Electrical Impedance of Acupuncture Meridians: The Relevance of Subcutaneous Collagenous Bands

Background

The scientific basis for acupuncture meridians is unknown. Past studies have suggested that acupuncture meridians are physiologically characterized by low electrical impedance and anatomically associated with connective tissue planes. We are interested in seeing whether acupuncture meridians are associated with lower electrical impedance and whether ultrasound-derived measures – specifically echogenic collagenous bands - can account for these impedance differences.

Methods/Results

In 28 healthy subjects, we assessed electrical impedance of skin and underlying subcutaneous connective tissue using a four needle-electrode approach. The impedances were obtained at 10 kHz and 100 kHz frequencies and at three body sites - upper arm (Large Intestine meridian), thigh (Liver), and lower leg (Bladder). Meridian locations were determined by acupuncturists. Ultrasound images were obtained to characterize the anatomical features at each measured site. We found significantly reduced electrical impedance at the Large Intestine meridian compared to adjacent control for both frequencies. No significant decrease in impedance was found at the Liver or Bladder meridian. Greater subcutaneous echogenic densities were significantly associated with reduced impedances in both within-site (meridian vs. adjacent control) and between-site (arm vs. thigh vs. lower leg) analyses. This relationship remained significant in multivariable analyses which also accounted for gender, needle penetration depth, subcutaneous layer thickness, and other ultrasound-derived measures.

Conclusion/Significance

Collagenous bands, represented by increased ultrasound echogenicity, are significantly associated with lower electrical impedance and may account for reduced impedances previously reported at acupuncture meridians. This finding may provide important insights into the nature of acupuncture meridians and the relevance of collagen in bioelectrical measurements.     

The cutaneous intrinsic visceral afferent nervous system: A new model for acupuncture analgesia

The mechanism of acupuncture, whilst not known with certainty, has previously been considered to be stimulatory. A novel hypothesis is presented here in which C fiber tactile afferent axons bifurcate at acupuncture points and then diverge, running along acupuncture meridians, to subsequently communicate with Merkel cells. It is proposed that acupuncture disrupts the bifurcation of these axons, preventing neural transmission between Merkel cells as well as central communication with the spinal cord. Making use of the known phenomenon that acupuncture points have lower electrical resistance than adjacent skin, this hypothesis was tested using an electrical circuit model and successfully predicted the observed 10³ reduction in skin resistance at acupuncture points. In addition to explaining acupuncture and the roles of both Merkel cells and C fiber tactile afferents, the model has greater implications for neuroscience, through the postulation of a new division of the autonomic nervous system.     

Newly explored electrical properties of normal skin and special skin sites.

Skin impedance measurements at various skin sites yield different impedance loci for normal skin and special skin sites. The results of skin impedance measurements taken at such sites with a two-electrode measurement system are presented herein. Some of these sites can be identified as acupuncture points. Data from 4 volunteers were acquired by means of a data acquisition board and a measuring system consisting of the measurement circuit, including several electrode types, and a power supply. The Cole model is a model for an equivalent electrical circuit of the skin-electrode system. The system was used to derive skin-typical parameters from the Bode plot of the whole system. These parameters are the fractional power a, the pseudo-capacity K, the parallel resistance Rp, and the serial resistance Rs of the equivalent electrical circuit. The results show that the measured parameters differ between normal skin and special skin sites. These effects have not previously been discovered by other authors, since there has been no systematic investigation of many acupuncture points to date, and there has been no apparent need for such an investigation. A number of necessary criteria for acupuncture point detection can be derived from the results obtained.     

