combination with allopurinol/BSO or with allopurinol alone. The data demonstrated at 4 days that BSO treatment produced a fourfold reduction in glutathione (3.51 +/- 1.78) over baseline (16.15 +/- 2.18) levels and twofold reduction (5.0 +/- 1.1) over untreated sham controls (11.1 +/- 2.3) (P < 0.05). Allopurinol provided no protection to glutathione levels. BSO treatment alone reduced wound burst strength compared to the other groups (P < 0.05). Allopurinol treatment enhanced wound strength over sham controls and BSO groups at 9 days after wounding (P < 0.05). Hydroxyproline content in wounds accumulated faster by Day 4 in the BSO-treatment groups compared to sham controls (P < 0.05), whereas the BSO-treatment groups had lower hydroxyproline levels measured at Day 6 (P < 0.05). These data provide the first evidence that wound healing is related to the temporal course of glutathione metabolism. The effect may not be related to oxidant stress since allopurinol provided enhanced wound burst strength without protecting wound glutathione levels.

Malignant melanoma of the foot and ankle

The records of sixty patients who had a malignant melanoma of the foot or ankle were reviewed retrospectively to determine the clinical features, prognostic factors, and distinguishing characteristics. Fifty-seven patients were white and three were black. There were forty-two women and eighteen men (a female-to-male ratio of 2.3 to 1). The mean age at the time of presentation was fifty-seven years (range, twenty-two to eighty-three years). The most common site of involvement was the plantar aspect of the foot. The mean duration of follow-up was forty-five months (range, three to 144 months). Kaplan-Meier life-table analysis revealed an over-all five-year survival rate of 63 per cent and an over-all ten-year survival rate of 51 per cent. The mean duration of survival for the patients who had a plantar or subungual lesion was significantly shorter than that for the patients who had a lesion at another site on the dorsal aspect of the foot or on the ankle (forty-seven compared with seventy-two months) (p = 0.02). The mean depth of the lesion, according to the criteria of Breslow, was 3.03 millimeters, and the mean level, according to the classification of Clark et al., was IV. According to the classification of the American Joint Commission on Cancer, forty-three patients had stage-I or II (local) disease, thirteen had stage-III disease (nodal or in-transit disease, defined as cutaneous or subcutaneous metastases more than two centimeters from the primary tumor but not beyond the regional lymph nodes), and four had stage-IV disease (distant visceral metastases) at the time of presentation. Lesions at plantar and subungual sites were also associated with a higher prevalence of clinical misdiagnosis compared with lesions on the dorsal aspect of the foot or on the ankle (p = 0.02). The misdiagnoses included a benign nevus (one patient), a paronychia (one patient), a pyogenic granuloma (two patients), a plantar wart (three patients), a ganglion cyst (one patient), a blister (two patients), and a traumatic lesion (five patients).(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of topical beta-blocker medications on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture

Several recent publications have suggested that the long-term use of topical antiglaucoma medications may be detrimental to the outcome of trabeculectomy. In this study we investigated the effect of topical beta-blocker medications on the proliferation and viability of human Tenon's capsule fibroblasts in tissue culture to see if there was a direct mechanism of enhanced proliferation. None of the tested medications stimulated the proliferation of fibroblasts. They were shown to have an inhibitory effect on proliferation and were toxic to cells at higher concentrations. The relevance of these findings to wound healing following trabeculectomy is discussed.

Ras gene-mutations are a rare event in human uveal and cutaneous melanomas

Melanomas are malignant tumours with high metastatic potential. The genetic alterations which lead to the transformation and progression of melanocytes to malignant melanoma remain obscure. Mutations in the ras gene family have been described, however their role in melanoma pathogenesis is still controversial. In this study we examined the incidence of H-, K- and N-ras mutations in 47 DNA samples isolated from paraffin-embedded 25 cutaneous and 22 uveal malignant melanoma tissues and a MeWo melanoma cell line using the Restriction Fragment Length Polymorphism (RFLP) analysis of PCR products. Only one mutation in codon 61 of the N-ras gene was found suggesting that the importance of ms mutations in melanoma tumourigenesis may be limited.

