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Objective To investigate the different expression levels of death-associated protein kinase ( DAPK) related miR-191 and phosphatase and tensin homolog deleted on chromosome ten ( PTEN) related miR-494 from fine-needle aspiration biopsy ( FNAB) samples and blood of both benign and malignant thyroid nodules, and to find new clinical molecular diagnostic markers. Methods FNAB specimens and peripheral venous blood were collected from 113 patients with thyroid nodules (48 cases of malignant and suspected malignant thyroid nodules, 38 cases of nodular goiter, and 27 cases of thyroid adenomas). The expression levels of miR-191 and miR-494 were detected by realtime fluorescence quantitative reverse transcription PCR ( qRT-PCR ) . qRT-PCR were applied to detect miR-191 and miR-494 expression level in 98 patients with thyroid nodules and peripheral circulation. Receiver operating characteristic curves ( ROC curves) were used to evaluate the sensitivity and specificity of miR-191 and miR-494 to diagnose malignant thyroid nodules. Results (1) The sensitivity of FNAB in diagnosing thyroid cancer was 91. 7％ (44/48) and the specificity was 90. 9％ (30/33),the diagnostic accuracy was 91. 35％. (2) In FNAB samples, as well as in peripheral circulation, the relative expression of miR-191 in thyroid cancer group is significantly lower than that of the benign group, while the relative expression of miR-494 in thyroid cancer group is significantly higher than that of the benign group (P<0. 05). (3) The sensitivity and specificity of miR-191 and miR-494 were acceptable (area under the ROC curve>0. 7). Sensitivity and specificity of miR-191 in FNAB and peripheral circulation were 76. 9％, 73. 5％ and 61. 5％, 64. 1％; miR-494 were 63. 6％,76. 5％ and 72. 7％, 84. 6％respectively. (4) In thyroid cancer FNAB samples and peripheral circulation, the differences between the relative expression level of miR-191 and miR-494, and the clinical characteristics of age, gender, nodule size, and calcification, with or without cervical lymph node enlargement, thyroid function and thyroid antibodies with or without abnormalities were not statistically significant(P>0. 05). Conclusion MiR-191 and miR-494 can be used as molecular diagnostic markers for early diagnosis of thyroid carcinoma with adjunctive FNAB.
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Objective To Pulse oximetry saturation has been wildly used clinically.It has been reported that pulse oximetry plethysmographic waveform (POP) reflected the peripheral tissue perfusion.In this study,we parameterized POP,observed the value of POP parameters in normal adults,and established the normal reference value range.Methods A multi-center prospective descriptive study.Total of 1 019 adult volunteers with normovolemia from 7 cities were enrolled in this study.Sex,age,height,weight and pulse oximetry data in awake and spontaneous breathing under in quiet conditions in the room temperature were collected.POP parameters and perfusion index were analyzed using MATLAB 2012a software.The normal reference value ranges of POP parameters,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),were formulated.Results Statistical differences of POP parameters were detected between men and women in the normal adult.The 95％ confidence reference value of POP parameters in normal population was as follows:Amp (104.8-2298.7) PVA and AUC (3265.8-6028.5) PVPGin total,Amp (129.4-2433.6) PVA and AUC (3319.0-5862.2) PVPG in male;Amp (89.5-2138.2) PVA and AUC (3163.9-5929.9) PVPG in female.Conclusions POP,including the amplitude of POP (Amp) and the area under the curve of POP (AUC),had normal reference value ranges in normal adults.
