The placebo effect, a response observed during the placebo arm of a clinical trial, is produced by the psychobiological action of the placebo as well as by other potential contributors to symptom amelioration such as spontaneous improvement, regression to the mean, biases, concurrent treatments, and study design. From a psychological viewpoint, there are many mechanisms that contribute to placebo effects, including expectations, conditioning, learning, and anxiety reduction. Placebo responses are also mediated by opioid and non-opioid mechanisms including dopamine, serotonin, cholecystokinin, and immune mediators. During recent years, a trend towards increased placebo effects in clinical trials of neuropsychiatric drugs has been noted. Indeed, the placebo effects observed in clinical trials constitute an increasing problem and interfere with signal-detection analyses of potential treatments. Several potential factors including protocol/study design and conduct related factors may account for the placebo effect observed in clinical trials. This paper reviews key issues related to this problem and aims to identify potential solutions.
Antipsychotic Agents ; Anxiety ; Arm ; Bias (Epidemiology) ; Cholecystokinin ; Dopamine ; Learning ; Placebo Effect ; Serotonin

No abstract available.
Angiotensin II ; Angiotensins ; Lithium ; Receptors, Angiotensin

No abstract available.
B-Lymphocytes ; Lymphoma, B-Cell ; Tolosa-Hunt Syndrome

In elderly acetabular fractures, central dislocation of the femoral head and impacted superior dome of the acetabulum is common. Unreduced dome impaction can lead to degenerative arthritis and results in poor results. Herein, we present a case of operative reduction and fixation performed via the modified Stoppa approach in acetabular fracture with superior dome impaction.
Acetabulum ; Aged ; Dislocations ; Head ; Humans ; Osteoarthritis

PURPOSE: Pelvic irradiation for the treatment of cancer can affect normal cells, such as the rapidly proliferating spermatogenic cells of the testis, leading to infertility, a common post-irradiation problem. The present study investigated the radioprotective effect of rolipram, a specific phosphodiesterase type-IV inhibitor known to increase the expression and phosphorylation of the cyclic adenosine monophosphate response element-binding protein (CREB), a key factor for spermatogenesis, with the testicular system against pelvic irradiation. MATERIALS AND METHODS: Male C57BL/6 mice were treated with pelvic irradiation (2 Gy) and rolipram, alone or in combination, and were sacrificed at 12 hours and 35 days after irradiation. RESULTS: Rolipram protected germ cells from radiation-induced apoptosis at 12 hours after irradiation and significantly increased testis weight compared with irradiation controls at 35 days. Rolipram also ameliorated radiation-induced testicular morphological changes, such as changes in seminiferous tubular diameter and epithelial height. Additionally, seminiferous tubule repopulation and stem cell survival indices were higher in the rolipram-treated group than in the radiation group. Moreover, rolipram treatment counteracted the radiation-mediated decrease in the sperm count and mobility in the epididymis. CONCLUSIONS: These protective effects of rolipram treatment prior to irradiation may be mediated by the increase in pCREB levels at 12 hours post-irradiation and the attenuated decrease in pCREB levels in the testis at 35 days post-irradiation in the rolipram-treated group. These findings suggest that activation of CREB signaling by rolipram treatment ameliorates the detrimental effects of acute irradiation on testicular dysfunction and the related male reproductive functions in mice.
Adenosine Monophosphate ; Animals ; Apoptosis ; Cyclic AMP Response Element-Binding Protein ; Epididymis ; Germ Cells ; Humans ; Infertility ; Male ; Mice* ; Phosphorylation ; Rolipram* ; Seminiferous Tubules ; Sperm Count ; Spermatogenesis ; Stem Cells ; Testis

MRI is useful for demonstrating the anatomy of various congenital cardiac lesions and plays an important role in the diagnosis of congenital cardiac lesions. Its large field of view and unlimited imaging planes enable the depiction of complex lesions, the complicated three-dimensional relations of the cardiac chambers and anomalies of the central pulmonary arteries, the systemic and pulmonary veins, and aorta. We describe the normal MR anatomy and MR imaging findings of a variety of congenital pathologies of the heart, in order to provide a better understanding and facilitate the interpretation of the MR features of various congenital heart diseases.
Aorta ; Diagnosis ; Heart ; Heart Defects, Congenital* ; Heart Diseases ; Magnetic Resonance Imaging* ; Pathology ; Pulmonary Artery ; Pulmonary Veins

OBJECTIVES: This study compared attitudes toward antipsychotic treatment according to awareness of the name of their illness in patients with schizophrenia. METHODS: Information on sociodemographic and clinical characteristics, including awareness of the importance of antipsychotic treatment, was obtained through a self-report questionnaire. The Drug Attitude Inventory (DAI) was administered. The data were compared according to awareness of the name of their illness. RESULTS: The study analyzed data for 199 patients with schizophrenia. Of these, 115 patients (57.8%) were aware that their illness was called schizophrenia, while 84 patients (42.2%) knew it by their psychotic symptoms or as another mental illness, such as depression. The patients aware of the name of their illness had significantly longer durations of illness and higher scores on the DAI. They were significantly more likely to have stopped taking medication on their own accord and to agree with the importance of antipsychotic treatment. Statistical significance was sustained in a logistic regression analysis after adjusting for the duration of illness and study site, except for the DAI score, which had borderline significance (p=0.055). In subjects with duration of illness > or =5 years, patients aware of the name of their illness had significantly higher scores on the DAI. CONCLUSION: Awareness of the name of their illness was associated with awareness of the importance of, and a positive attitude toward, antipsychotic treatments in patients. Psycho-education, including telling the patient the correct name of his or her illness, might be needed for maintaining antipsychotic treatment in patients with chronic schizophrenia.
Antipsychotic Agents ; Depression ; Humans ; Logistic Models ; Surveys and Questionnaires ; Schizophrenia

