The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation

Background

As laser acupuncture is being increasingly used to treat mental disorders, we sought to determine whether it has a biologically plausible effect by using functional magnetic resonance imaging (fMRI) to investigate the cerebral activation patterns from laser stimulation of relevant acupoints.

Methodology/Principal Findings

Ten healthy subjects were randomly stimulated with a fibreoptic infrared laser on 4 acupoints (LR14, CV14, LR8 and HT7) used for depression following the principles of Traditional Chinese Medicine (TCM), and 1 control non-acupoint (sham point) in a blocked design (alternating verum laser and placebo laser/rest blocks), while the blood oxygenation level-dependent (BOLD) fMRI response was recorded from the whole brain on a 3T scanner. Many of the acupoint laser stimulation conditions resulted in different patterns of neural activity. Regions with significantly increased activation included the limbic cortex (cingulate) and the frontal lobe (middle and superior frontal gyrus). Laser acupuncture tended to be associated with ipsilateral brain activation and contralateral deactivation that therefore cannot be simply attributed to somatosensory stimulation.

Conclusions/Significance

We found that laser stimulation of acupoints lead to activation of frontal-limbic-striatal brain regions, with the pattern of neural activity somewhat different for each acupuncture point. This is the first study to investigate laser acupuncture on a group of acupoints useful in the management of depression. Differing activity patterns depending on the acupoint site were demonstrated, suggesting that neurological effects vary with the site of stimulation. The mechanisms of activation and deactivation and their effects on depression warrant further investigation.     

The effect of laser puncture on the functional indices of the mammalian body

Biologically active points (acupuncture points) and reflexogenic zones of Wistar rats of different age were exposed to He-Ne laser radiation with the subsequent control of acetylcholine esterase activity, electric parameters of skeletal muscles and heart, and physical activity. Laser puncture was shown to increase the sympathetic nervous system tonus which was manifested by the decreased acetylcholine esterase activity and increased heart rate. Laser puncture stimulated the growth of membrane potential and increased considerably the performance capability of animals, particularly of three-month-olds.     

光子中医信息疗法

本文简述了弱激光血疗的机理及其发展过程,并在此基础上详细阐述了我们自己提出的光子中医信息疗法。该疗法根据中医辨证施治的原则,选用经中医信息调制的半导体激光束照射患者口咽部（或鼻腔）和与疾病关联的穴位,综合激光血疗、激光针疗和激光理疗,可引发多种激光生物效应,启动人体生理功能的整体调节机制,逐渐改善和恢复生理功能。除此之外,我们还设计研制了相应的治疗仪器。     

Sedation Agents Differentially Modulate Cortical and Subcortical Blood Oxygenation: Evidence from Ultra-High Field MRI at 17.2 T

Background

Sedation agents affect brain hemodynamic and metabolism leading to specific modifications of the cerebral blood oxygenation level. We previously demonstrated that ultra-high field (UHF) MRI detects changes in cortical blood oxygenation following the administration of sedation drugs commonly used in animal research. Here we applied the UHF-MRI method to study clinically relevant sedation drugs for their effects on cortical and subcortical (thalamus, striatum) oxygenation levels.

Methods

We acquired T2*-weighted images of Sprague-Dawley rat brains at 17.2T in vivo. During each MRI session, rats were first anesthetized with isoflurane, then with a second sedative agent (sevoflurane, propofol, midazolam, medetomidine or ketamine-xylazine) after stopping isoflurane. We computed a T2*-oxygenation-ratio that aimed at estimating cerebral blood oxygenation level for each sedative agent in each region of interest: cortex, hippocampus, thalamus and striatum.

Results

The T2*-oxygenation-ratio was consistent across scan sessions. This ratio was higher with inhalational agents than with intravenous agents. Under sevoflurane and medetomidine, T2*-oxygenation-ratio was homogenous across the brain regions. Intravenous agents (except medetomidine) induced a T2*-oxygenation-ratio imbalance between cortex and subcortical regions: T2*-oxygenation-ratio was higher in the cortex than the subcortical areas under ketamine-xylazine; T2*-oxygenation-ratio was higher in subcortical regions than in the cortex under propofol or midazolam.