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Aerobic exercise therapy is recommended to prevent and improve life-style related diseases and diabetes mellitus (DM). Heart rate and subjective symptom are used as indices when aerobic exercises are performed. The peripheral capillary observation unit M320 (JMC Co., Kyoto, Japan) was developed to observe capillaries and erythrocyte movement on a PC monitor, and noninvasively analyze capillary blood flow velocity in proximal nail folds. This study was performed to evaluate changes in peripheral blood flow using M320 and thermography (SC620, FLIR Co., USA). Seven healthy men performed bicycle ergometer aerobic exercise tests for 20 min. Thermography was performed and their heart rate was monitored during and until 10 min after exercise. Capillaries in the proximal nail folds of the 4th finger of the right hand were observed and capillary blood flow velocity analyzed before and after aerobic exercise. One-way repeated-measure ANOVAs and multiple comparison tests were used to analyze heart rate and skin temperature, whereas paired t-test was used to analyze mean blood flow velocity. Statistical significance was set at P<0.05. Mean heart rate before exercise (68±3 bpm) significantly increased after 4, 7, 10, 11, and 13-20 min of exercise. The temperature of the 4th finger of the left finger also significantly increased from baseline (34.0±0.3°C) after 6-10 min of exercise. The temperature of the left big toe also showed significant differences, with the temperature at the beginning of exercise (31.5±0.4°C) dropping after 8 min of exercise (28.8±0.4°C). The mean blood flow velocity significantly increased (after: 133.1±2.2 μm/s, before: 124.6±3.4 μm/s). In conclusion, this study showed it is easy to observe improvements in peripheral blood flow using the M320 unit and thermography. This technique may help people understand the effects of proper exercise.
ABSTRACT
Aerobic exercise therapy is recommended to prevent and improve life-style related diseases and diabetes mellitus (DM). Heart rate and subjective symptom are used as indices when aerobic exercises are performed. The peripheral capillary observation unit M320 (JMC Co., Kyoto, Japan) was developed to observe capillaries and erythrocyte movement on a PC monitor, and noninvasively analyze capillary blood flow velocity in proximal nail folds. This study was performed to evaluate changes in peripheral blood flow using M320 and thermography (SC620, FLIR Co., USA). Seven healthy men performed bicycle ergometer aerobic exercise tests for 20 min. Thermography was performed and their heart rate was monitored during and until 10 min after exercise. Capillaries in the proximal nail folds of the 4th finger of the right hand were observed and capillary blood flow velocity analyzed before and after aerobic exercise. One-way repeated-measure ANOVAs and multiple comparison tests were used to analyze heart rate and skin temperature, whereas paired <i>t</i>-test was used to analyze mean blood flow velocity. Statistical significance was set at P<0.05. Mean heart rate before exercise (68±3 bpm) significantly increased after 4, 7, 10, 11, and 13-20 min of exercise. The temperature of the 4th finger of the left finger also significantly increased from baseline (34.0±0.3°C) after 6-10 min of exercise. The temperature of the left big toe also showed significant differences, with the temperature at the beginning of exercise (31.5±0.4°C) dropping after 8 min of exercise (28.8±0.4°C). The mean blood flow velocity significantly increased (after: 133.1±2.2 <i>μ</i>m/s, before: 124.6±3.4 <i>μ</i>m/s). In conclusion, this study showed it is easy to observe improvements in peripheral blood flow using the M320 unit and thermography. This technique may help people understand the effects of proper exercise.
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Background: Peripheral circulation is often disturbed in patients with connective tissue diseases (CTDs) and its objective evaluation is an important issue. Infrared thermography has been used for the purpose for decades [1]. Raynaud phenomenon (RP) is prevalent in and considerably characteristic of CTDs and we have long noticed colour unevenness among fingers in patients during RP attacks. We hypothesized that temperature unevenness among fingers detected by thermography would be a useful parameter to evaluate peripheral circulation. Objectives: To evaluate temperature unevenness among fingers as a thermographic parameter by comparing it with other parameters validated in previous studies. Methods: Patients who visited our hospital and had been diagnosed as having RP by their attending physicians and underwent thermographic examinations were included and compared with healthy volunteers. Skin temperatures of dorsum of hands at 10 fingers’ nail folds and MCP