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- Castelnuovo, Gianluca, et al.
(författare)
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What Is the Role of the Placebo Effect for Pain Relief in Neurorehabilitation? : Clinical Implications From the Italian Consensus Conference on Pain in Neurorehabilitation
- 2018
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Ingår i: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 9
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Forskningsöversikt (refereegranskat)abstract
- Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use.Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form.Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results.Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy.
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| 2. |
- Grisendi, Giulia, et al.
(författare)
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GMP-manufactured density gradient media for optimized mesenchymal stromal/stem cell isolation and expansion
- 2010
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Ingår i: Cytotherapy. - : Elsevier BV. - 1465-3249 .- 1477-2566. ; 12:4, s. 466-477
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AIMS: Bone marrow (BM) mesenchymal stromal/stem cells (MSC) are therapeutic tools in regenerative medicine and oncology. MSC isolation is often performed starting from a separation step based on research-grade 1.077 g/mL density gradient media (DGM). However, MSC clinical application should require the introduction of good manufacturing practice (GMP) reagents. We took advantage of two novel GMP DGM with densities of 1.077 and 1.073 g/mL (Ficoll-Paque PREMIUM and Ficoll-Paque PREMIUM 1.073, respectively) to test whether these reagents could isolate MSC efficiently while simultaneously comparing their performance. METHODS: BM samples were processed using either 1.077 or 1.073 g/mL GMP DGM. BM mononucleated cell (MNC) fractions were analyzed for viability, immunophenotype, clonogenic potential, ex vivo expansion and differentiation potential. RESULTS: No differences were noticed in cell recovery and viability between the groups. Fluorescence-activated cell-sorting (FACS) analyzes on freshly isolated cells indicated that the 1.073 g/mL GMP DGM more efficiently depleted the CD45(+) fraction in comparison with 1.077 GMP DGM. Moreover, in the 1.073 group, fibroblastic colony-forming units (CFU-F) were 1.5 times higher and the final MSC yield 1.8 times increased after four passages. Both reagents isolated MSC with the expected phenotype; however, 1.073-isolated MSC showed a higher expression of CD90, CD146 and GD2. Additionally, MSC from both groups were capable of fully differentiating into bone, adipose cells and cartilage. CONCLUSIONS: Both GMP DGM enriched MSC from BM samples, suggesting that these reagents would be suitable for clinical-grade expansions. In addition, the density of 1.073 g/mL provides a significant advantage over 1.077 g/mL GMP DGM, impacting the quantity of MSC obtained and reducing the ex vivo expansion time for optimized cell-based clinical applications.
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| 3. |
- Quinn, Terence J, et al.
(författare)
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Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008
- 2009
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Ingår i: Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1651-2081. ; 41:2, s. 99-111
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Despite recent high-profile advances in our understanding of rehabilitation post-stroke, the evidence base remains weaker than in other areas of stroke management. Under the aegis of the European Stroke Organisation a select committee was assembled to collate and appraise the evidence base for rehabilitation interventions. METHODS: Following systematic literature searching, relevant abstracts were screened for data quality and relevance. These data were summarized and presented to the members of the expert panel, who, both individually and across group discussions, modified the content. The process was repeated until a final document was produced that all members of the panel and the European Stroke Organisation editorial group were happy with. RESULTS: The final guidelines offer a comprehensive review of post-stroke rehabilitation, incorporating discussion of optimal timing, setting and duration of therapy as well as individual sections on the role of professions allied to medicine; use of assistive technologies and dealing with the common complications encountered during the rehabilitation period. CONCLUSION: There is a lack of robust evidence for many of the prevalent post-stroke rehabilitation interventions. Available data are discussed and presented as key points; more importantly, specific areas that require further study are also highlighted. METHODS: Following systematic literature searching, relevant abstracts were screened for data quality and relevance. These data were summarized and presented to the members of the expert panel, who, both individually and across group discussions, modified the content. The process was repeated until a final document was produced that all members of the panel and the European Stroke Organisation editorial group were happy with. RESULTS: The final guidelines offer a comprehensive review of post-stroke rehabilitation, incorporating discussion of optimal timing, setting and duration of therapy as well as individual sections on the role of professions allied to medicine; use of assistive technologies and dealing with the common complications encountered during the rehabilitation period. CONCLUSION: There is a lack of robust evidence for many of the prevalent post-stroke rehabilitation interventions. Available data are discussed and presented as key points; more importantly, specific areas that require further study are also highlighted.
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