Short-term effects of acupuncture on open-angle glaucoma in retrobulbar circulation: additional therapy to standard medication.

Background. The relation between glaucoma and retrobulbar circulation in the prognosis has been indicated. Purpose. To investigate the effects of acupuncture on retrobulbar circulation in open-angle glaucoma (OAG) patients. Methods. Eleven OAG patients (20 eyes with OAG) who were treated by topical antiglaucoma medications for at least 3 months were enrolled. Acupuncture was performed once at acupoints BL2, M-HN9, ST2, ST36, SP6, KI3, LR3, GB20, BL18, and BL23 bilaterally. Retrobulbar circulation was measured with color Doppler imaging, and intraocular pressure (IOP) was also measured at rest and one hour after rest or before and after acupuncture. Results. The Δ value of the resistive index in the short posterior ciliary artery (P < .01) and the Δ value of IOP (P < .01) were decreased significantly by acupuncture compared with no acupuncture treatment. Conclusions. Acupuncture can improve the retrobulbar circulation and IOP, which may indicate the efficacy of acupuncture for OAG.

Changes of blood flow volume in the superior mesenteric artery and brachial artery with abdominal thermal stimulation.

In traditional Chinese medicine, moxibustion is a local thermal therapy that is used for several conditions. Quantifying the effects of moxibustion therapy has been difficult because the treatment temperature depends on the physician's experience, and the temperature distribution in the target area is not uniform. This prospective observational study aims to quantify the effect of local thermal stimulation to the abdomen. We developed a heat transfer control device (HTCD) for local thermal stimulation. Twenty-four healthy subjects were enrolled and they underwent abdominal thermal stimulation to the para-umbilical region with the device for 20 min. Blood flow volume in the superior mesenteric artery (SMA) and brachial artery (BA), the heart rate and the blood pressure were measured at rest, 15 min after starting thermal stimulation and 10, 20, 30 and 40 min after completing thermal stimulation. Blood flow parameters were measured by high-resolution ultrasound. In the SMA, blood flow volume was significantly increased during thermal stimulation (P < .01), as well as at 10 min (P < .01) and 20 min (P < .05) after stimulation. In the BA, blood flow volume decreased at 40 min after stimulation (P < .01). In conclusion we could quantify the effect of local thermal stimulation with an HTCD and high-resolution ultrasound. Thermal stimulation of the para-umbilical region increased blood flow in the SMA 20 min after stimulation in healthy subjects.

A mobile communications system for home-visit medical services: the Electronic Doctor's Bag.

In the present study, "Electronic Doctor's Bag" which is a tele-healthcare tool for home-visit medical service using the mobile communications environment has been proposed and evaluated by preliminary experiments. It was shown that its basic function was sufficiently evaluated by a few doctors and nurses but further improvement in portability and operability is required on the basis of much more opinions of medical and nursing professionals.

Influence of rotary blood pumps over preload recruitable stroke work.

When recovery of the cardiac function is detected in assisted hearts, the ventricular assist device can be removed. Due to the invasiveness of the surgical procedure, an accurate assessment of cardiac function is fundamental for the treatment success. The main challenge for the detection of cardiac function during assistance is to know whether the cardiac function index represents the cardiac function after pump removal independently of the pump assist rate. Therefore in this paper we present an evaluation of the influence of the pump over the slope of the preload recruitable stroke work, a cardiac function index. Analyzing data from four acute animal experiments, we found that the pump affects the stroke work, which could be corrected by the end diastolic volume. However, the data set examined was limited and further investigation is necessary.

The effect of warming of the abdomen and of herbal medicine on superior mesenteric artery blood flow - a pilot study.

