Analysis of nocturia with 24-h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration: concept for effective treatment modality.

OBJECTIVE: • To determine the relationship between the number of nocturia and 24-h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration as well as to assess the significance of these factors with respect to eliminating nocturnal voidings in individual patients with nocturia. PATIENTS AND METHODS: • Among 532 participants who completed a 3-day bladder diary between April 2005 and December 2006, the diaries of 450 participants without 24-h polyuria were analyzed. • Clinical variables such as the number of daytime and night-time voids, 24-h urine volume, nocturnal polyuria index, daytime and night-time maximum voided volumes (MVV), night/day MVV ratio, sleep duration and proportion of night/day urine production rates were obtained from each diary. • Participants were classified into eight groups according to values of three factors: nocturnal MVV, proportion of night/day urine production rates and length of sleep duration. • Each group was divided into three subgroups: non-nocturics (number of nocturnal voidings is zero), mild nocturics (number of nocturnal voidings is one) and severe nocturics (number of nocturnal voidings is two or more). • The data from non-nocturics with three normal factors were regarded as the normal control and compared with the variables of the other subgroups using Dunnett's method. RESULTS: • Variables that form the basis of classifying participants into eight groups and corresponding to abnormal factors of each group were statistically significant in all the subgroups of each group. • Furthermore, a significantly increased 24-h urine volume was found in severe nocturics of the group with three normal factors. • A significantly decreased 24-h urine volume was found in non-nocturics of groups with nocturnal polyuria, decreased bladder capacity and both long sleep duration and nocturnal polyuria. • A significantly increased nocturnal MVV and night/day MVV ratio were shown in non-nocturics and mild nocturics of the groups with nocturnal polyuria and both long sleep duration and nocturnal polyuria. CONCLUSIONS: • Because nocturia is a multifactorial disorder and closely related to four factors (i.e. 24-h urine volume, nocturnal urine volume, nocturnal bladder capacity and length of sleep duration), the evaluation of all these factors appears to be clinically useful for determining the main contributing factor in patients with nocturia as well as the suitable treatment modality on an individual basis. • Physicians should take all these factors into consideration in the evaluation and treatment of nocturia.

Using a radiopaque marker with radiography for evaluating colonic transit by geometric center in conscious rats: A novel method.

This study developed a new method using radiopaque markers under X-ray to measure rat colonic transit by geometric center repeatedly and/or over a time series in the same individually. Additionally, the utility of this method was shown by elucidating the innervation of the autonomic nerve on colonic transit in detail with a pharmacological technique in conscious rats. An in-dwelling silastic cannula was inserted into the cecum and the proximal part was moved through the abdominal wall, where it was fixed to the posterior neck skin. Twenty markers were administered from the cannula to the proximal colon with saline on the fifth day after surgery. The markers were observed with soft X-ray before required repeated short anesthesia. Experimentation 1: Rats were measured colonic transit twice over 2 days with no administration. Experimentation 2: Rats were administered saline on the first day and pharmacology on the second day intraperitoneally before measurement. Experimentation 1: The markers administrated from the cannula and transited from proximal colon to distal colon over a time series. It showed no significant difference in complication rates between 2 days. Experimentation 2: The colonic transit was increasingly accelerated by neostigmine and phentolamine but not propranolol. Significant changes in 1.0 mg/kg atropine were noted although no differences were found between control and 0.05 mg/kg atropine and between each other's. We have presented the method using radiopaque markers under X-ray with short anesthesia for evaluating the colonic transit. The methods could show rat colonic transit changes in detail with a pharmacological technique.

Impact of convenience void in a bladder diary with urinary perception grade to assess overactive bladder symptoms: a community-based study.

