BACKGROUND: Ice hockey is an international sport. Injuries occur in a full body fashion, to a number of tissues, commonly through body contact. There is a lack of literature documenting the scope of sports chiropractic practice. Thus, it was the aim to document the type, scope and severity of conditions presenting to, and the treatment provided by, the New Zealand team chiropractor acting as a primary health provider for the duration of the 2007 World Ice Hockey Championships. METHODS: All conditions presenting were recorded. Diagnosis was recorded along with clinical parameters of injury: injury type, severity, mechanism and whether referral or advanced imaging was required. All treatment provided was continuously recorded, including information on the number of treatments required and the reason, duration, type and location of treatment. RESULTS: Players presented for diagnosis of injury 50 times. Muscle (34%), joint (24%) and tendon injuries (18%) were most common. Players presented with a new injury 76% of the time. Most injuries had been present for less than one week (84%), with 53% occurring through a contact mechanism. Injuries were common at training and match locations. Only two injuries required the player to stop playing or training, both of which were referred for advanced imaging. During the study, 134 treatment consultations were rendered to 45 player injuries. Eighty per-cent of injuries were managed with four or less treatments. Three quarters of treatment was provided at training locations with treatment duration predominantly being between 11-15 minutes (71%) and 16-20 minutes (27%). Most treatment delivered was passive in nature (71%) although combination active and passive care was provided (27%). Treatment typically involved joint (81%) and soft tissue based therapies (81%) and was delivered in a full body manner. CONCLUSIONS: This study documented the injury profile of ice hockey at an international level of competition. It documented the conditions presenting to a chiropractor for diagnosis and the treatment provided. Treatment was consistent with that recommended for chiropractic management of athletic injuries. This documentation of sports chiropractic scope of practice fills a void in the literature and assists in determining a role for sports chiropractors as primary health providers or in multidisciplinary sports management teams.

Chiropr Osteopat. 2010 Dec 3;18:32. Julian C, Hoskins W, Vitiello AL. Department of Surgery, Royal Melbourne Hospital, Grattan St, Parkville 3050, Victoria, Australia. waynehoskins@iinet.net.au.

Full Title: Adaptive coping strategies and attitudes toward health and healing in German homeopathy and acupuncture users.

CONTEXT: Although acupuncture and homeopathy both have a theoretical background that refers to immaterial forces difficult to verify, they are nevertheless used and accepted as effective treatments by many individuals. OBJECTIVE: We intended to investigate whether and how users of acupuncture and homeopathy differ with respect to sociodemographic data, adaptive coping strategies, and attitudes toward complementary and alternative medicine (CAM). DESIGN AND PATIENTS: In an anonymous questionnaire survey among 5,830 elderly German health insurants, we identified individuals who used CAM within the last five years. RESULTS: Acupuncture was used by 10% of the population, homeopathy by 7%, and both by 5%. More men than women used acupuncture, whereas homeopathy was used equally by women and men. Acupuncture users had a reduced physical health status compared to homeopathy users. In most cases, it was not a disappointment with conventional medicine that accounted for CAM usage. Stepwise regression analyses revealed that the best predictors of acupuncture and homeopathy usage were the conviction that CAM is more profound and expends more time, fear of the side effects of conventional medicine, and high scores in the measure of search for information and alternative help. Negative predictors were physical health, male gender, age, and trust in a scientific rationale of treatments. CONCLUSION: We found that usage of distinct CAM approaches might depend on particular psychosocial profiles, attitudes, and convictions. In contrast to homeopathy users, acupuncture users seemed to be much more pragmatic and referred more often to an expected scientific background of chosen treatment. Our findings fill a gap of knowledge that needs further attention.

Explore (NY). 2010 Jul-Aug;6(4):237-45. Büssing A, Ostermann T, Raak C, Matthiessen PF. Center for Integrative Medicine, University of Witten/Herdecke, Herdecke, Germany. arndt.buessing@uni-wh.de

Full Title: Biofeedback for training balance and mobility tasks in older populations: a systematic review.

ABSTRACT: Context: An effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity. Objectives: To evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults. Data Sources: PubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists. Study Selection: For evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task. Data Extraction: Rating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated. RESULTS AND CONCLUSIONS: Although most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery. IMPLICATIONS: Further appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.

J Neuroeng Rehabil. 2010 Dec 9;7(1):58. Zijlstra A, Mancini M, Chiari L, Zijlstra W.

Full Title: Human ultraweak photon emission and the yin yang concept of Chinese medicine.

The relationship between connective tissue and meridian function is discussed in terms of energy transmission. The network of hydrogen-bonded water molecules interspersed within the collagen fibrillar matrix is especially significant for both the sensitivity of connective tissue to weak signals of mechanical pressure, heat, or electricity and the electrical intercommunication that may correlate with the meridian acupuncture system. Special electromagnetic properties of connective tissue have similar collective properties of ultraweak photon emission. A relationship between ultraweak photon emission and yin yang dynamics is based on three types of ultraweak photon emission studies, focusing on diurnal and annual dynamics, diseased states, and acupuncture points. A novel concept explains the functional (health) integrity of physiologic systems in relation to the left-right balance in ultraweak photon emission by pointing to, (1) balanced corticoneuromusculoskeletal activities and triboluminescent aspects of ultraweak photon emission by skeletal structures, and (2) local fine-tuning in oxygen supply and the formation of radical oxygen species. This approach offers testable hypotheses for further validation utilizing a combination of human photon recording techniques and specialized metabolomics for the estimation of organ-specific oxidative states.

J Acupunct Meridian Stud. 2010 Dec;3(4):221-31. van Wijk R, van der Greef J, van Wijk E. Meluna Research, Amersfoort, The Netherlands.

FULL TITLE: Effect of Hypnosis on Pain and Blink Reflexes in Patients With Painful Temporomandibular Disorders.