BACKGROUND: In traditional Japanese and Chinese medicine, warming the abdomen with moxibustion or herbal medicines has been used for various diseases. However, the effects of these therapies on hemodynamics have not been clear. We clarify the physiological effects of these therapies on the superior mesenteric artery (SMA) blood flow. PARTICIPANTS AND METHODS: 28 healthy male volunteers were randomly assigned to groups A and B. Group A (n = 14) underwent local thermal stimulation of the paraumbilical region for 20 min at a temperature of 40 °C; this simulated the heat and mechanical pressure effects of moxibustion. Group B (n = 14) took the herbal medicine Daikenchuto (TJ-100; 5.0 g) with distilled water. As a control, group C (n = 14) took distilled water alone. Blood flow volume in the SMA was measured by ultrasound from rest to 50 min after the start of each intervention. RESULTS: The SMA blood flow volume increased significantly between 10 to 40 min after the start of thermal stimulation (p < 0.05), and it also increased significantly between 10 to 50 min after administration of TJ-100 (p < 0.01) as compared to the resting volume. However, SMA blood flow volume did not change significantly after administration of water alone. There was no significant difference in SMA blood flow changes between groups A and B. CONCLUSIONS: The results suggest that one of the physiological effects of warming the abdomen according to a traditional concept in thermal stimulation and herbal medicine is an increase of SMA blood flow volume.

Estimation of maximum ventricular elastance under assistance with a rotary blood pump.

The maximum ventricular elastance is a reliable index for assessing the cardiac function from changes in its pressure-volume relationship. The advantage of this index is that it can represent the contractility of either unassisted hearts or native hearts assisted with rotary blood pumps. However, there are situations in which changes in the ventricular load required for the conventional estimation method might be risky. For example, in a bridge-to-recovery the cardiac function should also be continuously observed after the implantation of a rotary blood pump. In this article, we present the results of the estimation of the maximum elastance with in vivo data using the parameter optimization method, which is a single-beat estimation method. The estimated values for the normal cardiac function (6.8 +/- 0.6, 4.5 +/- 0.9, 4.2 +/- 1.8 mm Hg/mL) were significantly different from those for the low cardiac function (3.2 +/- 1.5, 1.9 +/- 1.0, 1.9 +/- 1.2 mm Hg/mL) from the data of the three animals that were analyzed. Besides, the maximum elastance values were independent of the pump rotational speed. These results indicate that this index might be useful for the detection of the myocardial recovery.

Brief effect of acupuncture on the peripheral arterial system of the upper limb and systemic hemodynamics in humans.

BACKGROUND: Pulse diagnosis of the peripheral artery is an important technique in Traditional Chinese Medicine, where, in acupuncture therapy, the treatment is adjusted according to the observed changes of the pulse. We investigated the change of blood flow in the peripheral artery and the cardiac index during acupuncture treatment. OBJECTIVES: The aim of this study is to explore the effect of acupuncture on radial and brachial artery blood flow volume and the cardiac index in healthy subjects. METHODS: Eighteen (18) healthy volunteers were enrolled. Acupuncture was performed bilaterally on LR-3 with manual rotation of the needles. The blood pressure and heart rate were measured at rest and 180 seconds after acupuncture. Radial and brachial artery blood flow volume was monitored continuously by an ultrasound with an echo-tracking system. Cardiac index was measured by impedance cardiography. The hemodynamic parameters were measured before, during, and 30, 60, 180 seconds after acupuncture. RESULTS: The peripheral artery blood flow volume decreased significantly during acupuncture (radial; p < 0.01, brachial; p < 0.05) but increased at 180 seconds after acupuncture (radial; p < 0.05, brachial; p < 0.05) compared with before acupuncture. The cardiac index did not change significantly after acupuncture, but systemic vascular resistance index significantly decreased (p < 0.05). CONCLUSIONS: The present study showed that radial and brachial artery blood flow volume decreased immediately during acupuncture on LR-3 acupoint, but increased at 180 seconds after acupuncture. This reaction is attributed to the change in peripheral vascular resistance.

Radial artery hemodynamic changes related to acupuncture.

