Patient- and Therapist-Related Risk Factors for Adverse Events in Acupuncture and Moxibustion in Japan: Multicenter Survey of Acupuncture and Moxibustion Teaching Clinics.

Background/Objective: To investigate the patient- and therapist-related factors underlying adverse events (AEs) in acupuncture and moxibustion (A&M). Design: Retrospective study using data from medical records. Subjects: Patients who underwent A&M therapy in 4 clinics providing A&M over a 6-month period and their therapists. Main Outcome Measures: Survey items included the number of patients, age, sex, number of sessions, number and type of AEs, patients' underlying disease, and the therapist's years of clinical experience. The chi-squared test was used for intergroup comparisons. Spearman's rank correlation coefficient was used to analyze the correlations between the number of sessions and AEs. Logistic regression analysis was performed with AEs as the objective variable to investigate the relationships between the various parameters and AEs. Results: The analysis included 615 patients and 113 therapists. A total of 421 AEs occurred in a total of 4,369 sessions (9.6%). The number of sessions and number of AEs were significantly and positively correlated with patients (r = 0.47, P < 0.001) and therapists (r = 0.65, P < 0.001). Logistic analysis identified patient sex (adjusted odds ratio: 1.78, 95% confidence interval: [1.39-2.30]), liver disease (0.40, [0.19-0.84]), and years of clinical experience (to a cutoff of 2 or fewer years, 2-4 years: 0.65, [0.48-0.88], 5-9 years: 0.62, [0.44-0.87], 10 years or more: 0.50, [0.37-0.68]) as significant variables. Conclusions: Female sex and fewer years of clinical experience were factors that increased the risk of AEs, and underlying liver disease was a factor that decreased the risk of AEs.

Muscle Deoxygenation and Its Heterogeneity Changes After Endurance Training.

The purpose of this study was to elucidate the time course of muscle deoxygenation and its heterogeneity changes through endurance training. Nine healthy untrained male participated in this study. The subjects performed a ramp incremental cycle exercise protocol to estimate VO2peak and muscle tissue oxygen saturation (SmO2) distribution in the VL muscle before and after 3 (3 wk-T) and 6 weeks of endurance training (6 wk-T). The probe of multi-channel near infrared spatially resolved spectroscopy was attached to the left vastus lateralis muscle along the direction of the long axis. The subjects performed cycle exercise at 60 % of VO2peak for 30 min/day, 3 days/week as the endurance training. After the training, VO2peak at 3 wk-T and 6 wk-T were significantly increased compared to pre-training (Pre-T) and VO2peak at 6 wk-T was significantly increased compared to 3 wk-T. Mean SmO2 within measurement sites at VO2peak was significantly decreased after 3 wk-T and 6 wk-T compared to Pre-T, but mean SmO2 was not significantly different between 3 wk-T and 6 wk-T. Conversely, the heterogeneity of the SmO2 during exercise was not significantly changed through endurance training. A significantly negative correlation was found between ΔVO2 and ΔSmO2 after the first 3 weeks of endurance training. In contrast, no correlation was found betweenΔVO2 and ΔSmO2 after the last 3 weeks of endurance training. These results suggest that the enhanced muscle O2 availability may be one of the primary factors in increasing VO2peak after the first 3 weeks of endurance training.

Regional Differences of Metabolic Response During Dynamic Incremental Exercise by (31)P-CSI.

The aim of this study was to detect the differences in muscle metabolic response of the quadriceps during incremental dynamic knee exercise using regional (31)Phosphorus Chemical Shift Imaging ((31)P-CSI). Sixteen healthy men participated in this study (age 28 ± 5 years, height 171.4 ± 3.9 cm, weight 67.1 ± 9.8 kg). The experiments were carried out with a 1.5-T superconducting magnet with a 5-in. diameter circular surface coil. The subjects performed isometric unilateral knee extension exercise to detect their maximum voluntary contraction (MVC) in prone position. Then they performed dynamic unilateral knee extension exercise in the magnet at 10, 20, 30 and 40 % of their MVC with the transmit-receive coil placed under the right quadriceps. The subjects pulled down a rope with the adjusted weight attached to the ankle at a frequency of 0.5 Hz for 380 s. Intracellular pH (pHi) was calculated from the median chemical shift of the inorganic phosphate (Pi) peak relative to phosphocreatine (PCr). The quadriceps were divided into three regions, (1) medial, (2) anterior, (3) lateral, and in comparison, there was no significant difference in Pi/PCr nor in pHi between regions, except Pi/PCr of the medial region was significantly higher than the anterior region at maximum intensity (p < 0.05). These results suggest that regional muscle metabolic response is similar in the quadriceps except at maximum intensity.

Effects of Acupuncture Stimulation on Muscle Tissue Oxygenation at Different Points.