OBJECTIVE: This study contrasted the effect of hypnosis on self-reported pain and changes in a nociceptive brainstem reflex, the blink reflex (BR), in 39 women with temporomandibular disorder. METHODS: The patients were randomized to hypnosis or control (nonhypnotic relaxation). Pain intensity was assessed 3 times daily on a 0 to 10 numerical rating scale. BRs were elicited by electrical stimulation with a nociceptive-specific electrode and recorded before and after treatment at pain threshold (Ip) and supra threshold (2×Ip). RESULTS: Significant reduction of pain intensity was observed in the hypnosis group from 4.5±2.1 at baseline to 2.9±2.4 after treatment (P<0.001). The pain reduction was generally unrelated to changes in the BR, with the exception being a lowered ipsilateral R2 BR component at the right side supra threshold (P=0.034). CONCLUSIONS: Hypnosis thus seems to reduce complex temporomandibular disorder pain, most likely because of cortical changes with little, if any, involvement of brainstem reflex pathways.

Clin J Pain. 2010 Dec 20. Abrahamsen R, Baad-Hansen L, Zachariae R, Svensson P. *Department of Clinical Oral Physiology, School of Dentistry, Aarhus University †Psychooncology Research Unit ‡Department of Oral Maxillofacial Surgery §MindLab, Center for Functionally Integrative Neuroscience (CFIN), Aarhus University Hospital, Aarhus, Denmark.

Full Title: A Randomized Clinical Trial of Acupuncture Versus Oral Steroids for Carpal Tunnel Syndrome: A Long-Term Follow-Up.

We prospectively followed up patients with carpal tunnel syndrome (CTS) in our previous study for 1 year. A total of 77 consecutive patients with electrophysiologically confirmed mild-to-moderate idiopathic CTS were randomized and assigned into 2 treatment arms: 1) 2 weeks of prednisolone 20 mg daily followed by 2 weeks of prednisolone 10 mg daily (n = 39); and 2) acupuncture administered in 8 sessions over 4 weeks (n = 38). In the current study, the patients were further followed up at 7 and 13 months using Global symptom score (GSS) assessments and nerve conduction studies repeated again at 13 months. When comparing with baseline levels, the percentages of patients with treatment failure, moderate improvement, and good improvement were significantly different between the 2 groups at month 7 10.5, 2.6, and 86.8% for the acupuncture group and 33.3, 7.7, and 59% for the steroid group, respectively (P = .014) and month 13 15.8, 2.6, and 81.6% versus 51.3, 0, and 48.7%, respectively (P = .002). The acupuncture group had a significantly better improvement in GSS, distal motor latencies and distal sensory latencies when compared to the steroid group throughout the 1-year follow-up period (P < .01). Furthermore, significant correlation was observed between changes of GSS (month 13-baseline) and all parameters of the electrophysiological assessments except for compound muscle action potential amplitude. PERSPECTIVE: This article demonstrates that short-term acupuncture treatment may result in long-term improvement in mild-to-moderate idiopathic CTS. Acupuncture treatment can be considered as an alternative therapy to other conservative treatments for those who do not opt for early surgical decompression.

J Pain. 2010 Nov 24. Yang CP, Wang NH, Li TC, Hsieh CL, Chang HH, Hwang KL, Ko WS, Chang MH. Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; Department of Nutrition, Huang-Kuang University, Taichung, Taiwan.

Full Title: How do homeopaths reason and make decisions? Integrating theory, practice, and education.

BACKGROUND: Homeopathy is a major modality in complementary and alternative medicine. Significant tensions exist between homeopathic practice and education, evident in the diversity of practice styles and pedagogic models. Utilizing clinical reasoning knowledge in conventional medicine and allied health sciences, this article seeks to identify and critique existing research in this important area. MATERIALS AND METHODS: A literature search utilizing MEDLINE,(®) Allied and Complementary Medicine (AMED), and CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature) was conducted. Key terms including clinical thinking, clinical reasoning, decision-making, homeopathy, and complementary medicine were utilized. A critical appraisal of the evidence was undertaken. RESULTS: Four (4) studies have examined homeopathic clinical reasoning. Two (2) studies sought to measure and quantify homeopathic reasoning. One (1) study proposed a reasoning model, based on pattern recognition, hypothetico-deductive reasoning, intuition, and remedy-matching (PHIR-M), resembling much that has been previously mapped in conventional medical reasoning research. The fourth closely investigated the meaning and use of intuition in homeopathic decision-making. CONCLUSIONS: Taken together, these four studies provide valuable insight into what is currently known about homeopathic clinical reasoning. However, despite the history and breadth of practice, little is known about homeopathic clinical reasoning and decision-making. Building on the research would require viewing clinical reasoning not only as a cognitive phenomenon but also as a situated and interactive one. Further research into homeopathic clinical reasoning is indicated.

J Altern Complement Med. 2010 Dec;16(12):1321-7. Levy D, Ajjawi R, Roberts C. Sydney Medical School, University of Sydney, Sydney, Australia. dlev1147@uni.sydney.edu.au

FULL TITLE: Masseter muscle sonographic features as indices for evaluating efficacy of massage treatment.

OBJECTIVE: The aim of this study was to clarify the sonographic features of the masseter muscle as indices for judging the efficacy of massage treatment. STUDY DESIGN: Fifteen patients with temporomandibular disorder (10 with unilateral and 5 with bilateral muscle pain) underwent massage treatment alternately on the bilateral masseter and temporal muscles with an oral rehabilitation robot. Sonography was performed before and after treatment, and the masseter thickness and existence of anechoic areas were evaluated. RESULTS: The thickness on the symptomatic side in the unilateral group significantly decreased after treatment. Anechoic areas were shown in 20 muscles (66.7%) before treatment, and disappeared or were reduced in size in 17 muscles (85.0%) after treatment. The pretreatment thickness was significantly related to visual analog scale (VAS) scores regarding posttreatment muscle pain and massage impression. The existence of anechoic areas was relevant to VAS scores regarding muscle pain. CONCLUSION: Masseter thickness and existence of anechoic areas might be related to the therapeutic efficacy regarding muscle pain.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Oct;110(4):517-26. Ariji Y, Katsumata A, Hiraiwa Y, Izumi M, Sakuma S, Shimizu M, Kurita K, Ariji E. Department of Oral and Maxillofacial Radiology, Asahi University School of Dentistry, Nagoya, Japan. yoshiko@dpc.agu.ac.jp

FULL TITLE: The efficiency and duration of the analgesic effects of musical therapy on postoperative pain.