The role of xanthine oxidase and xanthine dehydrogenase in skin ischemia

The importance of sequential events which lead to skin necrosis has significant implications in trauma, vascular injury, and wound healing. In this series of experiments, we tested the hypothesis that xanthine oxidase (XO) activity was increased along an ischemic gradient of a skin flap and that the XO enzyme activity correlated with an increase in neutrophils. There were two animal groups in which the skin flaps were raised and assayed at 0, 1, or 6 hr. In the other group, they were created as bipedicle flaps for 7 days, before the distal attachment was divided and the tissue assayed. In the acutely raised flaps, some animals were treated with the XO inhibitor, allopurinol. Xanthine dehydrogenase (XD) and XO activity was measured with a fluorometric pterin assay and neutrophil concentration was measured using a myeloperoxidase marker. In this model, there was consistent skin necrosis in the distal end of the skin flap (48 +/- 8%). The data showed that both XD and XO activity in the distal ends was statistically significantly increased over the sham control or proximal ends of the skin flaps at 1 hr (P < 0.05). XO activity remained elevated in the distal ends at 6 hr. Allopurinol significantly reduced the neutrophil concentrations in the distal ends of the skin flaps when compared to untreated animals (P < 0.05). Moreover, allopurinol reduced skin necrosis to 12 +/- 1%. Preconditioning of the skin flap reduced the XO activity to sham control levels. The observations implicate XO activity as source of free radical injury in skin necrosis seen in random skin flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of omental transposition in the treatment of recurrent sarcoma of the back

We report 2 patients with paraspinous sarcoma treated with omental transposition tunneled through a defect in the lumbar fascia that resurfaced in the soft tissues of the lower back. Traditional reconstruction with skin flaps was unsatisfactory because of prior irradiation to the area. In 1 patient the omentum obliterated a cavity connecting the dura to the skin to prevent cerebrospinal fluid leak. In the other patient a large soft tissue defect overlying the lower back and dura was covered with omentum and skin grafted. Although both patients lived < 2 years, the durable wound coverage remained intact over the surgical site.

The stress response in skin: the role of neutrophil products in preconditioning

In this study we tested the hypothesis that neutrophil products are present in ischemic skin flaps and that they are abolished with preconditioning of the skin. Random back flaps were created on rats, and the sequential appearance of neutrophil products and tissue oxidants was measured in the skin flaps. These flaps had predictable skin necrosis (4.7 +/- 0.8 cm) in the distal ends, while preconditioned flaps had no skin necrosis. Neutrophil products were assayed by both histomorphometrics and myeloperoxidase assays. Lipid peroxidation products were measured to assess tissue oxidant production. These data demonstrate that there is an increase in myeloperoxidase activity in skin flaps that is statistically significantly greater in the distal ends of the flaps at 24 hours (p < 0.05). The lipid peroxidation products were statistically significantly elevated at 48 hours in the distal ends (p < 0.05). Preconditioning the skin as a bipedicled skin flap for 7 days and then dividing the distal attachment abolished neutrophil products and tissue oxidant activity in the skin flaps (p < 0.05). These data suggest that neutrophil products and oxidant production are increased in ischemic skin and that preconditioning of the flap markedly attenuates this response.

The effect of frequency transposition on the untrained auditory discrimination of congenitally deaf children

Various frequency lowering schemes have been developed for use with deaf people who have little or no measurable hearing in the high frequencies. In general, results of studies evaluating such schemes have been discouraging, except for studies evaluating a frequency recoding device devised by Velmans (1973a). Previous evaluation studies with this device have demonstrated that FRED transposition can improve the auditory discrimination of certain subjects with sensorineural deafness after training (e.g. Velmans and Marcuson, 1980; Velmans et al., 1982; Velmans et al., 1988). Using selection criteria developed in the 1988 study, the current study evaluated the effect of FRED transposition on the untrained auditory discrimination of eight congenitally deaf students, aged between 7 years 2 months and 14 years 10 months with high frequency hearing losses. Results demonstrated that FRED transposition significantly enhanced the auditory discrimination of consonants in the high speech frequencies for the subject group. This suggests that FRED transposition may produce some benefits in everyday situations even without formal training. Evaluation tests with and without transposition, such as those used in this study, may provide one means of selecting congenitally deaf people who would be likely to benefit from using FRED aids.