BACKGROUND: Assessment of the radial pulse by palpation (pulse diagnosis) is an important diagnostic technique in Traditional Chinese Medicine (TCM), but the changes of blood flow volume in the radial artery during and after acupuncture are unknown. OBJECTIVE: The aim of this study was to explore the changes of radial artery blood flow volume during and after acupuncture in healthy subjects. DESIGN: This study was conducted as a pilot study utilizing a one-group intervention design. SETTING: The study was conducted at a TCM outpatient clinic of Tohoku University Hospital. PARTICIPANTS: Twenty-six healthy volunteers participated in the study. INTERVENTION: Acupuncture was performed at LR-3 bilaterally with manual rotation of the needles. OUTCOME MEASURES: Blood pressure was measured at rest and 180 seconds after acupuncture. Radial artery hemodynamics were monitored continuously with a high-resolution ultrasound echo-tracking system. The vessel diameter and blood flow volume of the right radial artery and heart rate were measured at rest, before acupuncture, during acupuncture, and 30, 60, and 180 seconds after acupuncture. RESULTS: The systolic and diastolic diameter of the radial artery did not significantly change. Radial artery blood flow volume decreased significantly during acupuncture (mean +/- SD, 0.16 +/- 0.11 mL/sec per m(2); P < .01) compared with baseline (0.43 +/- 0.27 mL/sec per m(2)), but was increased at 180 seconds after acupuncture (0.54 +/- 0.28 mL/sec per m(2); P < .01). CONCLUSIONS: The present study showed that radial artery blood flow volume decreased immediately during acupuncture at the LR-3 acupoint, but was increased at 180 seconds after acupuncture.

Estimation of blood pressure variability using independent component analysis of photoplethysmographic signal.

The maximum cross-correlation coefficient rho(max) between blood pressure variability and heart rate variability, whose frequency components are limited to the Mayer wave-related band, is a useful index to evaluate the state of the autonomic nervous function related to baroreflex. However, measurement of continuous blood pressure with an expensive and bulky measuring device is required to calculate rho(max). The present study has proposed an easier method for obtaining rho(max) with measurement of finger photoplethysmography (PPG). In the proposed method, independent components are extracted from feature variables specified by the PPG signal by using the independent component analysis (ICA), and then the most appropriate component is chosen out of them so that the rho(max) based on the component can fit its true value. The results from the experiment with a postural change performed in 17 healthy subjects suggested that the proposed method is available for estimating rho(max) by using the ICA to extract blood pressure information from the PPG signal.

The herbal medicine Daikenchuto increases blood flow in the superior mesenteric artery.

Daikenchuto is a traditional herbal medicine that is used for the treatment of cold feeling in the abdomen, while Orengedokuto, also a traditional herbal medicine, is used for treating inflammatory and ulcerative diseases affecting internal organs. However, the effects of these herbal medicines on cardiac output (CO) and intestinal blood flow have never been investigated. This examiner-blinded randomized crossover study intended to clarify the influence of Daikenchuto and Orengedokuto on CO and blood flow volume in the superior mesenteric artery (SMA). Fourteen healthy men (35 +/- 7 years old) were randomly assigned to two groups: group A and group B. Initially, all subjects were given 50 ml of water orally. After 7 days, subjects in group A were given 5.0 g of Daikenchuto, and 7 days later they were given 2.5 g of Orengedokuto. These herbal medicines were given to group B subjects in the reverse order. CO and SMA blood flow volume were measured from rest to 90 min after the administration of water or each medicine. There was a significant increase in SMA blood flow volume after the administration of Daikenchuto, compared to water alone (p < 0.05) and Orengedokuto (p < 0.05). SMA blood flow volume was significantly increased between 5 and 90 min after administration of Daikenchuto (p < 0.01) compared to the resting state. However, there was no significant change in CO after the administration of either agent. The present study indicates that Daikenchuto increases SMA blood flow volume without increasing CO.