BACKGROUND: This study aimed to assess the effectiveness of exercise intervention in reducing body weight and glycosylated hemoglobin (HbA1c) level in patients with type 2 diabetes mellitus (T2DM) in Korea. METHODS: Cochrane, PubMed, Embase, KoreaMed, KMbase, NDSL, KCI, RISS, and DBpia databases were used to search randomized controlled trials and controlled clinical trials that compared exercise with non-exercise intervention among patients with non-insulin-treated T2DM in Korea. The effectiveness of exercise intervention was estimated by the mean difference in body weight changes and HbA1c level. Weighted mean difference (WMD) with its corresponding 95% confidence interval (CI) was used as the effect size. The pooled mean differences of outcomes were calculated using a random-effects model. RESULTS: We identified 7,692 studies through literature search and selected 23 articles (723 participants). Compared with the control group, exercise intervention (17 studies) was associated with a significant decline in HbA1c level (WMD, −0.58%; 95% CI, −0.89 to −0.27; I 2=73%). Although no significant effectiveness on body weight was observed, eight aerobic training studies showed a significant reduction in body weight (WMD, −2.25 kg; 95% CI, −4.36 to −0.13; I 2=17%) in the subgroup analysis. CONCLUSION: Exercise significantly improves glycemic control; however, it does not significantly reduce body weight. Aerobic training can be beneficial for patients with non-insulin-treated T2DM in Korea.
Body Weight Changes ; Body Weight ; Diabetes Mellitus, Type 2 ; Exercise Therapy ; Hemoglobin A, Glycosylated ; Humans ; Korea

PURPOSE: We measured the BMD (bone mineral density) of elderly patients with hip fracture in order to understand the relationship between osteoporosis and hip fracture, and also to suggest a reference point for starting an osteoporosis treatment program. MATERIALS AND METHODS: From February 2004 to April 2007, we investigated 172 elderly hip fracture patients. Their BMD was checked by DEXA (Hologic QDR-4500w, S/N 49492) at the proximal femur and at the 1st to 4th lumbar vertebrae. The average T-score of the hip fracture patients and the fracture threshold was calculated. RESULTS: The average BMD of the patients with hip fracture was -2.63 of the T-score in the proximal femur and - 2.95 of that in the lumbar vertebrae. The BMD in the patients with intertrochanteric fracture was significantly decreased compared to that of femur neck fracture (p=0.04, 0.19). For the femur neck fracture patients, the BMD of the displaced group was decreased compared to that of the undisplaced group (p=0.04, 0.01). The fracture threshold was -1.29 of the T-score in lumbar vertebrae, and the fracture threshold was -1.15 in the proximal femur. CONCLUSION: The BMD in elderly patients with hip fracture was significantly decreased compared that of normal people. For the prevention of hip fracture in elderly patients, we propose that the aggressive treatment of osteoporosis should be started for patients with a T-score less than -1.5.
Aged ; Femoral Neck Fractures ; Femur ; Hip ; Hip Fractures ; Humans ; Lumbar Vertebrae ; Osteoporosis

PURPOSE: We compared the outcomes of primary consecutive THAs performed via the direct lateral approach through minimally invasive incisions (<8 cm) and through standard incisions (15~20 cm). MATERIALS AND METHODS: Eighty primary consecutive THAs were performed via direct lateral approach through minimally invasive incisions or through standard size incisions. The standard incision is Hardinge's direct lateral approach. For the MIS group, an approximately 8 cm long oblique skin incision was made centered at the tip of the greater trochanter and running anterosuperiorly to posteroinferiorly. RESULTS: The surgical time was shorter (p=0.03) and the average amount of Hemovac drainage was smaller (p=0.02) in the MIS group. Alignment of the femoral stem and acetabular cup, post-operative pain and limping, HHS, and infection rate were no different between the two groups. In the MIS group, two complications (5.0%) occurred (one lateral positioning of the acetabular cup, one intra-operative acetabular fracture), and one varus stem insertion occurred. CONCLUSION: Minimization of the skin incision length for primary THAs performed via the direct lateral approach appears to have benefits with regard to shortening the wound closing time and decreasing the amount of postoperative Hemovac suction drainage. However, the minimally exposed operative field raises technical problems, so sufficient surgical experience and training are required.
Aldosterone ; Arthroplasty ; Drainage ; Femur ; Hip ; Operative Time ; Running ; Skin ; Suction ; Tacrine