Tim Hideaki Tanaka

Effects of drug, biobehavioral and exercise therapies on heart rate variability in coronary artery disease: a systematic review

Background Heart rate variability (HRV) is reported as a surrogate index for clinical outcome in trials of secondary prevention strategies for coronary artery disease (CAD), but a standardized guide for interpreting HRV change is not established. Design We evaluated HRV change in trials with CAD patients who received conventional medications (β-blockers, calcium channel blockers, angiotensin converting enzyme inhibitors), biobehavioral treatment (psychotropics, biofeedback, relaxation) or exercise training. Methods Medline, Pubmed, Psycinfo, the Cochrane database, and Embase were searched until July 2007, without language restriction. We identified 33 randomized controlled trials. Two reviewers independently abstracted all trials using a standardized form. A hierarchy of frequency and time domain HRV indices defined outcome. Results A random-effects model yielded an overall pooled standardized mean difference (SMD) between treatment and control groups of moderate magnitude across treatment classes, based on a composite of time and frequency domain indices (SMD = 0.40, P < 0.0001), or only time or frequency indices (SMD = 0.37 and 0.43, respectively, both P < 0.0001). This change was equivalent to an increase in standard deviation of all normal-to-normal RR intervals of 9.0 ms (95% Confidence Interval, CI, 7.3, 10.7 ms) or a relative increase of 15.9% (95% CI, 13.2, 18.6%). To detect HRV change of this magnitude, a hypothetical trial would require a sample size of 660 patients for conventional medications or 1232 patients for all treatment classes. Conclusion Pharmacologic, biobehavioral and exercise strategies for secondary prevention of CAD significantly increase HRV. This review provides a framework to assist efforts to evaluate the contribution of HRV change to CAD prognosis. Eur J Cardiovasc Prev Rehabil 15:386-396

The effect of massage on localized lumbar muscle fatigue

BackgroundThere is not enough evidence to support the efficacy of massage for muscle fatigue despite wide utilization of the modality in various clinical settings. This study investigated the influence of massage application on localized back muscle fatigue.MethodsTwenty-nine healthy subjects participated in two experimental sessions (massage and rest conditions). On each test day, subjects were asked to lie in the prone position on a treatment table and perform sustained back extension for 90 seconds. Subjects then either received massage on the lumbar region or rested for a 5 minute duration, then repeated the back extension movement. The median frequency (MDF), mean power frequency (MNF), and root mean square (RMS) amplitude of electromyographic signals during the 90 second sustained lumbar muscle contraction were analyzed. The subjective feeling of fatigue was then evaluated using the Visual Analogue Scale (VAS).ResultsMDF and MNF significantly declined with time under all conditions. There was no significant difference in MDF, MNF or RMS value change between before and after massage, or between rest and massage conditions. There was a significant increase in fatigue VAS at the end of the 2nd back extension with rest condition. There was a significant difference in fatigue VAS change between massage and rest condition.ConclusionsA significant difference was observed between massage and rest condition on VAS for muscle fatigue. On EMG analysis, there were no significant differences to conclude that massage stimulation influenced the myoelectrical muscle fatigue, which is associated with metabolic and electrical changes.

Is there a difference between the effects of single and triple indirect moxibustion stimulations on skin temperature changes of the posterior trunk surface

Objectives To determine whether any difference exists in responses to indirect moxibustion (IM) relative to thermal stimulation duration. Methods In experiment 1, 9 subjects attended two experimental sessions consisting of single stimulation with IM or triple stimulation with IM, using a crossover design. A K-type thermocouple temperature probe was fixed on the skin surface at the GV14 acupuncture point. IM stimulation was administered to the top of the probe in order to measure the temperature curve. In addition, each subject evaluated his or her subjective feeling of heat on a visual analogue scale after each stimulation. Experiment 2 was conducted on 42 participants, divided into three groups according to the envelope allocation method: single stimulation with IM (n=20), triple stimulation with IM (n=11) and a control group (n=11). A thermograph was used to obtain the skin temperature on the posterior trunk of the participant. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk. Result In experiment 1, no significant difference in maximum temperature was found in IM and subjective feeling of heat intensity between single and triple stimulation with IM. In experiment 2, increases in skin temperature occurred on the posterior trunk, but no differences in skin temperature occurred between the groups receiving single and triple stimulation with IM. Conclusion No difference exists in the skin temperature response to moxibustion between the single and triple stimulation with IM.