Evidence that interleukin-4 suppression of lymphokine-activated killer cell induction is mediated through monocytes

Recombinant human interleukin-4 (IL-4) and transforming growth factor-beta (TGF-beta) reduce recombinant interleukin-2 (IL-2) induction of lymphokine-activated killer (LAK) cell activity from human peripheral blood mononuclear cells (PBMC). Monocytes can be removed from PBMC by adherence, leaving a peripheral blood lymphocyte population (PBL) which also responds to IL-2 to generate LAK activity. PBL generation of LAK cytotoxicity is susceptible to inhibition by TGF-beta, but not by IL-4. Readdition of purified monocytes to PBL is accompanied by return of the suppressive action of IL-4 on the generation of LAK activity. Induction of LAK cytolysis from Percoll-isolated T cells (greater than 90% CD3+) is also refractory to the inhibitory effect of IL-4. When PBMC were cultured in IL-2, with and without IL-4, subsequent sorting of CD3+ and CD3- lymphocytes by flow cytometry demonstrated that IL-4 had suppressed LAK induction in both effector populations. This suggests that, although isolated CD3+ cells are not susceptible to IL-4 suppression of IL-2 activation, they are sensitive to inhibition when part of a mixed PBMC population. Evidence is presented for the first time that this suppression is mediated via the action of IL-4 on monocytes.

Xanthine oxidase: its role in the no-reflow phenomenon

This study was designed to probe the hypothesis that oxygen-derived free radicals are involved in initiation of the no-reflow phenomenon. We developed a reproducible model of no reflow in the rat hind limb. Laser Doppler studies confirmed that the hind limbs perfused well after 2 or 4 hours of ischemia, but perfusion ceased in the first 10 minutes after 6 hours of ischemia. Venous blood samples and biopsy specimens of skin and muscle were taken after 2 and 4 hours of ischemia to study tissue injury. Blood samples were evaluated for xanthine oxidase (XO), xanthine dehydrogenase, and creatine phosphokinase (CPK) activities. Conjugated dienes and iodine 125-labeled albumin extravasation were quantified in tissue samples. Groups of animals were treated with inhibitors of XO (allopurinol), antioxidant enzymes (superoxide dismutase plus catalase), and free radical scavengers (dimethyl sulfoxide and dimethyl thiourea) to assess the roles of free radicals in ischemia-reperfusion injury in the hind limbs. After 4 hours of ischemia followed by reperfusion, plasma XO activity rose threefold over preischemia levels (p less than 0.05). Xanthine dehydrogenase activity did not change; conjugated diene levels in muscle rose twofold; CPK levels rose sixfold, and 125I albumin extravasation rose twofold (p less than 0.05). Pretreatment with the XO inhibitor allopurinol reduced XO activity to negligible levels and significantly attenuated conjugated diene levels, CPK levels, and albumin extravasation. Albumin extravasation was also significantly attenuated by pretreating animals with superoxide dismutase together with catalase, dimethyl thiourea, and dimethyl sulfoxide. In all animals pretreated with allopurinol or superoxide dismutase and catalase, reperfusion persisted after 6 hours of ischemia. These data suggest that, in ischemia followed by reperfusion, tissue injury is related to oxygen products derived from XO activity.

C-myc oncogene expression in ocular melanomas

We have investigated the expression of c-myc in 24 ocular melanomas by immunohistochemistry, using two monoclonal antibodies raised against a mid-sequence portion of the c-myc product (6E10) and against the C-terminus (9E10). The results were compared with other putative prognostic factors, including tumour size, cell type, proliferation index (determined by flow cytometry), and ploidy, as well as immunohistochemical staining for HMB-45 and S-100 antigens. Staining, often focal, for c-myc was found in both the nucleus and the cytoplasm of a proportion of the cells in most tumours studied. Total cell staining for myc protein correlated with proliferative index in diploid tumours; seven out of nine aneuploid and mixed aneuploid/diploid cells showed strong staining in at least one cellular compartment. A positive correlation with myc expression was also found for HMB-45 staining, but not for cell type or staining for S-100. The results support the hypothesis that myc protein is involved in cellular proliferation in uveal melanomas and indicate that immunohistochemistry for myc antigen may be a useful prognostic marker in these tumours.