Conclusion

Preclinical UHF MRI is a powerful method to monitor the changes in cerebral blood oxygenation level induced by sedative agents across brain structures. This approach also allows for a classification of sedative agents based on their differential effects on cerebral blood oxygenation level.     

激光针灸理论与光剂量选择

激光针灸和传统针灸由于物理过程的差异其治疗机理不同。应用生物能量模型定量讨论激光热作用效应,利用几何光学模型解释光作用力的产生及其作用。根据光子中医理论和物理学基本原理,从理论角度探讨激光针灸作机理,并分析影响激光针灸作用的基本因素和最佳治疗光剂量。     

Quantification of gender specific thermal sensory and pain threshold before and after laser needle stimulation]

Quantitative thermal sensory and pain threshold testing (QST) was performed in 29 adult healthy volunteers (mean age 24.2 +/- 2.7 years; range: 18-29 years; 20 females, 9 males) using the Thermal Sensory Analyser TSA-II (Medoc Advanced Medical Systems, Ramat Yishai, Israel, and Minneapolis, Minnesota, USA) before and after laser needle acupuncture and placebo stimulation, respectively. Significant (p < or = 0,001; t-test) gender-specific differences were seen on cold pain threshold analysis. No significant changes in parameters of thermal sensory and pain thresholds were found before and after laser needle or placebo stimulation at acupuncture points for acute pain. However, a trend towards change in the median value of cold pain sensation after laser needle stimulation (p = 0.479; paired t-test; n.s.) was seen within the group of healthy females. The influence of stimulation of acupuncture points for chronic pain on the various parameters needs to be clarified in future studies.     

氦氖激光穴位照射对兔子宫和卵巢酸性磷酸酶（ACP）、碱性磷酸酶（ALP）的作用效应

用不同功率的Ｈｅ—Ｎｅ激光照射雌兔外生殖器,照射穴位,用生化方法分别测定兔子宫和卵巢的酸性磷酸酶（ＡＣＰ）、碱性磷酸酶（ＡＬＰ）的活性。激光照射后,子宫和卵巢的ＡＣＰ酶活性保持基本恒定状态,与正常对照组比较无显著差异;相反,ＡＬＰ酶活性显著提高。分析这两种酶在激光用射后表现出来的差异,作者认为是激光作用使细胞内环境改变之故,且这两种酶对Ｈｅ—Ｎｅ激光的耐受性有所不同。     

Endotracheal intubation with airtraq? versus storz? videolaryngoscope in children younger than two years - a randomized pilot-study

Background

Beach chair positioning during general anesthesia is associated with a high incidence of cerebral desaturation; poor neurological outcome is a growing concern. There are no published data pertaining to changes in cerebral oxygenation seen with increases in the inspired oxygen fraction or end-tidal carbon dioxide in patients anesthetized in the beach chair position. Furthermore, the effect anesthetic agents have has not been thoroughly investigated in this context. We plan to test the hypothesis that changes in inspired oxygen fraction or end-tidal carbon dioxide correlate to a significant change in regional cerebral oxygenation in anesthetized patients in beach chair position. We will also compare the effects that inhaled and intravenous anesthetics have on this process.

Methods/design

This is a prospective within-group study of patients undergoing shoulder arthroscopy in the beach chair position which incorporates a randomized comparison between two anesthetics, approved by the Institutional Review Board of the University of Michigan, Ann Arbor. The primary outcome measure is the change in regional cerebral oxygenation due to sequential changes in oxygenation and ventilation. A sample size of 48 will have greater than 80% power to detect an absolute 4-5% difference in regional cerebral oxygenation caused by changes in ventilation strategy. The secondary outcome is the effect of anesthetic choice on cerebral desaturation in the beach chair position or response to changes in ventilation strategy. Fifty-four patients will be recruited, allowing for drop out, targeting 24 patients in each group randomized to an anesthetic. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor (Covidien, Boulder, CO). Following induction of anesthesia, intubation and positioning, inspired oxygen fraction and minute ventilation will be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded and venous blood gas analysis performed. The overall statistical analysis will use a repeated measures analysis of variance with Tukey??s HSD procedure for post hoc contrasts.

Discussion

If simple maneuvers of ventilation or anesthetic technique can prevent cerebral hypoxia, patient outcome may be improved. This is the first study to investigate the effects of ventilation strategies on cerebral oxygenation in patients anesthetized in beach chair position.