OBJECTIVES: The aim of this study was first to find out the effect of music therapy on postoperative analgesia and second to determine the duration of its effect. METHODS: Seventy patients who were undergoing elective cesarean delivery were enrolled. The patients were randomly allocated into two groups as follows: In Group 1, patients listened to music through a headphone for one hour after surgery, while in Group 2, patients did not listen to any music during the same period. In the postanesthesia care unit, patients were connected to a Patient Controlled Analgesia (PCA) device. The PCA device (tramadol 3 mg/ml) was set to deliver a bolus of 20 mg, with a lockout interval of 15 min and 4-hour maximal dose of 150 mg. Postoperative pain was assessed with a visual analog scale (VAS) and consumption of tramadol was recorded at 4, 8, 12, 16, 20 and 24 hours. RESULTS: There was a significant decrease in Group 1 with respect to PCA delivery frequency at the 4th hour postoperatively (p<0.05). Concerning the postoperative tramadol consumption, values measured at the 4th hour were significantly lower in Group 1 (p<0.05). The total amount of tramadol consumption and additional analgesic use in the postoperative 24 hours were again lower in Group 1 when compared with Group 2 (p<0.05). All VAS values were lower in Group 1 when compared with Group 2 (p<0.05). CONCLUSION: We suggest that music therapy given after surgery decreases postoperative pain in the first 24 hours and the analgesic consumption during the first four hours.

Agri. 2010 Oct;22(4):145-50. Sen H, Yanarate? O, S?zlan A, K?l?ç E, Ozkan S, Da?l? G. Department of Anesthesiology and Reanimation, Gülhane Military Medical Academy, Haydarpa?a Training Hospital, ?stanbul, Turkey. drhuseyinsen@hotmail.com

FULL TITLE: Symboldrama, a psychotherapeutic method for adolescents with dissociative and PTSD symptoms: a pilot study.

A total of 15 clinically referred adolescents who had been sexually or physically abused participated in this pilot study of the use of symboldrama psychotherapy. Symboldrama is a psychotherapeutic method that uses imagery as the major psychotherapeutic tool. All adolescents reported to be suffering from a high level of dissociative symptoms and other symptoms such as anxiety, depression, posttraumatic stress, and anger after their traumas. The objective of the study was to test the hypothesis that symboldrama psychotherapy in addition to psycho-education of the non-offending parent would significantly reduce the reported symptoms. Before treatment, the participants answered three questionnaires: (a) the Life Incidence of Traumatic Events Scale, (b) the Trauma Symptom Checklist for Children, and (c) the Dissociation Questionnaire-Swedish version. After treatment, the participants once again filled out the Trauma Symptom Checklist for Children and the Dissociation Questionnaire-Swedish version. The scores from before and after treatment were compared, and the results showed that the symptoms had been statistically significantly reduced.

J Trauma Dissociation. 2010 Jul;11(3):308-21. Nilsson D, Wadsby M. BUP-Elefanten, Department of Child and Adolescent Psychiatry, Linkoping University, Linkoping, Sweden. doris.nilsson@liu.se

Chamomile is one of the most ancient medicinal herbs known to mankind. It is a member of Asteraceae/Compositae family and represented by two common varieties viz. German Chamomile (Chamomilla recutita) and Roman Chamomile (Chamaemelum nobile). The dried flowers of chamomile contain many terpenoids and flavonoids contributing to its medicinal properties. Chamomile preparations are commonly used for many human ailments such as hay fever, inflammation, muscle spasms, menstrual disorders, insomnia, ulcers, wounds, gastrointestinal disorders, rheumatic pain, and hemorrhoids. Essential oils of chamomile are used extensively in cosmetics and aromatherapy. Many different preparations of chamomile have been developed, the most popular of which is in the form of herbal tea consumed more than one million cups per day. In this review we describe the use of chamomile in traditional medicine with regard to evaluating its curative and preventive properties, highlight recent findings for its development as a therapeutic agent promoting human health.

Mol Med Report. 2010 Nov 1;3(6):895-901. Srivastava JK, Shankar E, Gupta S. Department of Urology & Nutrition, Case Western Reserve University, Cleveland, Ohio 44106.

FULL TITLE: Reestablishment of hope as an intervention for a patient with cystic fibrosis awaiting lung transplantation.

Patients with cystic fibrosis (CF) experience a progressive deterioration in health leading to a shortened life expectancy with concomitant psychologic challenges that also may require intervention. Approaches to address psychologic dysfunction include insight-oriented therapy, cognitive-behavioral therapy, biofeedback, hypnosis, massage, music therapy, relaxation, and family therapy. Patients who learn to use coping strategies are more likely to adhere to treatment, which helps improve both their physical and psychologic well-being. Unique stressors arise for patients awaiting lung transplant as a result of their advanced state of disease along with their fear of death before donor lungs become available. This case report demonstrates some of the psychologic struggles faced by a 10-year-old with CF as he awaited lung transplantation, which led to a loss of hope and his request for withdrawal of care. Encouraging of the patient to express how his life might be improved yielded changes in his management that restored his hopefulness, and allowed him to survive long enough to undergo successful lung transplantation. Thus, reestablishment of hope might be studied as an additional intervention to help improve the well-being of patients who are seriously ill.

J Altern Complement Med. 2010 Sep;16(9):1007-10. Anbar RD, Murthy VV. Department of Pediatrics, State University of New York Upstate Medical University, Syracuse, NY, USA. Anbarr@upstate.edu

FULL TITLE: Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners.