Potential applications of electrical impedance techniques in female mammalian reproduction

The measurement of electrical impedance is one of many methods that can be used for monitoring various reproductive events in female mammals. This paper summarizes the key findings in this research area that have been achieved during the past four decades. The electrical impedance in the vagina, vaginal vestibule and vulva during the estrous/menstrual cycle shows significant changes that vary among these reproductive organs, different locations in these organs and mammalian species. The changes of vaginal and vulvar impedance during periestrus are temporarily associated with the preovulatory luteinizing hormone (LH) peak and are significantly correlated with systemic levels of estradiol and progesterone. In humans, significant impedance changes during the menstrual cycle and their close association with the LH peak and ovulation have been found not only in the vagina, but also in the tongue. Findings of a number of studies suggest the possibility of using vaginal, vestibular and vulvar impedance to predict and confirm the fertile period of the estrous/menstrual cycle. There is some evidence that vulvar and cervical impedance may be a reliable indicator of impending parturition. Results in several studies also indicate the possibility of using electrical impedance methods to confirm the existence of ovarian follicular cysts, endometriosis and cervical neoplasia. However, physical and biological factors that may affect the impedance variation in the female reproductive system and tongue are still poorly understood. Their detection allows us to improve our ability to predict more precisely various reproductive processes by impedance techniques. This review also provides some considerations about the origin of impedance changes in the female reproductive system and tongue that may be useful for the systematic development of impedance methods in the field of female mammalian reproduction.     

Acupuncture for migraine prophylaxis: a randomized controlled trial

Background:

Acupuncture is commonly used to treat migraine. We assessed the efficacy of acupuncture at migraine-specific acupuncture points compared with other acupuncture points and sham acupuncture.

Methods:

We performed a multicentre, single-blind randomized controlled trial. In total, 480 patients with migraine were randomly assigned to one of four groups (Shaoyang-specific acupuncture, Shaoyang-nonspecific acupuncture, Yangming-specific acupuncture or sham acupuncture [control]). All groups received 20 treatments, which included electrical stimulation, over a period of four weeks. The primary outcome was the number of days with a migraine experienced during weeks 5–8 after randomization. Our secondary outcomes included the frequency of migraine attack, migraine intensity and migraine-specific quality of life.

Results:

Compared with patients in the control group, patients in the acupuncture groups reported fewer days with a migraine during weeks 5–8, however the differences between treatments were not significant (p > 0.05). There was a significant reduction in the number of days with a migraine during weeks 13–16 in all acupuncture groups compared with control (Shaoyang-specific acupuncture v. control: difference –1.06 [95% confidence interval (CI) –1.77 to –0.5], p = 0.003; Shaoyang-nonspecific acupuncture v. control: difference –1.22 [95% CI –1.92 to –0.52], p < 0.001; Yangming-specific acupuncture v. control: difference –0.91 [95% CI –1.61 to –0.21], p = 0.011). We found that there was a significant, but not clinically relevant, benefit for almost all secondary outcomes in the three acupuncture groups compared with the control group. We found no relevant differences between the three acupuncture groups.

Interpretation:

Acupuncture tested appeared to have a clinically minor effect on migraine prophylaxis compared with sham acupuncture.

Trial Registration:

Clinicaltrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00599586","term_id":"NCT00599586"}}NCT00599586About 6%–8% of men and 16%–18% of women in the United States and England experience migraines, with or without an aura.^1,2 A prevalence of 1% has been reported in mainland China,³ compared with 4.7% in Hong Kong and 9.1% in Taiwan.^4,5 A recent Cochrane meta-analysis suggests that acupuncture as migraine prophylaxis is safe and effective and should be considered as a treatment option for willing patients.⁶Although the specific effects acupuncture are controversial, acupuncture, as it is currently practised, clearly differentiates between real acupuncture points and nonacupuncture points. The Chinese Government launched the National Basic Research Program to obtain more data about the specificity of acupuncture points.⁷Trials from Italy and Brazil^8,9 showed that acupuncture was more effective than sham acupuncture in preventing migraines, but other trials have reported no differences.^10–13 There is no evidence that one acupuncture strategy is more effective than another for treating migraines. According to acupuncture theory, a headache on the lateral side is usually defined as a Shaoyang headache. In Jinkuiyi,¹⁴ migraines are said to affect the yang meridians (including the Taiyang, Yangming and Shaoyang meridians). In Lingshu,¹⁵ the Shaoyang meridians are said to go through the lateral side of the body, therefore the Shaoyang meridians are thought to be superior for treating migraines. Some points on the Shaoyang meridians are regarded as being more specific for migraines than other points.¹⁶Our aim was to investigate whether acupuncture at specific acupuncture points was more efficacious in preventing migraine than sham acupuncture at nonacupuncture points. We also investigated whether the efficacy varied when acupuncture points along different meridians or points along the same meridian were used.     

