Daith piercing is a special ear-piercing method that punctures the crus of the helix. The penetrated site at the ear's innermost point is assumed to stimulate a pressure point associated with the ...vagus nerve. It has been reported that the pierced spot relieves migraine and tension-type headaches by activating vagal afferents, leading to the inhibition of neurons in the caudal trigeminal nucleus via the nucleus tractus solitarii.
The objective of this narrative literature review is to summarize the current state of knowledge concerning daith piercing for the treatment of migraine and tension-type headaches from the perspectives of the Chinese and Western auricular systems.
PubMed and China National Knowledge Infrastructure databases were searched using the keywords "daith piercing," "auricular points," "headache," and "acupuncture" from database inception to September 1, 2023. Only studies on humans were eligible; otherwise, no further restrictions were applied to the study designs, type of headache, or patient population of the identified articles. Bibliographies of all eligible studies were screened for further eligible studies. The main outcome of interest was a quantitative measure of pain relief by daith piercing. Secondary outcomes were relapse time of headache and further outcomes related to daith piercing, if available.
From a total of 186 identified articles, one retrospective study and three case reports fulfilled the inclusion criteria. No clinical trial was identified. The obtained studies describe patients experiencing chronic headaches undergoing daith piercing without changing or reducing their usual medication. In all case studies and the retrospective study, patients reported substantial reductions in pain immediately after daith piercing; however, headache symptoms recurred several weeks to months thereafter. From the perspective of the Chinese and Western auricular systems, no sufficient explanation for the described treatment effect of daith piercing was found.
The available literature, combined with the reported recurrence of pain as well as the associated side effects of daith piercing, indicate that current evidence does not support daith piercing for the treatment of migraine, tension-type headaches, or other headache disorders.
This paper summarizes what we know about Daith piercing (DP) for chronic migraine and tension-type headache and discusses how DP might work. Current evidence does not support DP as an effective treatment of chronic migraine and tension-type headache. These findings might assist clinicians in discussing this subject with patients as well as guide future research.
Chassis dynamometer emissions testing of 11 heavy-duty goods movement vehicles, including diesel, natural gas, and dual-fuel technology, compliant with US-EPA 2010 emissions standard were conducted. ...Results of the study show that three-way catalyst (TWC) equipped stoichiometric natural gas vehicles emit 96% lower NOx emissions as compared to selective catalytic reduction (SCR) equipped diesel vehicles. Characteristics of drayage truck vocation, represented by the near-dock and local drayage driving cycles, were linked to high NOx emissions from diesel vehicles equipped with a SCR. Exhaust gas temperatures below 250 °C, for more than 95% duration of the local and near-dock driving cycles, resulted in minimal SCR activity. The low percentage of activity SCR over the local and near-dock cycles contributed to a brake-specific NOx emissions that were 5–7 times higher than in-use certification limit. The study also illustrated the differences between emissions rate measured from chassis dynamometer testing and prediction from the EMFAC model. The results of the study emphasize the need for model inputs relative to SCR performance as a function of driving cycle and engine operation characteristics.
This paper has given a fresh approach of hybridization of invasive weed optimization (IWO) with improved particle swarm optimization (IPSO) to obtain the optimal path for each robot in multi-robots ...system in a non-stationary environment. The main emphasis of the algorithm is to lessen the path length and time taken by all robots to arrive at the respective destined target in the cluttered environment. Each robot takes independent decisions of their own to evaluate the next positions from their current position in the global map using proposed hybrid IWO-IPSO. The proposed approach embedded the spatial dispersion method of IWO with motion mechanism of IPSO called IWO-IPSO. The main aim of the hybridization is to maintain a good balance between intensification and diversification and avoid local minima value because of adopting co-evolutionary techniques to update the velocity and particle positions with IPSO simultaneously. The effectiveness of the algorithm has been validated through simulation and real platform. Finally, the experimental and simulation results of IWO-IPSO for multi-robot path planning are weighed against with results obtained by IPSO, IWO in a analogous environment to make sure the integrity of the algorithm is maintained. The results obtained from simulation on top of Khepera environment justifies that, the proposed IWO-IPSO performs superiorly than IPSO and IWO with respect to arrival time, energy utilization during travel of path, optimal path length and deviation of path.
Ibuprofen is a poorly soluble and poorly compressible drug and is unsuitable for “direct tableting”. Microcrystalline cellulose (Avicel® PH 101) based ibuprofen powder formulations have been comilled ...in presence of Aerosil® (colloidal silicon dioxide) as lubricant, and the total compression behavior was evaluated using the Cooper–Eaton equation. Scanning electron microscopy (SEM) revealed about the damage of crystal geometry of the crystalline drug after comilling. Differential scanning calorimetry (DSC) indicated decrease of melting endotherm (partially) attributing to the decrease in crystalline intensity of ibuprofen upon comilling. Small changes in the infrared spectra such as shift of characteristic bands, reduction in intensity, and appearance of new bands are mainly related to the possible physical interaction and/or amorphization of the drug in the comilled mixtures. Increased compaction can be achieved after milling of the microcrystalline cellulose based blends. Milling decreased particle size and improved wettability of the drug and increased dissolution. Microcrystalline cellulose based comilled ibuprofen powder with improved compression and dissolution may be taken as a future scope of scale up for “direct tableting”.