The aim of this study was to assess the levels of flexibility, functional autonomy and QoL in elderly yoga practitioners. The subjects were divided into a yoga group (YG; n=52; age=66.79±3.30 years; BMI=24.77±3.18) and control group (CG; n=31; age=69.33±4.84 years; BMI=24.32±3.71) and submitted to flexibility tests through goniometry, the LADEG autonomy protocol and QoL, using the WHOQOL-Old questionnaire. Repeated measures ANOVA showed increases in articular range of motion in shoulder abduction (?%SA=14.11%; p=0.0001), horizontal shoulder extension (?%HSE=33.90%; p=0.0001), lumbar spine flexion (?%LSF=50.74%; p=0.0001), hip flexion (?%HF=35.75%; p=0.0001), hip extension (?%HE=10.93%; p=0.021) and knee flexion (?%KF=3.90%; p=0.001) and in the GDLAM autonomy index (?%AI=-13.67%; p=0.0001) in the YG compared to the CG. The Mann-Whitney test revealed increases in QoL scores in Facet 1 (?%Fac1=9.04%; p=0.043), Facet 5 (?%Fac5=51.06%; p=0.0001) and in overall QoL (?%OqoL=8.13%; p=0.046) in the YG compared to the CG. The remaining variables showed no significant intergroup modifications. Thus, the study suggests that the regular practice of yoga may lead to improved range of motion in the performance of activities of daily living in elderly women.

Arch Gerontol Geriatr. 2010 Dec 15. Gonçalves LC, Vale RG, Barata NJ, Varejão RV, Dantas EH. Laboratory of Human Motricity Biosciences (LABIMH), Castelo Branco University (UCB), Av. Salvador Allende, n. 6700, Recreio do Bandeirantes, Rio de Janeiro, RJ, CEP 22780-160, Brazil.

Infant massage was first introduced in China in 2nd century BC. Massaging the newborn has been a tradition in India and other Asian countries since time immemorial. Various oil-based preparations have been used depending on the regional availability. There has been a recent surge in this ancient art particularly as a therapy among parents and professionals in the Western world. Evidence exists supporting the benefits of touch and massage therapy. We reviewed the literature to look at the various techniques of providing massage, its benefits, possible mechanism of action and adverse effects. The review suggests that massage has several positive effects in terms of weight gain, better sleep-wake pattern, enhanced neuromotor development, better emotional bonding, reduced rates of nosocomial infection and thereby, reduced mortality in the hospitalized patients. Many studies have described the technique and frequency of this procedure. Massage was found to be more useful when some kind of lubricant oil was used. Harmful effects like physical injury and increased risk of infection were encountered when performed inappropriately. The review also discusses the different hypotheses put forward regarding the mechanism of action. As of now there are very few studies describing the long term impact of neonatal massage.

Indian Pediatr. 2010 Sep;47(9):771-6. Kulkarni A, Kaushik JS, Gupta P, Sharma H, Agrawal RK. Division of Neonatology, Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi, India.

BACKGROUND: Mechanical ventilation often causes major distress and anxiety in patients. Music interventions have been used to reduce anxiety and distress and improve physiological functioning in medical patients; however its efficacy for mechanically ventilated patients needs to be evaluated. OBJECTIVES: To examine the effects of music interventions with standard care versus standard care alone on anxiety and physiological responses in mechanically ventilated patients. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE, CINAHL, AMED, EMBASE, PsycINFO, LILACS, Science Citation Index, www.musictherapyworld.net, CAIRSS for Music, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the National Research Register, and NIH CRISP (all to January 2010). We handsearched music therapy journals and reference lists and contacted relevant experts to identify unpublished manuscripts. There was no language restriction. SELECTION CRITERIA: We included all randomized and quasi-randomized controlled trials that compared music interventions and standard care with standard care alone for mechanically ventilated patients. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data and assessed the methodological quality. Additional information was sought from the trial researchers, when necessary. Results were presented using mean differences for outcomes measured by the same scale and standardized mean differences for outcomes measured by different scales. Post-test scores were used. In cases of significant baseline difference, we used change scores. MAIN RESULTS: We included eight trials (213 participants). Music listening was the main intervention used, and seven of the studies did not include a trained music therapist. Results indicated that music listening may be beneficial for anxiety reduction in mechanically ventilated patients; however, these results need to be interpreted with caution due to the small sample size. Findings indicated that listening to music consistently reduced heart rate and respiratory rate, suggesting a relaxation response. No strong evidence was found for blood pressure reduction.Music listening did not improve oxygen saturation level.No studies could be found that examined the effects of music interventions on quality of life, patient satisfaction, post-discharge outcomes, mortality, or cost-effectiveness. AUTHORS' CONCLUSIONS: Music listening may have a beneficial effect on heart rate, respiratory rate, and anxiety in mechanically ventilated patients. However, the quality of the evidence is not strong. Most studies examined the effects of listening to pre-recorded music. More research is needed on the effects of music offered by a trained music therapist.

Cochrane Database Syst Rev. 2010 Dec 8;12:CD006902. Bradt J, Dileo C, Grocke D. The Arts and Quality of Life Research Center, Boyer College of Music and Dance, Temple University, 2001 N 13 Street, Philadelphia, PA, USA, 19122.

FULL TITLE: The chiropractic care of children with "growing pains": A case series and systematic review of the literature.

OBJECTIVE: To describe the successful chiropractic care of two pediatric patients with complaints of "growing pain." CLINICAL FEATURES: A 2¾-yr-old female and 3½-yr-old male were presented by their mothers with complaints of "growing pains" that awakened both patients at night. The girl's problem began 3 months prior to care with awakening due to leg pain at 1-2 nights weekly in the first month and progressed to 5-6 nights per week in the month prior to presentation. The boy's growing pain was of "several months" duration that awakened the patient 2-3 nights per week. The parents of both children denied trauma or an "organic" cause to their children's pain complaints. Spinal segmental dysfunctions were noted in both patients at the lumbosacral spine. INTERVENTION AND OUTCOME: Spinal manipulative therapy (SMT) characterized as high velocity, low amplitude thrusts to sites of segmental dysfunction was rendered to both patients. Following a trial of care (i.e., 3 visits scheduled over a 3-week period and 4 visits over a period of 14 weeks), the patient's symptoms resolved and were released from care. CONCLUSION: This case series provides support on the effectiveness of chiropractic SMT for children with complaints of "growing pain." We support further research in the care of similar patients.