Reaction of the biologically active points of the skin to immunization with typhus vaccine

Electroacupuncture diagnosis was used to demonstrate the reaction of biologically active points of the skin (BAPS) to immunization with typhus vaccine. In 7 persons immunized with chemical and live (strain E) typhus vaccines, the reaction differed significantly from the initial parameters and other measurement data obtained in a group of unvaccinated subjects. The reaction of the BAPS was noticeable starting from the first day after vaccination and was far ahead of seroimmune shifts detectable in the host. The best correlation was established between the seroimmune response and the activity of the acupuncture points on meridians X and I (a positive correlation) and on meridians III, VIII and XI (a negative correlation).     

Nitric oxide modulation of norepinephrine production in acupuncture points

The purpose of this study was to examine the levels of norepinephrine (NE) turnover in skin tissues and to determine the effect of nitric oxide (NO) on NE production in acupuncture points (acupoints) and meridians. The rats were pretreated with alpha-methyl-tyrosine methyl ester and intravenously infused with L-(2,3,5,6-(3)H)-tyrosine. Blood was withdrawn and skin tissues were excised from the low skin resistance points, non-acupoint, and non-meridian areas located on leg, arm, or trunk. The results showed that the skin NE concentration and (3)H-NE release in acupoints were significantly higher than those in non-acupoints and non-meridian controls. (3)H-NE releases in the acupoints were increased by intravenous infusion of 2-N,N-diethylamino-diazenolate-2-oxide, an NO donor, but lowered by N(G)-Propyl-L-arginine, an inhibitor of neuronal NO synthesis. NE turnover rates in the acupoints were lower in the NO donor treated group while the inhibitor of NO synthesis reversed the trend. In contrast, NE turnover rates were not altered by NO donor and inhibitor of NO synthesis in non-acupoint and non-meridian control tissues. This is the first evidence that NE turnover was consistently decreased in acupoints and enhanced NE synthesis/release in acupoints were facilitated by presence of an NO donor and inhibited by an inhibitor of NO synthesis. The data suggest that skin NE synthesis/release in acupoints/meridians is increased in skin acupoints, which is modulated by L-arginine-derived NO synthesis in sympathetic nervous system.     

Corresponding measurements of delayed luminescence and impedance spectroscopy on acupuncture points

Measurements of impedance spectroscopy and delayed luminescence have been performed on the acupuncture points PC4 and PC8 and other two control points of ten volunteers. The results show that there is a highly significant difference between the imaginary parts of the impedance of the acupunctural points and that of the control points. The same difference has not be observed in the values of the total number of counts of delayed luminescence. However a relationship has been detected between the imaginary part of the impedance of PC8 point and the total number of delayed luminescence counts, similar to that one found before for collagen, and it has been seen that the temporal dynamics of the two phenomena measured on one control points are similar. In particular, these final results confirm the close connection between the delayed luminescence and the dielectric properties of biological tissues.     

Do sexual ornaments demonstrate heightened condition-dependent expression as predicted by the handicap hypothesis?

The handicap hypothesis of sexual selection predicts that sexual ornaments have evolved heightened condition-dependent expression. The prediction has only recently been subject to experimental investigation. Many of the experiments are of limited value as they: (i) fail to compare condition dependence in sexual ornaments with suitable non-sexual trait controls; (ii) do not adequately account for body size variation; and (iii) typically consider no stress and extreme stress manipulations rather than a range of stresses similar to those experienced in nature. There is also a dearth of experimental studies investigating the genetic basis of condition dependence. Despite the common claim that sexual ornaments are condition-dependent, the unexpected conclusion from our literature review is that there is little support from well-designed experiments.     