Background: Multiple sclerosis (MS) is an autoimmune, chronic, inflammatory, demyelinating, and axonal degeneration disease of the central nervous system. Trigeminal neuralgia (TN), a neuropathic ...facial paroxysmal pain, is prevalent among MS patients. Because of the inadequacy of the comprehension of MS-related TN pathophysiological mechanisms, TN remains arduous in its treatment approaches. Acupuncture as a non-pharmacological therapy could be a promising complementary therapy for the treatment of TN. MS gradual neural damage might affect the muscles’ function. This can lead to acute or paroxysmal pain in the form of spasms that might progress to formation of myofascial trigger points also known in traditional Chinese medicine as Ashi points (AP). Localising these AP through palpation and pain sensation feedback in patients with MS is an indicator of disease progression. Pathologically, these points reveal the disharmony of soft tissue and internal organs. Methods: This case report examined the pain relief outcome with Ashi scalp acupuncture (ASA) in a secondary TN patient who was unsuccessfully treated multiple times with body acupuncture. The main outline measure was to quantify pain intensity using a numerical rating scale (NRS) before and after each acupuncture therapy. The patient was treated on the scalp for a total of eight times, twice a week over four weeks. Results: A reduction in secondary TN pain intensity was observed after each session. On average, the patient expressed severe pain (NRS: 8.0 ± 2.20) before ASA treatment, which significantly decreased after therapy to mild pain (NRS: 2.0 ± 1.64). Conclusions: Significant improvements in pain intensity reduction after each acupuncture treatment without any adverse effects were observed.
Emissions were measured from seven heavy-duty (HD) on-road vehicles that were operated along six common route types used for freight transport in California. All vehicles had engines that were ...certified to the 0.01 g/bhp-h particulate matter (PM) and either a 0.2, 0.3, or 2.3 g/bhp-h nitrogen oxide (NOx) standard. Diesel vehicles had low carbon monoxide (CO) and total hydrocarbon (THC) emissions below brake-specific standards, with route averages ranging from 0.24 to 3.35 g CO/mi and from 0.02 to 0.45 g THC/mi. Diesel vehicles equipped with selective catalytic reduction (SCR) had route average NOx emissions ranging from 0.58 to 3.99 g/mi (0.16 to 0.96 g/bhp-h). NOx emissions were less route-dependent for the one vehicle with a 12-L compressed natural gas (CNG) engine and three-way catalyst (TWC), with route averages ranging from 0.16 to 0.46 g/mi (0.06 to 0.13 g/bhp-h). The ranking of certification NOx emissions for the seven engines reported during engine-dynamometer-based certification was not maintained during real-world testing; for example, highway driving NOx emissions were lower than certification values for some engine families and higher than certification values for others. Route-average gravimetric particulate matter (PM) emissions ranged from 4 to 12 mg/mi, which on a brake-specific basis were at least two times below the 0.01 g/bhp-h standard. Ion speciation of PM emissions indicated that the most prevalent species were sulfate (SO
4
2−
) for the model year (MY) 2007 diesel vehicle equipped with a diesel particulate filter (DPF) and no SCR, nitrate (NO
3
−
) for conventional diesel vehicles with a DPF and SCR, and sodium (Na
+
) was the most abundant species for the CNG vehicle. NOx and PM emissions were compared to, and show generally good agreement with, the latest California mobile source model (EMFAC2014).
Chinese herbal medicine is considered relatively safe, inexpensive, and easily accessible. Wen Dan Tang (WDT), a Jing Fang ancient classical Chinese herbal formula with a broad indication profile has ...been used for several centuries in China to treat various illnesses.
Are there evidence-based clinical trials that show that WDT has a significant impact on the treatment of various diseases, especially in patients with migraine and tension-type headaches (TTH)?
This study is based on an online database search using PubMed, Medline, Cochrane Library, AcuTrials, Embase, Semantic Scholar, Jstor, internet research, and review of ancient and modern Chinese medical textbooks regarding WDT and its compounds.
There were no studies on WDT in migraine and TTH; therefore, this work gathers and describes data for every single compound in the formula.
This study suggests that the bioactive compounds found in WDT composition show potential in treating patients with neurological, psychiatric disorders, cardiovascular diseases, metabolic syndrome, and digestive disorders. Some coherence between WDT in headache reduction and improvements in the quality of life in patients with migraines and TTH could be evaluated, showing positive results of WDT in these patients.