Complement Ther Clin Pract. 2011 Feb;17(1):28-32. Alcantara J, Davis J. International Chiropractic Pediatric Association, 327N Middletown Rd, Media, PA 19063, USA.

Female sexual pain disorders are prevalent and have a deleterious effect on women's well-being. Because there are psychological elements to this pain, cognitive-behavioral therapy (CBT) may be a viable treatment alternative, particularly when compared to more physically invasive treatments such as surgery or medication. This article provides a critical analysis of research studies in this area by evaluating each study in detail, identifying gaps in the research base, and providing directions for future study. For the most part, all of the studies reviewed in this article found CBT to be effective. However, CBT modalities with minimal therapist direction or interaction were found to be problematic. In addition, there may be other noninvasive treatment types that are equally or more effective, such as biofeedback or supportive psychotherapy.

J Sex Res. 2010 Dec 22:1-7. Lofrisco BM. Psychological and Social Foundations, University of South Florida.

Full Title: Meridian electrical potential response to acupuncture stimulation between operator and subject.

The human body has a symmetric structure and maintains a physiological balance through the harmony of yin and yang. One of the fundamental principles of acupuncture is that unbalanced or abnormal bioenergetic conditions on the left and right meridians may be restored to a balanced, normal condition by acupuncture therapy. In this study, the electrical potential along the stomach meridian was measured to investigate the bioenergy consensus between the operator and subject during acupuncture stimulation, and the acupuncture response on opposite meridians was investigated by comparing the electric potential on the left and right stomach meridian during stimulation of the left side stomach meridian-36. When meridian electrical potential was simultaneously measured in both the operator and subject, opposite polarities were observed, which might indicate the transfer of bioenergy between operator and subject. In addition, the meridian electrical potentials of the subjects' left and right stomach meridians were also always of opposite polarity and presented three different signal patterns, which might have represented the condition of the associated meridian.

J Acupunct Meridian Stud. 2010 Dec;3(4):249-54. Lee Y, Kim S, Son T, Kang D, Jung B. Department of Biomedical Engineering, Yonsei University, Wonju, Korea; Institute of Medical Engineering, Yonsei University, Wonju, Korea.

In breast cancer patients, menopausal symptoms such as hot flashes, urogenital problems, musculoskeletal symptoms and cognitive dysfunction are common, regardless of age at diagnosis. They affect quality of life and systemic therapy will worsen this. Endocrine and/or chemotherapy may induce temporary or permanent ovarian failure and can exacerbate these symptoms. Hormone therapy (HT) has been studied in breast cancer survivors, but safety has been questioned. The HABITS trial investigating estrogen-based HT, as well as the LIBERATE trial investigating tibolone, found a reduction in disease-free survival for those treated. Alternative strategies are needed, as menopause symptoms may reduce compliance with breast cancer treatments. This article reviews recently published strategies to tackle menopausal problems in breast cancer patients. Antidepressants may help with hot flashes. Acupuncture and hypnosis can also be used but the evidence is conflicting. For urogenital problems vaginal moisturizers or topical estrogens can be employed. A musculoskeletal syndrome induced by aromatase inhibitors (AIs) is frequently encountered and currently there are no effective treatment strategies. Bisphosphonates reduce AI-induced bone resorption and can also increase disease-free and overall survival. Standard-dose endocrine and chemotherapy are associated with a decline in cognitive function.

Maturitas. 2010 Dec 22. Loibl S, Lintermans A, Dieudonné AS, Neven P. German Breast Group, GBG Forschungs GmbH, Martin-Behaim-Str. 12, 63263 Neu-Isenburg, Germany.

Acupuncture, the insertion of sterile needles into acupuncture points of traditional meridians on the body, is a common and effective treatment for a number of supportive care issues in oncology including acute chemotherapy-induced nausea and vomiting. In the Integrative Oncology setting, acupuncture and Traditional Oriental Medicine have become more visible and many oncology clinics, academic health centers and comprehensive cancer centers recommend and administer acupuncture treatment. Continued basic studies on the physiologic mechanisms of acupuncture and recent clinical trials of acupuncture for cancer patients are enhancing our knowledge and informing our guidelines. While debates on methodological problems confronting the study of acupuncture remain, the most recent research demonstrates that acupuncture is safe, tolerable and effective for a range of side effects resulting from conventional cancer treatments.

Curr Treat Options Oncol. 2010 Dec;11(3-4):87-94. Capodice JL. Department of Urology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 11th Floor, New York, New York, USA. jc2346@columbia.edu

Full Title: A review of three simple plant models and corresponding statistical tools for basic research in homeopathy.

In this paper, we review three simple plant models (wheat seed germination, wheat seedling growth, and infected tobacco plants) that we set up during a series of experiments carried out from 1991 to 2009 in order to study the effects of homeopathic treatments. We will also describe the set of statistical tools applied in the different models. The homeopathic treatment used in our experiments was arsenic trioxide (As2O3) diluted in a decimal scale and dynamized. Since the most significant results were achieved with the 45th decimal potency, both for As2O3 (As 45x) and water (W 45x), we here report a brief summary of these results. The statistical analysis was performed by using parametric and nonparametric tests, and Poisson distribution had an essential role when dealing with germination experiments. Finally, we will describe some results related to the changes in variability, which seems to be one of the targets of homeopathic treatment effect.

ScientificWorldJournal. 2010 Dec 14;10:2330-47. Betti L, Trebbi G, Zurla M, Nani D, Peruzzi M, Brizzi M.

FULL TITLE: Caring for overseas liver transplant recipients: taiwan primary family caregivers' experiences in mainland china.