A method for evaluating effects of visually-induced motion sickness using ICA for photoplethysmography.

A human watching a swaying image displayed on a wide-field display or screen sometimes suffers from visually-induced motion sickness (VIMS) that causes symptoms related to the autonomic nervous system such as nausea, vomiting, and dizziness. Previous studies indicated that the maximum cross-correlation coefficient (rho(max)) between blood pressure and heart rate, whose frequency components were limited to the neighborhood of 0.1Hz, was a useful index to evaluate the effects of VIMS on humans. The present study proposed a new method for obtaining rho(max) with measurement of neither continuous blood pressure nor ECG but using only finger photoplethysmography (PPG). In this study, heart rate was obtained from the foot-to-foot-interval of the PPG signal, and blood pressure-related and event-related pieces of information were obtained from the parameter extracted from using the independent component analysis. The adequacy of the proposed method was evaluated by two experiments with the Valsalva maneuver and with presentation of a swaying video image. The experimental results have shown that the proposed method could extract the independent component related to blood pressure and an event signal of Valsalva maneuver. In addition, the effects of VIMS could be estimated with the independent component.

Preliminary study on the estimation of Emax using single-beat methods during assistance with rotary blood pumps.

Recently, rotary blood pumps (RBPs) have been used as bridge to recovery. In such application the RBP might be weaned once the cardiac function has been recovered. In such cases, the detection of the cardiac function is fundamental for the treatment efficiency. However, most of the widely used cardiac function indices (CFIs) were proposed for unassisted hearts and have not been completely evaluated under assistance. In contrast, Emax, which is known as a reliable CFI, has already been validated under assistance with RBP. However, since the conventional method for the estimation of Emax has some limitations for the clinical application, the objective of this study was to evaluate different single-beat estimation methods qualitatively and also quantitatively using in vivo data. The preliminary results showed that although single-beat estimation have more clinical applicability, not all those estimation methods are suitable for the RBP assistance.

Comparison of maximum cross-correlation coefficient between blood pressure and heart rate with traditional index associated with baroreflex sensitivity.

In general, it is difficult to compare biological reactions to some kind of stimulation among subjects on the basis of a single physiological parameter such as heart rate variability because there is a large individual variability in its values. A solution to this problem is to utilize the correlation between physiological parameters. In previous works, the maximum cross-correlation coefficient between heart rate and blood pressure variabilities changed when subjects were strongly affected by visual stimulation. In the present work, this index was compared with a traditional one associated with the arterial baroreflex gain to investigate the mechanism of the change in the index. Resting heart rate and continuous blood pressure of twenty-eight healthy adults were measured for five minutes and analyzed. The results showed that these two indices changed similarly to each other while there was little correlation in the mean value between them. Furthermore, the lag time from blood pressure variability to heart rate variability was inversely correlated with the traditional index.

Which skeletal myoblasts and how to be transplanted for cardiac repair?

Clinical efficacy of skeletal myoblast (skMb) transplantation is controversial whether this treatment produces beneficial outcome in patients with dilated cardiomyopathy (DCM). Based on immunological tolerance between wild-type and DCM hamsters with the deletion of delta-sarcoglycan (SG) gene, skMb engraftment in TO-2 myocardium (3x10(5) cells in approximately 100mg heart) was verified by the donor-specific expression of delta-SG transgene constitutively produced throughout myogenesis. At 5 weeks after the transplantation, the cell rates expressing fast-myosin heavy chain (MHC) exceeded slow-MHC in delta-SG(+) cells. Fifteen weeks after (corresponding to approximately 12 years in humans), fast MHC(+) cells nullified, but the delta-SG(+) and slow MHC(+) cell number remained unaltered. These skMbs fused with host cardiomyocytes via connexin-43 and intercalated disc, modestly improving the hemodynamics without arrhythmia, when engrafted skMbs were sparsely disseminated in autopsied myocardium. These results provide us evidence that disseminating delivery of slow-MHC(+) myoblasts is promising for repairing DCM heart using histocompatible skeletal myoblasts in future.