Chronic low back pain (CLBP) cannot sufficiently be treated by pharmacological therapy and generates substantial health-care costs worldwide. Acupuncture, a cost-effective, safe and ...non-pharmacological therapy, has shown promising results in relieving acute low back pain; however, the optimal acupuncture therapy for CLBP remains controversial. This study will compare two acupuncture methods for pain relief in CLBP.
This randomized, controlled, single-blind, parallel trial will be conducted in patients with clinically diagnosed CLBP with a disease duration ≥3 months and an average pain intensity of ≥4 points on an 11-point Pain Intensity Numerical Rating Scale (pain-NRS) on the previous 7 days. Patients will be randomized to 9-week acupuncture therapy using Jiu Gong Points (termed Swiss low back acupuncture, SLBA) or standard acupuncture (SA) therapy (weeks 1-6: two sessions/week, weeks 7-9: one session/week, 15 sessions/patient in total). Measurements will be conducted before the first session (T1), at the end of the 9-week therapy (T2) and after 3- and 6-month follow-up (T3 and T4). The primary hypothesis is that 9 weeks of SLBA will be superior in reducing the pain severity assessed by the pain-NRS compared to SA therapy for CLBP. Secondary outcomes will be derived from the Short-Form 36, Oswestry Disability Index, Multidimensional Pain Inventory questionnaire, Symptom Checklist-90 - Revised questionnaire and a daily pain diary. Assuming a minimal clinically important difference in the pain-NRS of 0.39 and an effect size of ≥0.6 between SLBA and SA, 80% power, 0.05 alpha level and 20% dropouts, a total of 55 patients/arm will be required. The primary outcome will be analyzed in the intention-to-treat population using chained linear regression models. Patients, outcome assessors and data analysts will be blinded to the treatment arm.
Clinicaltrials.gov Identifier: NCT05232487.
Older population often have multiple and complex needs that are consequently challenged by the presence of polypharmacy, adverse drug reactions and drug-drug interaction. We aimed to determine home ...medication management practices (MMP) and its associated factors among chronically ill older population of selected districts of Nepal.
A community based cross-sectional survey was conducted among 386 chronically ill older individuals from selected areas of Nepal between April to September 2016. Appropriateness of MMP was assessed through scores of questions using interview method. Multivariate logistic regression analysis using potential variables from bivariate analysis were used to determine factors affecting MMP.
The overall home MMP was mostly inappropriate (80.1%). Most participants had multiple prescribers for single disease (202, 52.3%) and inappropriate medication storage (188, 48.7%). Though the majority of them had drug administration schedule (378, 97.9%), expired medicines were also used (2, 0.5%). Regression analysis showed less than one year duration of disease (odds ratio OR = 3.901, 95% confidence interval CI = 1.528 to 9.959, P = 0.004), 1-2 years duration of disease (OR = 2.415, 95% CI = 1.210 to 4.821, P = 0.012) and smokers (OR = 2.025, 95% CI = 1.036 to 3.956, P = 0.039) as the major factors affecting appropriate home MMP.
The home MMP was associated with duration of disease and smoking status among chronically ill older patients living in selected districts of Nepal. Proper counselling and monitoring of such patients might be necessary to improve the practice.
Objective:
This observational cohort pilot study aimed to evaluate the effects of the acupuncture methods, Jiu Cang Zhen (JCZ) and Huang Guan (HG), on changes in headache intensity in an inpatient, ...multimodal Zurzach Headache Programme (ZHP).
Methods:
Study participants consisted of patients diagnosed with chronic headache disorder (headache ds, 30 days per month) or daily persistent headache. All patients received conventional therapies with active and passive approaches. The patient group was treated with JCZ and HG acupuncture methods, receiving a total of six to eight acupuncture sessions of 50 to 60 minutes each, during a 3–4-week multimodal ZHP at the RehaClinic Bad Zurzach. Pain intensity was quantified using a Numerical Rating Scale (NRS) before and after each acupuncture therapy session.
Results:
Ten patients were recruited, six women and four men, with a mean age of 41.7 (standard deviation, SD =13.9). A reduction in headache intensity was reported by all patients in each of the sessions. The average NRS for pain was 4.21 (SD = 1.44) before acupuncture and 1.24 (SD = 0.93) after acupuncture (means first by number of sessions, then per
n
= 10 patients). This resulted in a mean difference of 2.97 (SD = 1.04), corresponding to a standardized response mean of 2.85 (95% confidence interval: 2.11–3.60, one-tailed P < 0.001), meaning there was a large effect.
Conclusions:
This pilot study shows that JCZ and HG are suitable acupuncture methods for reducing headache intensity in the treatment of headaches. A comparison with the conventional classical acupuncture methods from the acupuncture textbook for traditional Chinese medicine students in China, exploration with a larger patient group, and prolonged monitoring of pain behavior could be foci of follow-up investigations.
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