INTRODUCTION: This study explores the motivations of overseas liver transplant recipient (OLTR) families of Taiwanese OLTR who undergo the procedure in mainland China. We report the waiting time to receive the transplant in mainland China as well as the rational and service. PATIENTS AND METHODS: This exploratory qualitative method reflects guided face-to-face, semistructured interviews with families members of OLTRs. Data were subjected to content analysis. RESULTS: We interviewed 19 OLTR family members (15 females and 4 males who were between 29 and 71 years of age; mean 55.1 years) regarding 19 patients who had (17 males and 2 females who were between 36 and 71 years of age, mean, 54.6 years). The OLTR underwent transplantation in three cities in mainland China: Tianjin, Shanghai, and Guangzhou. After arrival the average waiting time was 33.1 days. Subjects reported the following reasons to help patients undergo the procedure in mainland China: (1) it is difficult to have the procedure in Taiwan; (2) the desire to extend life; and ((3)) there is no domestic living donor. Seven reasons for serving as OLTR supportive family members were identified: (1) The role and obligation in the marital relationship; (2) a close bloodline relationship; (3) insufficient manpower; (4) an individual's availability; (5) evasion of responsibility by other family members; (6) compensation for inadequate caring efforts earlier in life; and (7) an unwillingness to disturb other relatives' lives. Finally, the following support for the OLTR was reported: providing company during medical treatment/doctor visits, food preparation, massage, daily assistance, medical care, and psychological support. CONCLUSIONS: Taiwanese OLTR family members' perspectives throughout the transplant process may provide better understanding of living experiences and concerns during the stages of overseas liver transplantation.

Transplant Proc. 2010 Dec;42(10):3921-3. Chen HM, Shih FJ, Chang CL, Lai IH, Shih FJ, Hu RH. Institute of Clinical and Community Health Nursing, National Yang-Ming University Taipei, Taiwan; Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan.

FULL TITLE: Impact of a lecture about empirical bases of hypnosis on beliefs and attitudes toward hypnosis among Cuban health professionals.

The aim of this study was to examine whether a lecture on hypnosis can modify attitudes and misconceptions about hypnosis. The sample consisted of 97 health professionals from institutions in Havana City, Cuba. Group 1 consisted of 46 participants who received a lecture on hypnosis. Group 2 consisted of 51 participants who received a lecture about urology. and Beliefs toward Hypnosis-Therapist was applied before and after the lecture. Results indicated that there were significant differences between the groups: Group 1 showed more positive attitudes toward hypnosis. However, both groups showed similar misconceptions about hypnosis and memory, which changed significantly in Group 1 after receiving the lecture about hypnosis but not in Group 2. Therefore, the lecture about hypnosis had a significant impact in correcting participants' misconceptions about memory and hypnosis.

Int J Clin Exp Hypn. 2010 Oct;58(4):476-96. Martín M, Capafons A, Espejo B, Mendoza ME, Guerra M, Enríquez Santos JA, Díaz-Purón S, Guirado IG, Castilla CD. University of Havana, Cuba.

FULL TITLE: Treatment of music performance anxiety via psychological approaches: a review of selected CBT and psychodynamic literature.

Performance anxiety, or stage fright, is anxiety aroused about potential mishaps in performance that expose feared inadequacies before an audience and which evoke feelings of embarrassment and humiliation. For affected musicians, performance anxiety can be emotionally devastating, as their career choice in music may be terminated or severely compromised. This paper focuses on the cognitive and psychodynamic literature about music performance anxiety, with the emphasis that for treatment "one size does not fit all." It reviews the factors underlying performance anxiety and those factors which can exacerbate the condition in musicians. The two major clinical treatment modalities within contemporary psychology, cognitive behavior therapy (CBT) and psychodynamic treatments, are reviewed. While there are more empirical studies of CBT in various populations in the literature, until recently there was an indifference to empirical research by psychodynamic investigators. However, meta-analyses show strong efficacy for psychodynamic psychotherapy (in various disorders, not specifically music performance anxiety), but also that the benefits of psychodynamic psychotherapy may endure longer and increase with time.

Med Probl Perform Art. 2010 Dec;25(4):141-8. Nagel JJ. 400 Maynard St., Ste. 706, Ann Arbor, MI 48104, USA. Tel 734-761-4764. jjnagel@comcast.net.

AIM: The primary aim was to study the effect of naturopathy and yoga interventions in treatment of mild to moderate hypertension. DESIGN: The variables of interest were measured at the beginning and end of the intervention using a pre-post design. SETTING: The study was conducted by INYS medical research society in Jindal Nature Cure Institute, Bangalore. SUBJECTS: A total of 104 subjects, already diagnosed with mild to moderate hypertension and on treatment with antihypertensive medicines were included in study. INTERVENTIONS: The intervention consisted of various inpatient administration of different naturopathy treatments, yoga therapies, low calorie and low sodium diet for 21 days. Antihypertensive medicines were withdrawn for some patients in one week based upon response to the treatment. OUTCOME MEASURES: The outcome measures were values of diastolic and systolic blood pressure and body weight. Subjects were followed for a period of one year after every 3 months. RESULTS: After starting nonpharmacological approach of naturopathy and yoga, Systolic blood pressure came down from mean of 139.6 to 129.6 where as it came down from 91.2 to 86.1 for diastolic blood pressure. At the same time favorable effect was also seen in other variables like lipid profile and body weight. At the end of one year out of 57 patients who came for follow-up, 14 cases were found to have blood pressure within normal ranges without any medication over the previous 12 months. CONCLUSION: Naturopathy and yoga therapy can be considered as a valuable nonpharmacoloical approach in treatment of hypertension.

Complement Ther Clin Pract. 2011 Feb;17(1):9-12. Murthy SN, Rao NS, Nandkumar B, Kadam A. INYS Medical Research Society, Jindal Naturecure Institute, Jindal Nagar, Bangalore 560073, India.