Influence of different durations of electroacupuncture stimulation on skin blood flow and muscle blood volume

Objective To determine whether skin blood flow (SBF) and muscle blood volume (MBV) responses differ according to the duration of electroacupuncture (EA) stimulation. Methods Two experiments were conducted. In Experiment 1, healthy male students (n=20) were randomly divided into two groups (an EA group and a no-stimulation group). In Experiment 2, healthy male students (n=37) were randomly divided into three groups with different stimulation durations of EA (5, 10 and 15 min). EA stimulation on the quadriceps femoris muscle was administered with a frequency of 1 Hz. SBF and MBV were estimated before, during and after stimulation. Results In Experiment 1 there was a significant difference between the groups (p=0.001). In the EA stimulation group, MBV increased immediately following EA (p=0.045) and 5 min (p=0.005) and 10 min (p=0.002) after EA compared with baseline. No significant change was observed in the no-stimulation group. In Experiment 2 there was no significant difference between the groups. All three stimulation durations (5, 10 and 15 min) yielded increases in MBV after stimulation compared with baseline. SBF following stimulation for 5 and 10 min was increased compared with baseline. Conclusions Based on these findings, we consider that 10 min EA stimulation could be a sufficient duration to induce a blood flow response in a clinical situation when increasing the blood flow is desirable.

Pupillary response induced by acupuncture stimulation – an experimental study

Objectives To investigate whether acupuncture stimulation affects autonomic nerve function by measuring pupil diameters with electronic pupillography. Methods Two studies were conducted (Experiment 1 and 2) in the Tsukuba University of Technology, Tsukuba, Japan. Experiment 1 examined the responses before, during and after acupuncture. Experiment 2 compared acupuncture and a no acupuncture control in a two period, repeated measurement crossover design. Twelve healthy male university students were recruited for Experiment 1 and nine healthy male university students for Experiment 2. The intervention was superficial acupuncture at the acupuncture point TE5. Following the insertion, gentle repetitive tapping stimulation was applied during the subjects exhalation phase in a sitting position for 90 seconds. The main outcome measures in Experiment 1 were pupil diameter, heart rate, pulse wave and blood pressure. In both experiments, pupil diameter was measured for three minutes before acupuncture stimulation, during stimulation and for three minutes after stimulation. Results In Experiment 1, a decrease in pupil diameter was observed after acupuncture stimulation (P=0.018) and a decrease in heart rate was observed during the stimulation (P=0.049). Moreover, a significant decrease of pulse wave amplitude was observed during and after acupuncture stimulation. In Experiment 2, a decrease in pupil diameter occurred after acupuncture stimulation (P=0.007), whereas no change occurred under the no acupuncture control. Conclusions It is thought that the pupillary constriction observed after gentle, superficial acupuncture stimulation may be attributed to an increase of parasympathetic nerve function. Further study is necessary in order to further clarify the duration of the observed response and to elucidate the mechanisms behind it.

Is there a difference between the effects of one-point and three-point indirect moxibustion stimulation on skin temperature changes of the posterior trunk surface?

Objective To determine whether any difference exists in responses to indirect moxibustion relative to thermal stimulation sites. Methods Twenty one healthy men of mean±SD age 22.5±6.1 years were randomly divided into two groups, one receiving a single moxibustion stimulation in three locations (the three-point stimulation group, n=10 participants) and the other receiving three stimulations in one location (the one-point stimulation group, n=11 participants). The thermal stimulation sites were GV14, GV9 and GV4 acupuncture points. A thermograph was used to obtain the skin temperature on the posterior trunks of the participants. To analyse skin temperature, four arbitrary frames (the scapular, interscapular, lumbar and vertebral regions) were made on the posterior trunk. Result An increase in skin temperature on the posterior trunk was observed following both one- and three-point moxibustion administrations. The skin temperature of the lumbar region showed a significant increase after three-point stimulation compared with single-point stimulation (p=0.011). There was also a significant increase in skin temperature of the spinal region after three-point stimulation compared with one-point stimulation (p=0.046). Conclusion Administration of single moxibustion doses on the GV14, GV9 and GV4 points produces greater changes in skin temperature than three applications of moxibustion to the GV14 point only.