Estimation of effects of visually-induced motion sickness using independent component analysis.

To quantify the effect of visually-induced motion sickness on the autonomic nervous system, the authors previously proposed a new physiological index rho max representing the maximum cross-correlation coefficient between blood pressure variability and heart rate variability whose frequency components are limited to the Mayer wave band. However, rho max requires measurement of continuous blood pressure with an expensive and bulky measuring device. In the present study, an easier method for obtaining rho max with measurement of neither continuous blood pressure nor ECG but using finger photoplethysmography (PPG) only has been developed. A blood pressure-related parameter was extracted from the PPG by using the independent component analysis. Two experiments in which subjects performed the Valsalva maneuver and then they watched a swaying video image were carried out to evaluate the adequacy of the proposed method. The experimental results have shown that the proposed method worked successfully as good as the conventional method. This means that the proposed method can contribute to increase in the number of subjects because multiple subjects can be used even in a single experiment.

Evaluation of adaptation to visually induced motion sickness by using physiological index associated with baroreflex function.

Visual images including intensive motions and the experience of virtual reality sometimes induce visually-indeuced motion sickness (VIMS). There are few studies that have objectively evaluated the effects of repetitive exposures to these stimuli on humans. In this study, an experiment was carried out in which the same video image was presented to human subjects three times. We evaluated changes of the intensity of VIMS they suffered from with a subjective score and a physiological index, rho(max) which is defined as the maximum cross-correlation coefficient between heart rate and pulse wave transmission time and is considered to reflect baroreflex function. The results showed that the adaptation to VIMS could be represented by a decrease in the objective index rho(max) as well as the subjective score. On the contrary, however, some subjects' rho(max) increased in a few similar time regions at every trial. This fact suggests that we can specify the part of the video image which is closely related to VIMS by analyzing the change in rho(max) with time.

Evaluation of adaptation to visually induced motion sickness based on the maximum cross-correlation between pulse transmission time and heart rate.

BACKGROUND: Computer graphics and virtual reality techniques are useful to develop automatic and effective rehabilitation systems. However, a kind of virtual environment including unstable visual images presented to wide field screen or a head mounted display tends to induce motion sickness. The motion sickness induced in using a rehabilitation system not only inhibits effective training but also may harm patients' health. There are few studies that have objectively evaluated the effects of the repetitive exposures to these stimuli on humans. The purpose of this study is to investigate the adaptation to visually induced motion sickness by physiological data. METHODS: An experiment was carried out in which the same video image was presented to human subjects three times. We evaluated changes of the intensity of motion sickness they suffered from by a subjective score and the physiological index rho(max), which is defined as the maximum cross-correlation coefficient between heart rate and pulse wave transmission time and is considered to reflect the autonomic nervous activity. RESULTS: The results showed adaptation to visually-induced motion sickness by the repetitive presentation of the same image both in the subjective and the objective indices. However, there were some subjects whose intensity of sickness increased. Thus, it was possible to know the part in the video image which related to motion sickness by analyzing changes in rho(max) with time. CONCLUSION: The physiological index, rho(max), will be a good index for assessing the adaptation process to visually induced motion sickness and may be useful in checking the safety of rehabilitation systems with new image technologies.

Acute and chronic consequences of non-pulsatile blood flow pattern in long-term total artificial heart experiment.