BACKGROUND: Most postoperative patients have unrelieved pain despite the use of patient-controlled analgesia. Nurses need additional effective modalities. Relaxation and music (RM), in addition to analgesics, have been shown to reduce pain more than do analgesics alone. OBJECTIVES: The objectives of the study were to test an intervention of patient teaching for pain management (PT) and compare it with RM for immediate and general effects on postoperative pain. METHODS: Patients having abdominal surgery and receiving patient-controlled analgesia aged 18-75 years (n = 517) were randomized to four groups: PT, RM, a combination (PTRM), and a control. A 2 x 2 factorial design was used to assess PT-Effects and RM-Effects. Immediate effects on pain were measured on visual analogue sensation and distress scales before and after five 20-min tests in the first 2 days. Because participants also listened independently, general nonimmediate effects were examined at eight other times. RESULTS: Using multivariate analysis of covariance with contrasts and pretest control, immediate RM-Effects on pain were found at Day 1 a.m. (p < .001), Day 1 p.m. (p = .04), and Day 2 a.m. (p = .04). No PT-Effects or nonimmediate RM-Effects were found. DISCUSSION: Patient teaching did not result in less pain and did not support the theoretical proposition that PT reduces pain. However, the immediate RM-Effects supported the proposition that nonpharmacological adjuvants to analgesics can ease pain without adding side effects.

Nurs Res. 2010 Jul-Aug;59(4):259-69. Good M, Albert JM, Anderson GC, Wotman S, Cong X, Lane D, Ahn S. Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio 44106-4904, USA. mpg@case.edu

Full Title: Effects of aromatherapy on changes in the autonomic nervous system, aortic pulse wave velocity and aortic augmentation index in patients with essential hypertension.

PURPOSE: To investigate the effectiveness of aromatherapy on blood pressure, heart rate variability, aortic pulse wave velocity and the aortic augmentation index of essential hypertensive patients. METHODS: Using a coin toss, 22 participants were assigned to the experimental group and 20 to the control. The experimental group was given a blend of oils of lemon (Citrus limonum), lavender (Lavandula angustifolia), and ylang ylang (Cananga odorata) which were prepared in the ratio of 2:2:1, respectively. The control group was given an artificial lemon fragrance of Limonene (35 cc) and Citral (15 cc) mixture. The experiment, inhalation, was conducted for 3 weeks (2 min per inhalation, 2 times per day) to both groups. RESULTS: There was a noticeable difference in systolic blood pressure between the groups (p=.001), however the difference in diastolic blood pressure between the two groups was not significant. There was a notable difference in sympathetic nerve system activity of heart rate variability (p=.047). However, the differences in aortic pulse wave velocity or the aortic augmentation index were not significant. CONCLUSION: Aromatherapy is effective in lowering systolic blood pressure and sympathetic nerve system activity.

J Korean Acad Nurs. 2010 Oct;40(5):705-13. [Article in Korean] Cha JH, Lee SH, Yoo YS. Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.

This study examined whether the behavioral and electrophysiological correlates of synaesthetic response conflict could be disrupted by posthypnotic suggestion. We recorded event-related brain potentials while a highly suggestible face-color synaesthete and matched controls viewed congruently and incongruently colored faces in a color-naming task. The synaesthete, but not the controls, displayed slower response times, and greater P1 and sustained N400 ERP components over frontal-midline electrodes for incongruent than congruent faces. The behavioral and N400 markers of response conflict, but not the P1, were abolished following a posthypnotic suggestion for the termination of the participant's synaesthesia and reinstated following the cancellation of the suggestion. These findings demonstrate that the conscious experience of synaesthesia can be temporarily abolished by cognitive control.

Neuropsychologia. 2010 Sep;48(11):3360-4. Epub 2010 Jul 17. Terhune DB, Cardeña E, Lindgren M. Department of Psychology, Lund University, Lund, Sweden. devin.terhune@psychology.lu.se

Music permeates the medical literature regarding disease therapy. However, there are only few articles concerning music as a tool for development of cultural competency and interpersonal relations. We share our experience of forming a musical act of students and faculty at a medical school. We believe that this group has encouraged medical humanism and enhanced communication in the learning environment.

Med Teach. 2011;33(1):76-7. Ortega RA, Andreoli MT, Chima RS. Boston University School of Medicine, USA.

FULL TITLE: Comparison of conventional therapies for dentin hypersensitivity versus medical hypnosis.

This study compared the efficacy of conventional treatments for dentin hypersensitivity (DHS) and hypnotherapy. During a 1-month period at an urban practice in a service area of approximately 22,000 inhabitants, all patients were examined. A total of 102 individuals were included in the evaluation. Values of 186 teeth were analyzed. The comparison of the different treatment methods (desensitizer, fluoridation, and hypnotherapy) did not show significant differences in success rates. However, a noticeable difference was observed in terms of onset and duration of effect. For both desensitizer and hypnotherapy treatments, onset of effect was very rapid. Compared to the other methods studied, hypnotherapy effects had the longest duration. In conclusion, hypnotherapy was as effective as other methods in the treatment of DHS.

Int J Clin Exp Hypn. 2010 Oct;58(4):457-75. Eitner S, Bittner C, Wichmann M, Nickenig HJ, Sokol B. Department of Prosthodontics,Friedrich-Alexander University, Erlangen Nuremberg, Erlangen, Germany. stephan.eitner@uk-erlangen.de

FULL TITLE: Thinking through the body: the conceptualization of yoga as therapy for individuals with eating disorders.

Yoga has historically been viewed as a discipline that increases self-awareness through body based practices, meditation, self-study, and the reading of philosophical texts. In the 21st century the mindfulness techniques of yoga have been adapted as an adjunct to the treatment of individuals with eating disorders. In an effort to understand the conceptualization of yoga as therapy for individuals with eating disorders, this article juxtaposes how mindfulness based yoga is regarded in three disciplines: sociology, neuroscience, and the "spiritual texts" of yoga.

Eat Disord. 2011 Jan;19(1):83-96. Douglass L. Interdisciplinary Educational Studies Program, Lesley University, Cambridge, Massachusetts, USA.