joints were measured at baseline. Then hands were immersed in 10°C water for 10 seconds. Skin temperatures were measured at 0, 3, 5, 10, 15, 20, and 30 min after immersion. Mean temperature, recovery rate (temperature recovery from immersion/decrease by immersion), and coefficient of variation (standard deviation/mean temperature) of nail fold temperature were calculated. Higher coefficient of variation means temperature among fingers is more uneven. Distal-dorsal difference (DDD: measured by subtracting mean temperature of MCP from that of nail fold) was also calculated and these parameters were compared between the two groups. Receiver operating characteristic (ROC) curve was generated to compare these parameters in terms of their capability of differentiating patients with RP from HCs. Results: Thirty-one patients with RP (10 with primary Raynaud, 11 with systemic sclerosis (SSc), 11 with other CTDs) were included and compared with 25 healthy controls (HCs). Baseline nail fold temperature was significantly lower in patients of RP than in HC (30.8±3.1 °C vs. 33.2±1.8 °C, p=0.0002). Cold-water immersion of hands revealed patients with RP had lower recovery rate, lower DDD, and higher coefficient of variation than did HCs. The differences in these parameters were the most evident at 5 min after immersion (patients with RP vs HCs: recovery rate; 49.6±27.7 vs 71.5±26.8, p=0.004 DDD; -1.4±2.8 vs 0.85±2.7, p=0.0008 coefficient of variation; 0.053±0.024 vs 0.021±0.015, p=1.2x10-6). On the basis of ROC curve analyses for these parameters, coefficient of variation of nail fold temperature most effectively differentiated patients with RP from HCs (Area under the curve; recovery rate: 0.64 DDD: 0.79 coefficient of variation: 0.88). Conclusions: Unevenness of temperature among fingers was the most useful thermographic parameter to evaluate disturbed peripheral circulation.
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<b>Background:</b> Peripheral circulation is often disturbed in patients with connective tissue diseases (CTDs) and its objective evaluation is an important issue. Infrared thermography has been used for the purpose for decades [1]. Raynaud phenomenon (RP) is prevalent in and considerably characteristic of CTDs and we have long noticed colour unevenness among fingers in patients during RP attacks. We hypothesized that temperature unevenness among fingers detected by thermography would be a useful parameter to evaluate peripheral circulation.<BR><b>Objectives:</b> To evaluate temperature unevenness among fingers as a thermographic parameter by comparing it with other parameters validated in previous studies.<BR><b>Methods:</b> Patients who visited our hospital and had been diagnosed as having RP by their attending physicians and underwent thermographic examinations were included and compared with healthy volunteers. Skin temperatures of dorsum of hands at 10 fingers’ nail folds and MCP joints were measured at baseline. Then hands were immersed in 10°C water for 10 seconds. Skin temperatures were measured at 0, 3, 5, 10, 15, 20, and 30 min after immersion. Mean temperature, recovery rate (temperature recovery from immersion/decrease by immersion), and coefficient of variation (standard deviation/mean temperature) of nail fold temperature were calculated. Higher coefficient of variation means temperature among fingers is more uneven. Distal-dorsal difference (DDD: measured by subtracting mean temperature of MCP from that of nail fold) was also calculated and these parameters were compared between the two groups. Receiver operating characteristic (ROC) curve was generated to compare these parameters in terms of their capability of differentiating patients with RP from HCs.<BR><b>Results:</b> Thirty-one patients with RP (10 with primary Raynaud, 11 with systemic sclerosis (SSc), 11 with other CTDs) were included and compared with 25 healthy controls (HCs). Baseline nail fold temperature was significantly lower in patients of RP than in HC (30.8±3.1 °C vs. 33.2±1.8 °C, p=0.0002). Cold-water immersion of hands revealed patients with RP had lower recovery rate, lower DDD, and higher coefficient of variation than did HCs. The differences in these parameters were the most evident at 5 min after immersion (patients with RP vs HCs: recovery rate; 49.6±27.7 vs 71.5±26.8, p=0.004 DDD; -1.4±2.8 vs 0.85±2.7, p=0.0008 coefficient of variation; 0.053±0.024 vs 0.021±0.015, p=1.2x10<sup>-6</sup>). On the basis of ROC curve analyses for these parameters, coefficient of variation of nail fold temperature most effectively differentiated patients with RP from HCs (Area under the curve; recovery rate: 0.64 DDD: 0.79 coefficient of variation: 0.88).<BR><b>Conclusions:</b> Unevenness of temperature among fingers was the most useful thermographic parameter to evaluate disturbed peripheral circulation.