Endogenous estrogen, testosterone and progesterone levels in relation to breast cancer risk

Multiple lines of evidence support a central role of hormones in the etiology of breast cancer. In epidemiologic studies, considerable effort has focused on delineating the role of endogenous hormones in risk of breast cancer among postmenopausal women. Recently, substantial additional data has accrued from prospective studies where endogenous hormones are measured in study subjects prior to disease diagnosis. In this review, the epidemiologic evidence linking sex steroids—estrogens, testosterone, and progesterone, specifically—with subsequent risk of breast cancer in both premenopausal and postmenopausal women is summarized. Overall, a strong positive association between breast cancer risk and circulating levels of both estrogens and testosterone has now been well confirmed among postmenopausal women; women with hormone levels in the top 20% of the distribution (versus bottom 20%) have a two- to three-fold higher risk of breast cancer. Evidence among premenopausal women is more limited, though increased risk associated with higher levels of testosterone is consistent. However, both positive and null associations have been observed with estrogens and progesterone and clearly more evaluation is needed.     

New spines, new memories

For more than a century dendritic spines have been a source of fascination and speculation. The long-held belief that these anatomical structures are involved in learning and memory are addressed. Specifically, two lines of evidence that support this claim are reviewed. In the first, we review evidence that experimental manipulations that affect dendritic spine number in the hippocampus also affect learning processes of various sorts. In the second, we review evidence that learning itself affects the presence of dendritic spines in the hippocampus. Based on these observations, we propose that the presence of spines enhances synaptic efficacy and thereby the excitability of the network involved in the learning process. With this scheme, learning is not dependent on changes in spine density but rather changes in the presence of dendritic spines provide anatomical support for the processing of novel information used in memory formation.     

Electrical impedance tomography via filtered-back projection of fan current distribution: a numerical simulation

An approach to electrical impedance tomography (EIT) data acquisition inspired by NMR-filtered back-projection imaging with fan isochromat distribution is proposed. A current projection is generated by injecting current at a certain point of the sample and simultaneously collecting the current itself at different points on the half space opposite the point of current injection. After that, the injection is shifted to another point and collected as above and so on. A very simple algebra and software support the numerical simulations. This method is expected to be more sensitive than the traditional method based on potential measurements. A preliminary low resolution experiment is presented.     

Oxidative stress-related biomarkers in autism: systematic review and meta-analyses

Autism spectrum disorders (ASDs) are rarely diagnosed in children younger than 2 years, because diagnosis is based entirely on behavioral tests. Oxidative damage may play a central role in this pathogenesis, together with the interconnected transmethylation cycle and transsulfuration pathway. In an attempt to clarify and quantify the relationship between oxidative stress-related blood biomarkers and ASDs, a systematic literature review was carried out. For each identified study, mean biomarker levels were compared in cases and controls providing a point estimate, the mean ratio, for each biomarker. After meta-analysis, the ASD patients showed decreased blood levels of reduced glutathione (27%), glutathione peroxidase (18%), methionine (13%), and cysteine (14%) and increased concentrations of oxidized glutathione (45%) relative to controls, whereas superoxide dismutase, homocysteine, and cystathionine showed no association with ASDs. For the C677T allele in the methylene tetrahydrofolate reductase gene (MTHFR), homozygous mutant subjects (TT) showed a meta-OR of 2.26 (95% CI 1.30-3.91) of being affected by ASD with respect to the homozygous nonmutant (CC). Case-control studies on blood levels of vitamins suggest a lack of association (folic acid and vitamin B12) or rare association (vitamins A, B6, C, D, E). Sparse results were available for other biomarkers (ceruloplasmin, catalase, cysteinylglycine, thiobarbituric acid-reactive substances, nitric oxide) and for polymorphisms in other genes. Existing evidence is heterogeneous and many studies are limited by small sample size and effects. In conclusion, existing evidence suggests a role for glutathione metabolism, the transmethylation cycle, and the transsulfuration pathway, although these findings should be interpreted with caution, and larger, more standardized studies are warranted.     