ABSTRACT: BACKGROUND: Longitudinal patterns of chiropractic use in the United States, particularly among Medicare beneficiaries, are not well documented. Using a nationally representative sample of older Medicare beneficiaries we describe the use of chiropractic over fifteen years, and classify chiropractic users by annual visit volume. We assess the characteristics that are associated with chiropractic use versus nonuse, as well as between different levels of use. METHODS: We analyzed data from two linked sources: the baseline (1993-1994) interview responses of 5,510 self-respondents in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD), and their Medicare claims from 1993 to 2007. Binomial logistic regression was used to identify factors associated with chiropractic use versus nonuse, and conditional upon use, to identify factors associated with high volume relative to lower volume use. RESULTS: There were 806 users of chiropractic in the AHEAD sample yielding a full period prevalence for 1993-2007 of 14.6%. Average annual prevalence between 1993 and 2007 was 4.8% with a range from 4.1% to 5.4%. Approximately 42% of the users consumed chiropractic services only in a single calendar year while 38% used chiropractic in three or more calendar years. Chiropractic users were more likely to be women, white, overweight, have pain, have multiple comorbid conditions, better self-rated health, access to transportation, higher physician utilization levels, live in the Midwest, and live in an area with fewer physicians per capita. Among chiropractic users, 16% had at least one year in which they exceeded Medicare's "soft cap" of 12 visits per calendar year. These over-the-cap users were more likely to have arthritis and mobility limitations, but were less likely to have a high school education. Additionally, these over-the-cap individuals accounted for 58% of total chiropractic claim volume. High volume users saw chiropractors the most among all types of providers, even more than family practice and internal medicine combined. CONCLUSION: There is substantial heterogeneity in the patterns of use of chiropractic services among older adults. In spite of the variability of use patterns, however, there are not many characteristics that distinguish high volume users from lower volume users. While high volume users accounted for a significant portion of claims, the enforcement of a hard cap on annual visits by Medicare would not significantly decrease overall claim volume. Further research to understand the factors causing high volume chiropractic utilization among older Americans is warranted to discern between patterns of "need" and patterns of "health maintenance".

Chiropr Osteopat. 2010 Dec 21;18(1):34. Weigel P, Hockenberry JM, Bentler SE, Obrizan M, Kaskie B, Jones MP, Ohsfeldt RL, Rosenthal GE, Wallace RB, Wolinsky FD.

Full Title: Breaking the cycle: Cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome.

The present article presents a case of cognitive behavioral therapy (CBT) along with heart rate variability (HRV) biofeedback training for the treatment of a medication unresponsive 13-year-old boy with cyclic vomiting syndrome (CVS). CVS is characterized by recurring stereotypic episodes of vomiting, interspersed with asymptomatic periods. Triggers for vomiting include anticipatory anxiety related to school examinations, family conflicts, and birthday parties as well as infectious diseases, and certain foods. Current treatment design addressed two pivotal etiological factors: autonomic dysregulation and anticipatory anxiety. Treatment outcome suggests that vomiting episodes may be successfully prevented by aiding the patient to identify and manage precipitant psychological stressors, to regulate HRV patterns, and gain a renewed sense of bodily control and self-efficacy. Further research is suggested using a controlled study with pre- and post-behavioral and stress measures to evaluate the effectiveness of CBT and biofeedback training compared to pharmacotherapy and placebo.

Psychol Health Med. 2010 Dec;15(6):625-31. Slutsker B, Konichezky A, Gothelf D. Psychosomatic Unit, Department of Child Psychiatry, Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petah Tiqwa.

Even in the palliative context complementary therapy has a high value for patients and their relatives. In contrast to the methods of conventional medicine naturopathy as a holistic system has positive meanings for patients and their family. Complementary medicine in the palliative setting can be used as a supportive therapy in carefully selected cases. Doctors and patients should be careful regarding effect and side effects and should make sure that supportive therapy is given adequately and in effective doses. Complementary therapy should not be used in order to avoid the question of life and death. An adequate approach to the topic is mandatory, which acknowledges the needs of patients but also looks for their safety. Patients following alternative therapies sometimes neglect helpful therapeutic options. Carefully providing information on these therapies is mandatory. Physicians should avoid losing patients' confidence in their competence and attention in their final course of disease. Also in palliative medicine a sensitive approach to the topic of complementary medicine is mandatory, which accounts for the eligible wishes of patients and their relatives but puts the patients safety first.

Internist (Berl). 2010 Dec 24. [Article in German] Hübner J, Stoll C. Palliativmedizin, supportive und komplementäre Onkologie, Universitäres Centrum für Tumorerkrankungen, Klinikum der J.W. Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60595, Frankfurt am Main, Deutschland, Jutta.Huebner@kgu.de.

Full Title: Acupuncture for treating temporomandibular disorder: retrospective study on safety and efficacy.

This study aimed to retrospectively examine the efficacy and safety of acupuncture for the relief of pain originating from temporomandibular joint disorder and trigeminal neuralgia. Participants included patients suffering from trigeminal neuralgia or temporomandibular disorder with osseous pathology ruled out by panoramic X-rays. Participants received a series of 8-10 weekly acupuncture treatments and rated their pain via a visual analogue scale. From assessment of a total of 39 patients, analysis of pain severity before and after treatment showed that acupuncture intervention was highly beneficial for patients with temporomandibular joint disorder (88.6%, p < 0.01), compared with patients with trigeminal neuralgia in which there was only a minor effect (25%). The data also demonstrated that acupuncture was both efficacious in acute patients (91%, p < 0.01) and chronic patients (70%, p < 0.05) and elicited no side effects during the course of treatment. Acupuncture treatment was a safe and efficient methodology for relieving the pain of patients suffering from temporomandibular disorder with no detectable osseous joint component. Based on these results, a randomized clinical trial is being initiated at the Stomatologic Clinic at the Tel Aviv Sourasky Medical Center to assess the role of acupuncture in treating temporomandibular joint disorder.

J Acupunct Meridian Stud. 2010 Dec;3(4):260-6. Noiman M, Garty A, Maimon Y, Miller U, Lev-Ari S. Unit of Complementary and Integrative Medicine, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.