Muscle tissue oxygenation is a critical issue in muscle complications such as pain, exhaustion, stiffness, or fatigue during and after exercise. The aim of this study was to investigate whether the changes of muscle tissue oxygenation could be observed at both erector spinae muscle at S1 level and gastrocnemius during and after acupuncture stimulation to ipsilateral erector spinae at S1 level. The subjects were ten healthy males. Muscle oxygenation was monitored by near infrared spectroscopy (NIRS), and the probes were placed on the right side of the erector spinae muscle at S1 level (Guanyuanshu, BL26) and the belly of the gastrocnemius on the right (Chengjin, BL56). The subjects lay on the bed in prone position for 10 min, followed by acupuncture insertion into the right side of BL26. The needle was left for 10 min and subjects were kept still for 10 min after removal. At BL26, oxygenated-hemoglobin (oxy-Hb) was significantly increased compared to the baseline at 10 min after insertion (p < 0.05), then continued increasing. Total hemoglobin (t-Hb) was increased at 2 min after removal (p < 0.05). Tissue-oxygen saturation (StO2) was increased at 7 min after insertion (p < 0.05). At BL56, oxy-Hb and t-Hb were increased at 6 and 2 min after removal, respectively (p < 0.05). StO2 showed no significant change. The acupuncture stimulation affected muscle tissue oxygenation differently at both stimulated and non-stimulated points in the same innervation.

Regional Differences in Muscle Energy Metabolism in Human Muscle by 31P-Chemical Shift Imaging.

Previous studies have reported significant region-dependent differences in the fiber-type composition of human skeletal muscle. It is therefore hypothesized that there is a difference between the deep and superficial parts of muscle energy metabolism during exercise. We hypothesized that the inorganic phosphate (Pi)/phosphocreatine (PCr) ratio of the superficial parts would be higher, compared with the deep parts, as the work rate increases, because the muscle fiber-type composition of the fast-type may be greater in the superficial parts compared with the deep parts. This study used two-dimensional 31Phosphorus Chemical Shift Imaging (31P-CSI) to detect differences between the deep and superficial parts of the human leg muscles during dynamic knee extension exercise. Six healthy men participated in this study (age 27±1 year, height 169.4±4.1 cm, weight 65.9±8.4 kg). The experiments were carried out with a 1.5-T superconducting magnet with a 5-in. diameter circular surface coil. The subjects performed dynamic one-legged knee extension exercise in the prone position, with the transmit-receive coil placed under the right quadriceps muscles in the magnet. The subjects pulled down an elastic rubber band attached to the ankle at a frequency of 0.25, 0.5 and 1 Hz for 320 s each. The intracellular pH (pHi) was calculated from the median chemical shift of the Pi peak relative to PCr. No significant difference in Pi/PCr was observed between the deep and the superficial parts of the quadriceps muscles at rest. The Pi/PCr of the superficial parts was not significantly increased with increasing work rate. Compared with the superficial areas, the Pi/PCr of the deep parts was significantly higher (p<0.05) at 1 Hz. The pHi showed no significant difference between the two parts. These results suggest that muscle oxidative metabolism is different between deep and superficial parts of quadriceps muscles during dynamic exercise.

Which is the best indicator of muscle oxygen extraction during exercise using NIRS?: Evidence that HHb is not the candidate.

Recently, deoxygenated hemoglobin (HHb) has been used as one of the most popular indicators of muscle O2 extraction during exercise in the field of exercise physiology. However, HHb may not sufficiently represent muscle O2 extraction, as total hemoglobin (tHb) is not stable during exercise. The purpose of this study was to measure various muscle oxygenation signals during cycle exercise and clarify which is the best indicator of muscle O2 extraction during exercise using NIRS. Ten healthy men performed 6-min cycle exercise at both moderate and heavy work rates. Oxygenated hemoglobin (O2-Hb), HHb, tHb, and muscle tissue oxygen saturation (SmO2) were measured with near-infrared spatial resolved spectroscopy from the vastus lateralis muscle. Skin blood flow (sBF) was also monitored at a site close to the NIRS probe. During moderate exercise, tHb, O2-Hb, and SmO2 displayed progressive increases until the end of exercise. In contrast, HHb remained stable during moderate work rate. sBF remained stable during moderate exercise but showed a progressive decrease at heavy work rate. These results provide evidence that HHb may not sufficiently represent muscle O2 extraction since tHb is not stable during exercise and HHb is insensitive to exercise-induced hyperaemia.

Induction of apoptosis in human leukemia cell (Jurkat) by neolignans isolated from seeds of Licaria puchury-major.

Ethanol extract of the seeds of Licaria puchury-major, a Brazilian herbal medicine, was found to inhibit cell proliferation in human leukemia cell line (Jurkat) by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Bioassay-guided fractionation of the active components led to the isolation of one phenylpropanoid (1) and ten neolignans (2-11). The apoptosis-inducing activity of the compounds showing cytotoxicity in Jurkat cells was assessed by flow cytometric analysis. Among the identified neolignans, compounds 3, 4, 6 and 7 which have similar molecular structures, showed apoptotic activity. To elucidate the mechanism of apoptosis induction by neolignans, intracellular caspase-3, -8 and -9 activity in Jurkat cells was evaluated. Compound 4 markedly elevated the activity of caspase-3 and -9.