Vessel pulsation is presumably a key physiological function for the optimal supply of peripheral tissues and vital organs by oxygen and nutrients. The absence of pulsatility might impair the peripheral perfusion stability and trigger microvascular dysfunction of vital organs. The main purpose of this study was to investigate the influence of non-pulsatile flow on the microcirculation in experimental goat with implanted undulation pump total artificial heart (UPTAH). A microscopic system (Keyence, Japan) for the direct observation of the microcirculation of bulbar conjunctiva was used. Following the acute flow pattern change (from pulsatile to non-pulsatile one), the number of perfused capillaries decreased significantly (from 34.7+/-6.3 to 19.7+/-4.1 number of capillaries/mm; P<0.05). The velocity of erythrocytes dropped (from 526+/-83 to 132+/-41mum/s; P<0.05). The velocity of erythrocytes and capillary density were only partly recovered, when the pulsatile flow mode was restored. Histopathological analysis after 33 days of pumping in non-pulsatile mode revealed the presence of chronic venostasis, tissue edema, hemorrhages, hypoxia and ischemic necroses in the tissue samples from liver, kidneys and lung. These findings could be regarded as a direct effect of the chronic non-pulsatile pumping mode and inadequate blood supply. We conclude that the presence of pulsatile flow should be considered as a vital condition for a successful long-term survival after total artificial heart implantation.

Autonomic nervous function and localization of cerebral activity during lavender aromatic immersion.

Changes in the autonomic nervous activity can be induced by various sensory and emotional stimuli. The authors examined whether the power spectral analysis of heart rate variability (HRV) could detect changes in autonomic tone following a lavender aroma treatment or not. Healthy young women (n=10, 23+/-3 years old) underwent continuous electrocardiographic (ECG) monitoring before and after (10, 20, 30 minutes) the lavender fragrance stimuli. HRV was expressed by three indices: low (0.04-0.15 Hz) and high (0.15-0.40 Hz) frequency components (nLF and nHF, respectively) as well as LF/HF ratio. Increases in the parasympathetic tone were observed after the lavender fragrance stimulus as seen as increases in the HF component and decreases in the LF/HF. Additional measurement with positron emission tomography (PET) demonstrated the regional metabolic activation in the orbitofrontal, posterior cingulate gyrus, brainstem, thalamus and cerebellum, as well as the reductions in the pre/post-central gyrus and frontal eye field. These results suggested that lavender aromatic treatment induced not only relaxation but also increased arousal level in these subjects.

Electrical stimulation of skeletal muscles. An alternative to aerobic exercise training in patients with chronic heart failure?

The aim of this study was to investigate whether electrical stimulation of skeletal muscles could represent a rehabilitation alternative for patients with chronic heart failure (CHF). Thirty patients with CHF and NYHA class II-III were randomly assigned to a rehabilitation program using either electrical stimulation of skeletal muscles or bicycle training. Patients in the first group (n = 15) had 8 weeks of home-based low-frequency electrical stimulation (LFES) applied simultaneously to the quadriceps and calf muscles of both legs (1 h/day for 7 days/week); patients in the second group (n = 15) underwent 8 weeks of 40 minute aerobic exercise (3 times a week). After the 8-week period significant increases in several functional parameters were observed in both groups: maximal VO2 uptake (LFES group: from 17.5 +/- 4.4 mL/kg/min to 18.3 +/- 4.2 mL/kg/min, P < 0.05; bicycle group: from 18.1 +/- 3.9 mL/kg/min to 19.3 +/- 4.1 mL/kg/min, P < 0.01), maximal workload (LFES group: from 84.3 +/- 15.2 W to 95.9 +/- 9.8 W, P < 0.05; bicycle group: from 91.2 +/- 13.4 W to 112.9 +/- 10.8 W, P < 0.01), distance walked in 6 minutes (LFES group: from 398 +/- 105 m to 435 +/- 112 m, P < 0.05; bicycle group: from 425 +/- 118 m to 483 +/- 120 m, P < 0.03), and exercise duration (LFES group: from 488 +/- 45 seconds to 568 +/- 120 seconds, P < 0.05; bicycle group: from 510 +/- 90 seconds to 611 +/- 112 seconds, P < 0.03). These results demonstrate that an improvement of exercise capacities can be achieved either by classical exercise training or by home-based electrical stimulation. LFES should be considered as a valuable alternative to classical exercise training in patients with CHF.