Trial registration

NCT01535274     

Acupuncture and moxibustion for stress-related disorders

Acupuncture and moxibustion, which medical doctors are licensed by the government of Japan to perform, can improve the psychological relationship between doctors and patients, especially when it is disturbed by a “game”, a dysfunctional interpersonal interaction that is repeated unintentionally. This advantage is due to the essential properties of acupuncture and moxibustion. Acupuncture and moxibustion are helpful in treating somatoform disorders, especially musculoskeletal symptoms. In Japan, a holistic acupuncture and moxibustion therapy called Sawada-style has been developed. This is based on fundamental meridian points that are considered to have effects on central, autonomic nervous, immune, metabolic, and endocrine systems to regulate the whole body balance. In addition, some of the fundamental points have effects on Qi, blood, and water patterns associated with major depression, generalized anxiety disorder, eating disorders, and somatoform disorders. The fixed protocol of Sawada-style would be suitable for large-scale, randomized, controlled studies in the future. Recent systematic reviews indicate that electroacupuncture would be a useful addition to antidepressant therapy for some symptoms accompanying fibromyalgia. Acupuncture and moxibustion are also recommended for irritable bowel syndrome, instead of Western drug therapy. Surprisingly, the dorsal prefrontal cerebral cortex, which is associated with a method of scalp acupuncture applied for gastrointestinal disorders, has been found to be activated in patients with irritable bowel syndrome. It is quite possible that regulation of this cortical area is related to the effect of scalp acupuncture. This acupuncture method can be effective not only for irritable bowel syndrome but also for other stress-related gastrointestinal disorders.     

Influence of laser needle-knife on PI-3K,AKT and VEGF mRNA expression in cervical spondylotic arteriopathy model rabbits

Objective

To determine the effect of laser needle-knife on PI-3K, AKT and VEGF mRNA expression of vertebral arteries in a rabbit model of cervical spondylotic arteriopathy (CSA) and the mechanism of action involved.

Multi-Acupuncture Point Injections and Their Anatomical Study in Relation to Neck and Shoulder Pain Syndrome (So-Called Katakori) in Japan

Katakori is a symptom name that is unique to Japan, and refers to myofascial pain syndrome-like clinical signs in the shoulder girdle. Various methods of pain relief for katakori have been reported, but in the present study, we examined the clinical effects of multi-acupuncture point injections (MAPI) in the acupuncture points with which we empirically achieved an effect, as well as the anatomical sites affected by liquid medicine. The subjects were idiopathic katakori patients (n = 9), and three cadavers for anatomical investigation. BL-10, GB-21, LI-16, SI-14, and BL-38 as the WHO notation were selected as the acupuncture point. Injections of 1 mL of 1% w/v mepivacaine were introduced at the same time into each of these points in the patients. Assessment items were the Pain Relief Score and the therapeutic effect period. Dissections were centered at the puncture sites of cadavers. India ink was similarly injected into each point, and each site that was darkly-stained with India ink was evaluated. Katakori pain in the present study was significantly reduced by MAPI. Regardless of the presence or absence of trigger points, pain was significantly reduced in these cases. Dark staining with India ink at each of the points in the anatomical analysis was as follows: BL-10: over the rectus capitis posterior minor muscle and rectus capitis posterior major muscle fascia; GB-21: over the supraspinatus muscle fascia; LI-16: over the supraspinatus muscle fascia; SI-14: over the rhomboid muscle fascia; and BL-38: over the rhomboid muscle fascia. The anatomical study suggested that the drug effect was exerted on the muscles above and below the muscle fascia, as well as the peripheral nerves because the points of action in acupuncture were darkly-stained in the spaces between the muscle and the muscle fascia.     

激光针灸对穴位组织温度和血流灌注率的影响

本文在Pennes方程的基础上研究了激光针灸治疗对穴位组织的温度和血流灌注率的影响。结果显示,连续激光与脉冲激光针灸都能使穴位组织的温度和血流灌注率升高,随着激光的功率密度升高则穴位组织的温度和血流灌注率亦升高。通过这些研究为激光针灸的临床实际应用提供了理论基础。     

He—Ne激光穴位照射对兔子宫和卵巢细胞超微结构的作用效应

本文报道了用Ｈｅ—Ｎｅ激光照射新西兰白兔的穴位。照射外生殖器后,兔子宫和卵巢细胞超微结构在形态及数量上发生改变。线粒体数目增多,嵴长且密;高尔基复合体及内质网扩张,同时还观察到较大功率照射实验组内部分细胞膜性结构受损现象。结果表明：适当功率激光照射后,可反映出氧化代谢率高,能量代谢功能活跃。     

Cerebral blood flow and metabolism during exercise: implications for fatigue.