AIM: Bladder diaries including bladder perception grade were analyzed to assess convenience void (CV) in community-dwelling women 40 years of age or older. METHODS: A total of 310 women completed a 3-day bladder diary with a grade for bladder perception. The grade was defined on scores 0-5 as follows: 0 = No bladder sensation, 1 = Sensation of bladder filling without desire to void, 2 = Desire to void, 3 = Strong desire to void, 4 = Urgency without urge urinary incontinence (UUI), and 5 = Urge incontinence episode. CV was defined as void without desire to void: when the grade was 0, CV in a narrow sense, and when 0 or 1, CV in a broad sense. RESULTS: The incidence of CV in the broad sense significantly decreased with age. Of the 310 women, 48 (15.5%) had overactive bladder (OAB) symptoms on the medical interview, including 37 (11.9%) without UUI (OAB-Dry) and 11 (3.5%) with UUI (OAB-Wet). Of the remaining 262 women, 111 (35.8%), who had urgency but a urinary frequency of 7 or less, and another 141 (48.7%) were classified into the Normal with Urgency and Normal without Urgency groups, respectively. The incidence of CV in a broad sense in the Normal without Urgency group was significantly greater than that in the Normal with Urgency and OAB-Wet groups. The mean voided volumes of CV in the broad sense in the OAB-Wet group were significantly smaller than those in the other three groups. CONCLUSIONS: The evaluation of CV may be a new tool in assessing storage condition and voiding dysfunction.

Effect of acupuncture on the haemodynamic system in men.

BACKGROUND: Acupuncture stimulation decreases heart rate (HR) through somato-autonomic reflexes. However, the mechanisms responsible for other cardiovascular changes induced by acupuncture, such as its effects on stroke volume (SV) and blood pressure (BP), remain obscure. OBJECTIVE: To evaluate continuously the comprehensive cardiovascular changes occurring during acupuncture. METHOD: 20 healthy men participated in the study. HR, SV and BP were measured in the supine position using electrocardiogram, transthoracic impedance cardiography and continuous non-invasive finger blood pressure, respectively. Manual acupuncture stimulation using a stainless steel needle was performed at LI10 for 60 s after resting periods of approximately 15 min. RESULTS: HR was reduced and SV increased, in parallel, during the period of acupuncture stimulation (P<0.01, respectively). Diastolic blood pressure (DBP) decreased in the 10 s period of acupuncture stimulation compared with the 120 s pre-stimulation period (P<0.01) and recovered close to the pre-stimulation reading instantly after the transient reduction. No change was observed in cardiac output (CO) derived from HR and SV. CONCLUSIONS: This study indicates that HR reduction during acupuncture does occur, as previous reports have indicated. SV increased during acupuncture stimulation in parallel with HR reduction and CO was maintained during these changes. Any reduction in DBP caused by acupuncture recovered to baseline, likely due to baroreflexes.

Sleep duration is an independent factor in nocturia: analysis of bladder diaries.

OBJECTIVE To analyse the relationship between the number of nocturia episodes and other variables obtained from a bladder diary, with special attention to the duration of sleep, as nocturia is closely related to sleep disorders. PATIENTS, SUBJECTS AND METHODS Between April 2005 and December 2006, 532 participants, including both community-dwelling subjects who underwent a mass screening programme and outpatients who consulted the department of urology, completed a 3-day bladder diary. Clinical variables, i.e. the number of daytime and night-time voids, diurnal and nocturnal urine volume, daytime and night-time maximum voided volume, sleep duration and nocturnal polyuria index (NPi) were obtained from the diary. The variables were assessed by univariate analysis in all participants, and by multiple regression analysis of all participants, males, females, subjects in mass screening and those with no 24-h polyuria, to determine which variables were independently associated with the number of nocturia episodes. RESULTS Univariate analysis showed a considerable correlation between the nocturia episodes and age, nocturnal urine volume, NPi and sleep duration. On multiple regression analysis, age, nocturnal urine volume, night-time maximum voided volume and sleep duration were independently related to number of nocturia episodes in all subgroups. CONCLUSIONS Sleep duration was confirmed as an independent factor in nocturia. Sleep conditions, including sleep duration, should be considered when evaluating and treating patients with nocturia.

Analysis of bladder diary with urinary perception to assess overactive bladder symptoms in community-dwelling women.