Tongue diagnosis: relationship between sublingual tongue morphology in three tongue protrusion angles and menstrual clinical symptoms

OBJECTIVE The morphological and color characteristics of the tongue sublingual veins (SLVs) can manifest differently within the subjects, depending on the way their tongue is curled upward. This study was conducted in order to investigate the clinical relevancy of tongue SLV diagnosis in relation to menstrual clinical symptoms (pain, clots, heavy, and scanty), using three different inspection procedures (IP1, IP2, and IP3). METHODS Three-hundred and seventy-seven female patients were asked to stick out their tongues in three specific ways which were intended to create different tongue protrusion angles. The SLV parameters for thickness (TK), length (LE), color (CL), shape (SP), and nodules (ND) were then evaluated. RESULTS According to the results of the Wald χ2 test, IP1 provides the best model for pain (R2=0.155), IP3 for clots (R2=0.437), IP2 for heavy (R2=0.268), and scanty (R2=0.192). Abnormal SLV diagnostic parameters were most strongly associated with the clinical symptom of clots (R2=0.492). CONCLUSION While the study showed the relations between tongue SLV features and menstrual clinical symptoms, as well it showed that IP2 was the best overall predictor for the symptomatic indexes used in this study, and using one particular SLV inspection procedure may not be sufficient. The application of a particular inspection method alone may cause under- or over-estimation of SLV abnormalities.

Near-infrared spectroscopy and hydrogen clearance: is there any difference between these two methods of muscle blood volume estimation?

Editor, Muscle blood volume (MBV) is commonly estimated using two methods: near-infrared spectroscopy (NIRS) and the hydrogen clearance method (HCM). The HCM, which is invasive, was initially introduced by Aukland,1–3 NIRS, in contrast, is non-invasive, and has been used to measure the local skeletal muscle deoxygenation and also to estimate regional MBV.4 When studying potential effects of acupuncture, it is desirable to minimise the potential artefacts caused by invasive testing procedures. For this reason, as well as out of consideration for the subjects comfort, the non-invasive NIRS method would be more desirable when evaluating muscle blood flow changes. Therefore, in this study we estimated MBV changes before and after electroacupuncture (EA) stimuli using NIRS and HCM, in order to determine applicability of the NIRS method in acupuncture experiments. Before the study began, the participants were told about the purpose and procedures of the study, and all participants signed consent forms. This study adhered strictly to the principles of the declaration of Helsinki and was approved by …

Effect of Different Dosages of ST36 Indirect Moxibustion on the Skin Temperature of the Lower Legs and Feet

Background: Indirect moxibustion (IM) has been previously performed between the spinous process while recording skin temperature of the trunk. However, moxibustion is often applied not only to acupuncture points on the back, but also to points located on the limbs. Thus, there is a need to investigate skin temperature (ST) responses following IM applied to the limbs. Methods: In Experiment 1 (Exp 1), subjects were randomly assigned to three groups: the left IM stimulation, right IM stimulation and control groups. In Experiment 2 (Exp 2), the subjects underwent two experimental sessions consisting of a single stimulation of IM or triple stimulations of IM. The IM stimulation was administered to the ST36 acupuncture point. A thermograph was used to obtain the ST on the lower limbs. Results: In Exp 1, the ST of the lower limbs increased in the stimulation groups whereas there was no increase in the non-stimulation group. In Exp 2, no significant response occurred between the single and triple stimulation of IM groups for all observed sites except for the left ankle ST. Conclusions: Lower limb ST increased following IM application to the ST36 point. No difference was observed between the dosage of the stimulation and ST responses.

Extraction of items identifying hiesho (cold disorder) and their utility in young males and females

OBJECTIVE Hie (cold sensation) is one of the most common health complaints in Japan. Those who suffer from severe hie are considered as having hiesho (cold disorder). However, exact hiesho symptoms have not been defined clearly and the decision as to whether a person suffers from hiesho is subjective and based on self-awareness. The study was conducted in attempt to develop a standardized hiesho diagnostic scale. METHODS Subjects comprised 1 146 students. From the self-awareness of hiesho symptoms, males and females were divided into hiesho and non-hiesho groups. Physical, behavioral and adaptive characteristics were compared using the 24-item questionnaire (four-grade survey) and indicators for hiesho symptoms were extracted. Based on the scores, a receiver operating characteristic curve was drawn for the total ordinal scale score of the extracted items in relation to the presence and absence of hiesho symptoms, and an optimal cutoff value was determined. RESULTS The self-awareness of having hiesho was found in 23.2% males and in 55.6% females. The sensitivity was 84.5% for males and 83.3% for females in the hiesho groups, and the specificity was 86.0% for males and 85.2% for females in the non-hiesho groups. CONCLUSION A questionnaire consisting of the extracted items may be useful to identify hiesho in young males and females with a high level of accuracy.