During exercise: the Kety-Schmidt-determined cerebral blood flow (CBF) does not change because the jugular vein is collapsed in the upright position. In contrast, when CBF is evaluated by (133)Xe clearance, by flow in the internal carotid artery, or by flow velocity in basal cerebral arteries, a approximately 25% increase is detected with a parallel increase in metabolism. During activation, an increase in cerebral O(2) supply is required because there is no capillary recruitment within the brain and increased metabolism becomes dependent on an enhanced gradient for oxygen diffusion. During maximal whole body exercise, however, cerebral oxygenation decreases because of eventual arterial desaturation and marked hyperventilation-related hypocapnia of consequence for CBF. Reduced cerebral oxygenation affects recruitment of motor units, and supplemental O(2) enhances cerebral oxygenation and work capacity without effects on muscle oxygenation. Also, the work of breathing and the increasing temperature of the brain during exercise are of importance for the development of so-called central fatigue. During prolonged exercise, the perceived exertion is related to accumulation of ammonia in the brain, and data support the theory that glycogen depletion in astrocytes limits the ability of the brain to accelerate its metabolism during activation. The release of interleukin-6 from the brain when exercise is prolonged may represent a signaling pathway in matching the metabolic response of the brain. Preliminary data suggest a coupling between the circulatory and metabolic perturbations in the brain during strenuous exercise and the ability of the brain to access slow-twitch muscle fiber populations.     

电针对局灶性脑缺血大鼠脑内神经生长因子受体trkA的影响

神经生长因子对神经元凋亡有拮抗作用,其作用方式是通过特异性受体——ｔｒｋＡ实现。为了探讨针刺对内源性抗凋亡因素的调节作用。本研究用大鼠局灶性脑缺血再灌注模型,应用免疫组织化学方法观察缺血再灌注时ｔｒｋＡ的变化及针刺对ｔｒｋＡ的影响。结果发现：缺血组对照侧大脑皮层偶见散在ｔｒｋＡ免疫阳性神经元,缺血侧大脑皮层ｔｒｋＡ阳性神经元与对照侧相比,显微镜下见无显著性差异。电针组缺血侧大脑皮层见大量ｔｒｋＡ免疫反应阳性神经元,主要分布于半影区,与对照侧及未电针的缺血侧相比,显微镜下见阳性神经元数目有差异。结果提示：电针可以诱导脑缺血时神经营养因子受体表达,调动机体内抗凋亡因素的作用。     

Laser Doppler imaging and cryoglobulinemia]

Continuous microcirculation monitoring of the right foot was carried out for the first time in a 62-year-old patient with cryoglobulinaemia prior to, during and after manual needle insertion at Jie Xi(St.41) acupuncture point using a new method of laser Doppler perfusion imaging (PIMII, Lisca AB, Link?ping, Sweden). In addition to visual inspection, changes in mean perfusion were also used as evaluation parameters. Our results suggest that the new biomedical technique of laser Doppler imaging is a useful method for monitoring the effects of acupuncture on the peripheral microcirculation.     

Recent Advances in the Understanding of Acupuncture

The controversy about acupuncture is familiar to us since its recent reintroduction into this country. Much of its philosophical concepts were taken at their face values as the bases for condemnation. Since I last reviewed these antiquated concepts in the light of modern medicine, much has developed. It seems that if the effects of acupuncture were transmitted along the peripheral nerves to the central nervous system, it would be more effective if applied segmentally to the site of noxious stimulation. Disruption of extralamniscal pathways would abolish its analgesic effect. The distant and nonsegmentally located acupuncture points exert their influences through the integrative efforts of the reticular formation and the thalamus. The demonstration of transmissibility of acupuncture analgesia through blood and cerebrospinal fluid in animals implicates the involvement of humoral factors. Since such an effect can be suppressed by naloxone or by hypophysectomy, endorphins are thought to be involved. Such laboratory evidences indeed begin to shed some light on a possible neurohumoral mechanism of acupuncture. The differences between acupuncture and hypnosis are discussed. Acupuncture points were compared with referred pain, trigger points and motor points of the skeletal muscles. Its possible uses for other than pain, such as drug addiction, alcoholism, etc. are also reviewed.     

Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials

Background

Acupuncture is frequently advocated as an adjunct treatment during stroke rehabilitation. The aim of this review was to assess its effectiveness in this setting.

Methods

We searched 25 databases and 12 major Korean traditional medicine journals from their inception to October 2009. We included randomized controlled trials, with no language restrictions, that compared the effects of acupuncture (with or without electrical stimulation) with sham acupuncture. We assessed the methodologic quality of the trials using the Cochrane risk-of-bias criteria and the PEDro (Physiotherapy Evidence Database) scale.

Results

Ten of 664 potentially relevant studies met our inclusion criteria. For acute and subacute stages after stroke, we included seven trials. A meta-analysis of the five studies that assessed functionality did not show a significant difference in favour of acupuncture, with high heterogeneity. A post-hoc sensitivity analysis of three trials with low risk of bias did not show beneficial effects of acupuncture on activities of daily living at the end of the intervention period (n = 244; standard mean difference 0.07, 95% confidence interval [CI] −0.18 to 0.32; I² = 0%) or after follow-up (n = 244; standard mean difference 0.10, 95% CI −0.15 to 0.35; I² = 0%). For the chronic stage after stroke, three trials tested effects of acupuncture on function according to the Modified Ashworth Scale; all failed to show favourable effects.

Interpretation

Our meta-analyses of data from rigorous randomized sham-controlled trials did not show a positive effect of acupuncture as a treatment for functional recovery after stroke.Acupuncture is often used as an adjunct to mainstream rehabilitation after stroke. It involves the insertion of an acupuncture needle into the skin at certain points of the body. Acupuncture is claimed to be effective for a wide range of conditions, such as pain, musculoskeletal disorders and several neurologic diseases.¹ Possible mechanisms of its effects on neurologic conditions include stimulation of neuronal cell proliferation,² facilitation of neural plasticity,³ reduction of the post-ischemic inflammatory reaction⁴ and prevention of neuronal apoptosis.⁵Before acupuncture can be recommended for routine use, we require evidence from rigorous randomized clinical trials. In acupuncture trials, it is difficult to allow blinding of the treatment allocation.⁶ A placebo must be indistinguishable from the real treatment and inert.⁶ “Sham” is used to describe any control procedure that is used to blind treatment allocation in clinical trials of acupuncture.⁶ Several sham procedures are now available, such as the use of penetrating acupuncture on nonacupuncture points, superficial puncture of the skin on acupuncture points and nonpenetration on acupuncture points with sham needle devices.⁶Several reviews assessing the effects of acupuncture for stroke have been published. However, some did not include all of the relevant articles published in Asian countries; others included interventions other than acupuncture; and several were not systematic. We conducted a systematic review to critically evaluate all of the currently available randomized sham-controlled trials of acupuncture as an adjunct to mainstream stroke rehabilitation.     

穴位激光照射的剂量和机理初探

穴位激光照射疗法是一种通过低强度激光束直接照射穴位的治疗方法,具有针灸作用。阐述了激光照射机体穴位在临床应用的本质,并对其使用的光剂量和作用机理做了初步讨论和分析。     

针刺抗脑缺血性神经元凋亡作用与机制的研究

本研究在肯定针刺抗缺血性神经元凋亡的基础上,进一步探讨针刺对内源性促凋亡因素及抑制凋亡因素的调整作用,寻找针刺对元保护作用的切入点及作用机制。结果表明：（１）针刺能减轻脑缺血导致的神经缺损行为异常,缩小梗塞面积;（２）ＰＩ荧光染色及ＴＵＮＥＬ染以显示：大鼠缺血皮层梗塞区有大量凋亡阳性信号细胞,电针后细胞凋亡受到明显抑制测定ＮＯ含量及观察ｃＮＯＳ和ｉＮＯＳ免疫活性显示：大鼠脑缺血－再灌注后脑内ＮＯ水