In vivo visualization of bonghan ducts inside blood vessels of mice by using an Alcian blue staining method

An in vivo method using Alcian blue (AB) was developed for visualizing floating threadlike tissues inside blood vessels of mice. These novel structures called intravascular Bonghan ducts (IBHDs) are considered as extension of acupuncture meridians. For in vivo imaging of IBHDs, AB solution (pH 7.4) that stains mucopolysaccharides like hyaluronic acid was used. After injecting AB solution into the femoral vein of a mouse, the threadlike structures, stained deep blue, inside the inferior vena cava. The histological results, such as hematoxylin, eosin, and AB staining, show the compositions of the cells and the extracellular matrix in the IBHD. Further studies are needed to investigate their physiological functions, especially in relation with those of other circulatory systems.     

Northern Goshawk Habitat: an Intersection of Science,Management, and Conservation

Abstract: We responded to the claim by Greenwald et al. (2005) that the management recommendations for the northern goshawk in the Southwestern United States (MRNG; Reynolds et al. 1992), a food web-based conservation plan that incorporated both northern goshawk (Accipiter gentilis) and multiple prey habitats, may be inadequate to protect goshawks. Greenwald et al. (2005) based this claim on their review of 12 telemetry studies of goshawk habitat selection and 5 nontelemetry studies of the effects of vegetation structure at the home range scale on goshawk nest occupancy and reproduction that appeared after the 1992 publication of the MRNG. Greenwald et al. (2005) summarized their review as showing that 1) goshawks were habitat specialists limited to forests with mature and old-growth structures including large trees, high canopy cover, multiple canopy layering, and abundant woody debris; 2) habitats were not selected on the basis of prey abundance and, therefore, managing for prey habitats diluted goshawk habitats; and 3) selection for openings, edges, and habitat diversity was inconclusive. Our review found that when the studies' respective authors pooled their radiotagged goshawks there were weak to strong selections for old forest structures. However, the studies also documented extensive variation in use of vegetation types and structures by individual goshawks; some avoided openings, edges, young forests, and old forests, whereas others selected for these characteristics. Additionally, by virtue of their wide geographic distribution, the studies showed that the focal populations themselves occurred in a variety of forest types, some with large structural differences. We found no evidence in Greenwald's et al. (2005) review that the MRNG are inadequate to protect goshawks. Rather, the studies reviewed by Greenwald et al. (2005), as well as many studies they missed, supported the MRNG. The suggestion of inadequacy by Greenwald et al. (2005) appeared rooted in misunderstandings of goshawk habitats described in the MRNG, a discounting of the extent of variation in vegetation structural and seral stages used by goshawks, a limited understanding of the extent to which prey limits goshawks, a failure to recognize the dynamic nature of forests, and an incomplete review of the literature. We believe the MRNG are adequate because they maximize the sustainable amount of mature and old forests in goshawk home ranges and specify the kinds and intermixtures of prey habitats within home ranges. Implementation of MRNG should reduce the likelihood that the availability of vegetation structures suited to goshawk nesting and foraging, as well as abundance and availability of prey, will limit goshawk nest occupancy and reproduction.     

Efficacy of Acupuncture for Bell’s Palsy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Acupuncture has emerged as an alternative therapy for Bell’s palsy in both adults and children. However, the use of acupuncture is controversial. We conducted a systematic review and meta-analysis to assess the efficacy of acupuncture for Bell’s palsy. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, irrespective of any language restrictions. Randomized controlled trials comparing acupuncture with other therapies for Bell’s palsy in adults or children were included. Fourteen randomized controlled trials involving 1541 individuals were included in this meta-analysis. Significant association was observed in acupuncture with a higher effective response rate for Bell’s palsy (relative risk, 1.14; 95% confidence interval, 1.04–1.25; P = 0.005) but there was a heterogeneity among the studies (I² = 87%). An assessment of the included studies revealed a high risk of bias in methodological quality. An evaluation of the incidence of complications was not available, owing to incomplete data. Acupuncture seems to be an effective therapy for Bell’s palsy, but there was insufficient evidence to support the efficacy and safety of acupuncture. However, the results should be interpreted cautiously, because of the poor quality and heterogeneity of the included studies.     