AIM: Bladder diaries including bladder perception grades were analyzed to assess overactive bladder (OAB) symptoms in community-dwelling women 40 years of age or older. METHODS: Three hundred ten women (mean 58 years) completed a 3-day bladder diary. The perception grades were defined as follows: 0 = no bladder sensation, 1 = sensation of bladder filling without desire to void, 2 = desire to void, 3 = strong desire to void, 4 = urgency without urge urinary incontinence (UUI), and 5 = urgency with UUI. RESULTS: Forty-eight women (15.5%) had OAB symptoms on medical interview, including 37 (11.9%) without UUI (OAB-Dry) and 11 (3.5%) with UUI (OAB-Wet). In the analysis of 5,709 voids, the voided volume significantly increased with the grades of perception. The 24 hr voided volume in the OAB-Dry group was significantly larger than that in the Normal group. The average voided volume in the OAB-Wet group was significantly smaller than in the OAB-Dry and the Normal groups. The mean voided volume at grade 3 in the Normal without urgency group was significantly larger than volumes in any other group. In the analysis of grades 4 and 5, voided volumes in the OAB-Wet group were significantly smaller than those in the Normal and/or OAB-Dry groups. CONCLUSIONS: A bladder diary that includes a new bladder perception grade was thought to be useful in assessing urinary sensation or incontinence as well as voiding pattern. The causes of symptoms such as urgency or urinary frequency may be different between the Normal, OAB-Dry, and OAB-Wet groups.

Acupuncture for premenstrual dysphoric disorder.

Premenstrual dysphoric disorder (PMDD), a severe type of premenstrual syndrome (PMS), is characterized mainly by psychological symptoms confined to the premenstrual period, which reduce not only patients' quality of life, but also their working activities. Although various therapies have been employed for PMDD, some patients do not respond to them. We recently employed acupuncture treatment for a patient in PMDD. Symptoms ameliorated during the acupuncture (+) period, but deteriorated during the acupuncture (-) period. This review describes the clinical course of this case. The diagnosis and treatment of PMDD are briefly summarized and previous acupuncture treatment for PMS are reviewed. The difficulties in evaluating the effectiveness of acupuncture for PMS/PMDD are addressed. It is suggested that acupuncture may be a treatment option for PMDD.

Mechanism of Electroacupuncture on Postoperative Ileus Induced by Surgical Stress in Rats.

Objectives: Acupuncture has been used for treating gastrointestinal (GI) disorders such as postoperative nausea and vomiting. Electroacupuncture (EA) accelerates GI transit following surgery and ameliorates postoperative ileus (POI) to restore colonic transit (CT); however, the mechanisms of this EA-induced restoration remain unclear. The aims of this study were to show CT following surgery and the effects of EA at ST 36 on POI induced by surgical stress (SS) in 45 conscious, male Sprague-Dawley rats. Materials and Methods: An operation was performed in each rat, setting a cannula into the cecum to connect the proximal colon to inject markers. On the day after surgery, 20 metal radiopaque markers were administered to the proximal colon of each rat. These markers were visible throughout the GI tract on soft X-ray immediately after administration and up to 240 minutes afterward. The rats were divided into 5 groups with 9 rats in each group: (1) SS; (2) 5 days post surgery (POST-5D); (3) SS + phentolamine; (4) EA alone; and (5) EA + atropine. The EA was performed at ST 36 for 20 minutes at a frequency of 10 Hz and agents were administered in the appropriate groups before markers were administered and measurements were taken. Measurements were performed the day after surgery except in the POST 5-D group. CT was calculated by the geometric center on the images showing the CT for each rat. Results: CT after surgery was delayed significantly and phentolamine accelerated CT. EA restored CT following surgery and atropine abolished the effect of EA on CT. Conclusions: The current study demonstrated that surgery induced a delay in CT through the sympathetic pathway via α-adrenoreceptors; CT was restored by EA. These results suggest that EA can be used to treat POI through mediation of the autonomic nervous system.

Effects of atropine sulfate and neostigmine on gastric electrical activity in human subjects--electrogastrographic study.