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<b>Purpose</b>: We examined the effects of foot baths containing artificial carbon dioxide (CO<sub>2</sub>) on peripheral circulation. Our goal was to obtain quantitative results bearing on the treatment and preservation of refractory leg ulcers and gangrene, which would occur in arteriosclerosis obliterans (ASO) and diabetic peripheral circulation disorders.<br><b>Procedures</b>: The lower legs of six healthy volunteers were placed for 10min into a 42°C bath of 10<i>l</i> in which 45g of artificial CO<sub>2</sub> “BUB” was dissolved. A laser Doppler blood-flowmeter was firmly attached. The measurements of blood flow were taken before, during, and 5, 15, 25, and 35min after each subject took a foot bath. Next, in order to examine the effects of peripheral blood flow on the whole body during the foot baths, each laser Doppler blood-flowmeters was attached on the subject's right arm, 10cm above the wrist joint.<br><b>Results</b>: The blood flow increased during the foot bath and decreased after the bath was removed; during in a 10min bath, the flow was 264±135 (%) (p<0.05) of the flow before the feet were placed into the bath. 5min after the bath was removed, the flow was 256±174 (%) of the original pre-bath rate. 15min later it was 146±60 (%), 25min later it was 112±23 (%), and 35min later it was 107±24 (%), as low as the flow before the feet were placed in the bath. The arm blood flow also increased during the foot bath and decreased after the bath was removed. During a 10min bath, the flow was 119±49 (%) of the rate before the feet were placed in the bath. 5min after the bath was removed, the flow was 120±66 (%) of the original pre-bath rate. 15min later it was 113±28 (%), 25min later it was 109±16 (%), and 35min later it was 95±14 (%), essentially the same as the flow before the feet were placed in the bath.<br><b>Discussion</b>: Our work demonstrates an increase in blood flow, by 2.6X, by using a foot bath containing artificial CO<sub>2</sub>. The increase was maintained for 5min after removed of the foot from the bath. However, the blood flow decreased 15min after the baths were removed. We hope that this simple and effective foot bath will be used both at home and elderly care service stations. Its use could see prevention from refractory leg ulcers or gangrene, particularly as average life span continues to increase in Japan.
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One of the methods of external treatment is herbal bathing. We studied the usefulness of herbal bathing by investigating the physiological and biochemical changes that occurred during whole-body herbal bathing.<br>Eleven healthy adult males (36±9 years old) were subjected to two types of bathing, herbal bathing and plain water bathing, at an interval of four or more days at random sequence after giving written informed consents. Physiological and biochemical changes were monitored 10min before bathing, 10min during herbal bathing in the sitting position, and up to 60min after bathing.<br>The results showed that the skin temperature of the face (forehead) and hands decreased at a slower rate, fluctuations of the blood pressure were smaller, and the peripheral vascular resistance decreased more faster in herbal bathing than in plain water bathing. These results suggest that herbal bathing is more effective in maintaining peripheral skin temperature, stimulates peripheral circulations, and suppresses excessive fluctuations of blood pressure better than in plain water bathing. Analysis of the autonomic nervous activity by ECG R-R variability showed that the parasympathetic tone was more predominant in the herbal bathing than in plain water bathing, supporting the result showing a larger relaxing effect in herbal bathing. Although there was no significant difference between herbal bathing and plain water bathing in terms of changes in the total blood volume of the Musculus Trapezius, the increase in the total blood volume of the forehead was greater in herbal bathing than in plain water bathing. These results suggested that the herbal bathing might be able to increase the blood volume of the frontal lobe.<br>These differences of the physiological changes between herbal bathing and plain water bathing indicated that the herbal bathing may stimulate the circulation in the frontal lobe as well as the skeletal muscles. These results supported the health-promoting effects of herbal bathing.