Testostérone circulante et cancer de la prostate. Revue de données récentes

In vitro andin vivo studies show that androgens stimulate prostate cancer. However, evidence from epidemiological studies of an association between circulating levels of androgens and prostate cancer risk has been inconsistent, but most studies have likely been undersized given that the association may be relatively weak. We review prospective studies on the association of serum levels of free and total testosterone, the principal androgen in circulation with risk of prostate cancer. No significant association between total or free testosterone and risk of prostate cancer was found in studies that together included 1,525 cases of prostate cancer and 4,349 controls. No support was found for the hypothesis that high levels of circulating testosterone within a physiological range stimulate development and growth of prostate cancer. Intraprostatic androgen metabolism may still be of importance for prostate cancer development.     

Acupuncture for the Treatment of Drug Addiction

Over the last three decades there has been an increasing interest in acupuncture treatment of substance abuse around the world. Three important steps can be identified in this field. Dr. Wen of Hong Kong was the first (1972) to report that acupuncture at 4 body points and 2 ear points combined with electrical stimulation can relieve opioid withdrawal signs in the addicts. The second major step was made by Dr. M. Smith in New York, the head of the National Acupuncture Detoxification Association (NADA) of the USA, who finalized a protocol (1985), using only ear points without electrical stimulation for the treatment of drug abuse. The recent advance in this field was made by Dr. Han of the Peking University, Beijing, who characterized a protocol (2005), using electrical stimulation of identified frequencies on body points to ameliorate heroin withdrawal signs and prevent relapse of heroin use. In this review, the efficacy of acupuncture and related techniques for the treatment of drug dependence in experimental settings and clinical practice will be reviewed, and the possible mechanisms underlying this effect be discussed. Special issue article in honor of Dr. Ji-Sheng Han.     

Is Diabetes a Risk Factor for a Severe Clinical Presentation of Dengue? - Review and Meta-analysis

Background

The mean age of acute dengue has undergone a shift towards older ages. This fact points towards the relevance of assessing the influence of age-related comorbidities, such as diabetes, on the clinical presentation of dengue episodes. Identification of factors associated with a severe presentation is of high relevance, because timely treatment is the most important intervention to avert complications and death. This review summarizes and evaluates the published evidence on the association between diabetes and the risk of a severe clinical presentation of dengue.

Methodology/Findings

A systematic literature review was conducted using the MEDLINE database to access any relevant association between dengue and diabetes. Five case-control studies (4 hospital-based, 1 population-based) compared the prevalence of diabetes (self-reported or abstracted from medical records) of persons with dengue (acute or past; controls) and patients with severe clinical manifestations. All except one study were conducted before 2009 and all studies collected information towards WHO 1997 classification system. The reported odds ratios were formally summarized by random-effects meta-analyses. A diagnosis of diabetes was associated with an increased risk for a severe clinical presentation of dengue (OR 1.75; 95% CI: 1.08–2.84, p = 0.022).

Conclusions/Significance

Large prospective studies that systematically and objectively obtain relevant signs and symptoms of dengue fever episodes as well as of hyperglycemia in the past, and at the time of dengue diagnosis, are needed to properly address the effect of diabetes on the clinical presentation of an acute dengue fever episode. The currently available epidemiological evidence is very limited and only suggestive. The increasing global prevalence of both dengue and diabetes justifies further studies. At this point, confirmation of dengue infection as early as possible in diabetes patients with fever if living in dengue endemic regions seems justified. The presence of this co-morbidity may warrant closer observation for glycemic control and adapted fluid management to diminish the risk for a severe clinical presentation of dengue.