BACKGROUND/AIMS: There are few reports about the cholinergic regulation of gastric electrical activities using percutaneous electrogastrograms (EGG). To determine the effect of intravenous administration of a vagal blocker (atropine sulfate) or a vagal stimulator (neostigmine) on gastric electrical activities EGG was utilized in this study. METHODOLOGY: EGG was recorded before and after administration of a vagal blocker (atropine sulfate, 0.02mg/kg) and/or vagal stimulator (neostigmine, 0.008mg/kg) in six normal volunteers. RESULTS: After administration of atropine sulfate, the original waves on EGG almost disappearedand decreased amplitudes were detected by visual inspection in all subjects. Moreover, increase amplitude on EGG was clearly demonstrated after administration of neostigmine in all subjects. It was also shown that the effects of these medicines persisted more than 60 minutes after injection. CONCLUSIONS: These findings suggest that the EGG reflected gastric motility, and that neurological regulation of EGG was mediated through the vagal and/or cholinergic efferent pathway.

Pudendal nerve electroacupuncture for lumbar spinal canal stenosis - a case series.

OBJECTIVE: To investigate the effectiveness of pudendal nerve electroacupuncture for lumbar and lower limb symptoms in patients with lumbar spinal canal stenosis for whom acupuncture of the lumbar and lower limb muscles had been ineffective. METHODS: Nine patients with lumbar spinal canal stenosis for whom conventional acupuncture at the lumbar and lower limb muscles had no effect. Pudendal nerve electroacupuncture was performed eight times (once per week). VAS scores and continuous walking distance were used to evaluate changes in symptoms. RESULTS: The following changes in symptoms occurred after pudendal nerve electroacupuncture: low back pain was improved from 45.3+/-17.4mm (mean +/- SD) to 39.2+/-14.0mm, lower limb pain was improved from 61.1+/-5.6mm to 35.4+/-11.9mm, lower limb dysaesthesia was improved from 63.9+/-8.4mm to 46.9+/-16.2mm, and continuous walking distance was improved from 100.0+/-35.4m to 250.0+/-136.9m. Conclusion Pudendal nerve electroacupuncture may be an effective treatment for lumbar and lower limb symptoms due to spinal canal stenosis, and is potentially useful in patients who have not responded to conventional acupuncture.

The effect of electrical stimulation of the pudendal nerve on sciatic nerve blood flow in animals.

OBJECTIVE: To investigate the mechanism of the clinical effect of electroacupuncture of the pudendal nerve on the lumbar and lower limb symptoms caused by lumbar spinal canal stenosis, we studied changes in sciatic nerve blood flow during electrical stimulation of the pudendal nerve in the rat. METHODS Using rats (n=5), efferent electrical stimulation to the pudendal nerve was performed and sciatic nerve blood flow was measured with laser Doppler flowmetry. Simultaneously, changes in the blood pressure and cardiac rate were measured. Furthermore, the effect of atropine on these responses to the stimulation was also studied. RESULTS: Electrical stimulation of the pudendal nerve significantly increased blood flow in the sciatic nerve transiently without increasing heart rate and systemic blood pressure. The significant increase in the sciatic nerve blood flow disappeared after administration of atropine. CONCLUSION: Electrical stimulation of the pudendal nerve causes a transient and significant increase in sciatic nerve blood flow. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves.

Trigger point acupuncture for treatment of knee osteoarthritis--a preliminary RCT for a pragmatic trial.