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We evaluated the clinical effect of acupuncture treatment on 21 patients with Arteriosclerosis Obliterans (ASO). Severity of ASO was grade I in one case, II in 17 cases, III in two cases, and IV in one case (Fontaine classification). Mainly low-frequency electroacupuncture was applied to inpatients two to four times per week and to outpatients, once or twice a week. Effects on claudication distance (ICD), pain, coldness, and Ankle Brachial Pressure Index (ABPI) were assessed on inpatients by comparing the status before starting treatment with that before the acupuncture treatment at the 17th visit. We also assessed the thermograph and plasma calcitonin gene-related peptide (CGRP) of the lower extremities.<br>Improved warmth, increased intermittent limping distance, and relief of pain during walking were observed in patients of grade I and II (Fontaine classification of severity). No improvement of symptoms was observed in patients of grade III and IV. No change in ABPI was observed in any patient. Surface temperatures in the peripheral extremities were significantly elevated from 15 minutes after insertion of the needles until 15 minutes after removal. A significant increase in plasma CGRP was observed immediately after the treatment.<br>These findings suggest that acupuncture treatment may be effective for some symptoms of grade I and II ASO and that improvement of peripheral circulation via vascular dilatation may be involved in the mechanism of action.
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We investigated the difference between muscle-EAT and nerve-EAT basically and clinically. A basic study was performed on healthy adult males. The skin blood flow, deep-tissue temperature, deep hemodynamics, heart rate, and deep-pain threshold were adopted as indexes, and they were compared for a total of three groups: the muscle stimulation-EA group, nerve stimulation-EA group and control group (no stimulation). An acupuncture needle was inserted into the gastrocnemius muscle for muscle stimulation-EA and another needle into the tibial nerve in the femoral region for nerve stimulation-EA. Electric current was then applied at 1Hz for 15 minutes after the flexibility of the foot joint was conformed. Each index was measured after it became stable and was recorded from 10 minutes before starting stimulation until 20 minutes after ending stimulation.<br>A clinical study was performed on 41 patients with cervical radiculopathy. Muscle-EAT was applied to the patients as the first choice. Cases graded five points or less in pain score (10-point method) after one month were included in the muscle-EAT group. Cases graded six points or more were subjected to nerve-EAT and were included in the nerve-EAT group. The therapeutic results in these two groups were examined for a period of three months at intervals of one month based on the pain score and the evaluation criteria for the results of treatment of cervical radiculopathy.<br>As a result, we found that the skin blood flow significantly increased on the stimulated side in both the muscle stimulation-EA and nerve stimulation-EA group. The increase was greater in the nerve stimulation group than in the muscle stimulation group. The deep-tissue temperature rose significantly on the stimulated side in the nerve stimulation-EA group. Regarding the deep hemodynamics, deoxy Hb decreased significantly in the nerve stimulation-EA group. No difference was found in heart rate between the two groups. The deep-pain threshold was significantly raised by nerve stimulation.<br>Patients with cervical radiculopathy who did not respond to continuous muscle-EAT for one month were subjected to nerve-EAT. After three months (two months after changing to nerve-EAT), similar improvements were found in both groups. Significant improvement of paresthesia was obtained with nerve-EAT.<br>These results suggested that the nerve-EAT influences the peripheral circulation and the deep pain threshold more effectively, enhancing the clinical efficacy.
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The effects of Qi Gong health maintenance exercises were compared with a control group of walkers considered to have an equivalent amount of exercise, by measuring the changes in the pulse, systolic blood pressure, diastolic blood pressure and peripheral circulation.<br>Although no significant differences were seen in either the pulse or blood pressure of the control group of walkers when the before and after exercise values were compared, in the Qi Gong group, a decrease in these values was seen over time, with significant decreases from the pre-exercise values indicated in all values 30 minutes after exercise. This is consistent with the findings in a previous report that there was a significant reduction in catecholamine in the Qi Gong group 30 minutes after performing Qi Gong exercises.<br>When the flow rate of the peripheral circulation was measured using Doppler ultrasound equipment, in comparison with the lack of notable change over time seen in the control group, a significant improvement in the peripheral circulation was suggested for the Qi Gong group when the pre- and post- exercise values were compared. It has also been suggested that Qi Gong health maintenance exercises lower stress hormones and act to improve the peripheral blood circulation; a discussion of which is also included in this paper.