BACKGROUND: There is evidence for the efficacy of acupuncture treatment in knee osteoarthritis, but it remains unclear which acupuncture modes are most effective. We evaluated the effects of trigger point acupuncture on pain and quality of life in knee osteoarthritis patients, compared with acupuncture at standard points, and sham acupuncture. METHODS: Thirty patients (27 women, 3 men; aged 61-82 years) with non-radiating knee osteoarthritis pain for at least six months and normal neurological examination were randomised to one of three groups for the study period of 21 weeks. Each group received five acupuncture treatment sessions. The standard acupuncture point group (n=10) received treatment at traditional acupuncture points for knee pain; the trigger point acupuncture group (n=10) received treatment at trigger points; and the third group (n=10) received sham acupuncture treatment at the trigger points. Outcome measures were pain intensity (visual analogue scale, VAS) and WOMAC index (Western Ontario and McMaster Universities Arthritis Index). The groups were compared by the area under the curve method. RESULTS: Five patients dropped out of the study because of lack of improvement, and one patient (in the trigger point acupuncture group) dropped out because of deterioration of symptoms; the remaining 24 patients were included in the analysis. After treatment, the trigger point acupuncture group reported less pain intensity on VAS than the standard acupuncture or sham treatment group, but both the trigger point acupuncture and standard acupuncture groups reported improvement of function of knee. There was a significant reduction in pain intensity between pre-treatment and five weeks after treatment for the trigger point acupuncture (P<0.01) and standard acupuncture groups (P<0.01) included in the analysis, but not for the sham treatment group. Group comparison using the area under the curves demonstrated a significant difference only between trigger point acupuncture and sham treatment groups analysed (P<0.025 for VAS, and P<0.031 for WOMAC). CONCLUSION: These results suggest that trigger point acupuncture therapy may be more effective for osteoarthritis of the knee in some elderly patients than standard acupuncture therapy.

Effect of electroacupuncture stimulation on long-term recovery following Achilles tendon rupture in a rat model.

AIMS: In this study we examined the effect of electroacupuncture (EA) stimulation on the mechanical strength of the rat Achilles tendon after long-term recovery. METHODS: Using 20 rats, an Achilles tendon rupture model was created in an invasive manner. The rats were assigned to one of three groups, that received EA treatment (EA group), minimal acupuncture (MA group) or remained untreated (Control group). In the EA group, EA stimulation (5 ms, 50 Hz, 20 µA, 20 min) was applied to the rupture region over a period of 90 days (five times/week). In the MA group, needles were inserted into the same positions as in the EA group but no electrical current was applied. After 90 days the tendon was measured to calculate the cross-sectional area of the rupture region. Then, the mechanical strength of the tendon was measured by tensile testing. RESULTS: No significant differences were observed between the three groups in cross-sectional area of the injured tendon. For maximum breaking strength, the EA group showed a significantly higher threshold compared with the Control group (P<0.05) but not the MA group (P=0.24). No significant difference was seen between the MA group and the Control group (P=0.96). CONCLUSION: Given the EA group showed a significant increase in maximum breaking strength, it is likely that EA stimulation increases the mechanical strength of a repaired tendon after long-term recovery, and EA stimulation could be useful for preventing re-rupture.

Randomised trial of trigger point acupuncture compared with other acupuncture for treatment of chronic neck pain.

INTRODUCTION: There is some evidence for the efficacy of acupuncture in chronic neck pain (CNP) treatment, but it remains unclear which acupuncture modes are most effective. Objective was to evaluate the effects of trigger point acupuncture on pain and quality of life (QOL) in CNP patients compared to three other acupuncture treatments (acupoints, non-trigger point and sham treatment). METHODS: Forty out-patients (29 women, 11 men; age range: 47-80 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating CNP for at least 6 months and normal neurological examination were randomised to one of four groups over 13 weeks. Each group received two phases of acupuncture treatment with an interval between them. The acupoint group (standard acupuncture; SA, n=10) received treatment at traditional acupoints for neck pain, the trigger point (TrP, n=10) and non-trigger point (non-TrP, n=10) groups received treatment at tenderness points for the same muscle, while the other acupuncture group received sham treatments on the trigger point (SH, n=10). Outcome measures were pain intensity (visual analogue scale; VAS 0-100mm) and disease specific questionnaire (neck disability index; NDI, 60-point scale). RESULTS: After treatment, the TrP group reported less pain intensity and improved QOL compared to the SA or non-TrP group. There was significant reduction in pain intensity between the treatment and the interval for the TrP group (p<0.01, Dunnett's multiple test), but not for the SA or non-TrP group. CONCLUSION: These results suggest that trigger point acupuncture therapy may be more effective on chronic neck pain in aged patients than the standard acupuncture therapy.

Effects of trigger point acupuncture on chronic low back pain in elderly patients--a sham-controlled randomised trial.

INTRODUCTION: There is some evidence for the efficacy of acupuncture, but it remains unclear whether trigger point acupuncture is effective. Our objective was to evaluate the effects of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared with sham acupuncture. METHODS: Twenty-six consecutive out-patients (17 women, 9 men; age range: 65-91 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to two groups. Each group received one phase of trigger point acupuncture and one of sham acupuncture with a three week washout period between them, over 12 weeks. Group A (n = 13) received trigger point acupuncture in the first phase and sham acupuncture in the second. Group B (n = 13) received the same interventions in the reverse order. Outcome measures were pain intensity (visual analogue scale, VAS) and Roland Morris Questionnaire. RESULTS: Nineteen patients were included in the analysis. At the end of the first treatment phase, group A receiving trigger point acupuncture scored significantly lower VAS (P < 0.001) and Roland Morris Questionnaire scores (P < 0.01) than the sham control group. There were significant within-group reductions in pain in both groups during the trigger point acupuncture phase but not in the sham treatment phase. However, the beneficial effects were not sustained. CONCLUSION: These results suggest that trigger point acupuncture may have greater short term effects on low back pain in elderly patients than sham acupuncture.

Relief of low back pain immediately after acupuncture treatment--a randomised, placebo controlled trial.

BACKGROUND: The purpose of this study was to examine the immediate effect of single acupuncture stimulation to the most painful point in patients with low back pain. METHOD: A randomised, evaluator-blinded, sham controlled clinical trial was conducted in which 31 patients with low back pain were randomly allocated to either an acupuncture group (n = 15) or a sham acupuncture group (n = 16). Both acupuncture and sham acupuncture were performed at the most painful point on the lower back of the subjects. For the acupuncture group, a stainless steel needle was inserted to a depth of 20 mm and manually stimulated (sparrow pecking method) for 20 seconds, while for the sham treatment a guide tube without a needle was placed at the point and tapped on the skin. Changes in low back pain were evaluated with a visual analogue scale (VAS) and the Schober test. Participants were also asked if they felt the needling sensation or not. The therapy and the evaluation were independently performed by two different acupuncturists. RESULTS: VAS score and the Schober test score showed significant improvement after treatment as compared with the sham group (P = 0.02, 0.001, respectively). There were no significant differences in the needling sensation between the acupuncture and sham group. CONCLUSION: These results suggest that acupuncture at the most painful point gives immediate relief of low back pain.

Acupuncture for the treatment of trigger finger in adults: a prospective case series.

OBJECTIVE: To determine the effect of acupuncture performed at the synovial and ligamentous tendon sheath (A1 pulley site) on pain during snapping and the severity of the snapping phenomenon in patients with trigger finger. METHODS: In this observational study, changes in the patients' condition were compared before and after acupuncture treatment. Acupuncture was performed on 19 fingers of 15 patients. Acupuncture needles were inserted into the radial and ulnar sides of the flexor tendon at the A1 pulley of the affected finger. Treatment was performed daily up to a maximum of five times. Before and after each treatment, pain during snapping and the severity of snapping were evaluated using a visual analogue scale (VAS). RESULTS: VAS scores for pain and snapping severity were significantly improved immediately after the first treatment (p<0.001). Pain during snapping, assessed before each treatment, improved over time, reaching statistical significance from the second treatment onwards (p<0.001); similarly, a significant improvement in the severity of snapping was observed, also from the second treatment (p<0.001). Patients with clinically significant improvements (≥50%) in pain and snapping severity had a significantly shorter duration of the disorder than those with <50% improvement (p<0.05). CONCLUSIONS: Acupuncture at the impaired A1 pulley site may be an effective treatment for trigger finger. We postulate that acupuncture may reduce inflammation/swelling of the synovial membrane of the tendon sheath, which predominates when the disorder is of short duration. Further research is required to confirm the efficacy/effectiveness of acupuncture for trigger finger and its mechanisms of action.

The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.

OBJECTIVE: To examine the effect of electroacupuncture (EA) on early post-rupture tendon repair in a rat model of Achilles tendon rupture using histological and mechanical evaluation. METHODS: An Achilles tendon rupture model was prepared in 90 Wistar rats, which were randomly assigned to EA, manual acupuncture or control groups. Rats in the EA group received EA (pulse width 5 ms; stimulation frequency 50 Hz; stimulation strength 20 µA; stimulation time 20 min) daily from 1 day following model preparation until the day of assessment (either 7 or 10 days after model preparation), when the region of interest was sampled to assess tendon repair using in vitro methods. Total cell count and the number of cells staining positive for transforming growth factor-ß1 (TGF-ß1) and basic fibroblast growth factor (b-FGF) were measured. Tension tests were performed 10 days after model preparation to measure the maximum breaking strength of the repaired tendon. RESULTS: Both the total cell count and the number of cells positive for b-FGF were significantly higher in the EA group (p<0.05). In the EA group only, immunostaining showed strong expression of TGF-ß1 7 days after model preparation (p<0.05). Maximum breaking strength of the repaired tendon 10 days after model preparation was significantly higher in the EA group (p<0.01). CONCLUSIONS: The marked increase in cell count and growth factor expression as well as increased tendon strength in the EA group suggest that EA may be a useful method for promoting tendon repair.

Comparison of transient heart rate reduction associated with acupuncture stimulation in supine and sitting subjects.

We investigated the difference in transient heart rate reduction associated with brief acupuncture in 20 healthy subjects at rest in a supine and in a sitting position. After the subjects had been at rest for about 20 minutes, acupuncture needling using the sparrow-pecking method, in which the needle is moved vertically lifting and thrusting, was performed for one minute at the Shousanli point on the right forearm (LI10). The procedure was carried out with the subjects in a supine position and in a sitting position. The position for stimulation of each subject, either supine or sitting, was selected at random, and on different days. The results showed that the average heart rate reduction associated with stimulation in supine subjects was 3.6 +/- 0.19 (mean +/- standard error (SE)) beats per minute (bpm), while that for sitting subjects was about 7.0 +/- 1.07 (mean +/- SE) bpm, indicating that stimulation reduces heart rate to a greater degree in subjects who are sitting (p<0.05, Mann-Whitney test). These results would be consistent with a mechanism involving reduced sympathetic drive to the heart, as sympathetic nerve activity has more influence on the heart rate in the sitting than in the supine position.

Trigger point acupuncture treatment of chronic low back pain in elderly patients--a blinded RCT.

OBJECTIVE: There is some evidence for the efficacy of acupuncture in chronic low back pain, but it remains unclear which acupuncture modes are most effective. Our objective was to evaluate the effects of two different modes of trigger point acupuncture on pain and quality of life in chronic low back pain patients compared to standard acupuncture treatment. METHODS: Thirty five consecutive out-patients (25 women, 10 men; age range: 65-81 years) from the Department of Orthopaedic Surgery, Meiji University of Oriental Medicine, with non-radiating low back pain for at least six months and normal neurological examination, were randomised to one of three groups over 12 weeks. Each group received two phases of acupuncture treatment with an interval between them. Nine patients dropped out during the course of the study. The standard acupuncture group (n=9) received treatment at traditional acupuncture points for low back pain, while the other acupuncture groups received superficial (n=9) or deep (n=9) treatments on trigger points. Outcome measures were VAS pain intensity and Roland Morris Questionnaire. RESULTS: After treatment, the group that received deep needling to trigger points reported less pain intensity and improved quality of life compared to the standard acupuncture group or the group that received superficial needling to trigger points, but the differences were not statistically significant. There was a significant reduction in pain intensity between the treatment and interval in the group that received deep needling to trigger points (P<0.01), but not in the standard acupuncture group or the group that received superficial needling to trigger points. CONCLUSION: These results suggest that deep needling to trigger points may be more effective in the treatment of low back pain in elderly patients than either standard acupuncture therapy, or superficial needling to trigger points.