In vivo evaluation of liver function by multimodal imaging in an alcohol-induced liver injury model.

Background: Visually evaluating liver function is a hot topic in hepatology research. There are few reliable and practical visualization methods for evaluating the liver function in vivo in experimental studies. In this study, we established a multimodal imaging approach for in vivo liver function evaluation and compared healthy mice with chronic alcoholic liver injury (cALI) model mice to explore its potential applicability in experimental research. Methods: In vivo fluorescence imaging (IVFI) technology was utilized to visually represent the clearance of indocyanine green from the liver of both healthy mice and mice with cALI. The reserve liver function was evaluated via IVFI using the Cy5.5-galactosylated polylysine probe, which targets the asialoglycoprotein receptor of hepatocytes. Hepatic microcirculation was assessed through laser speckle perfusion imaging of hepatic blood perfusion. The liver microstructure was then investigated by in vivo confocal laser endomicroscopy imaging. Finally, hepatic asialoglycoprotein receptor expression, histology, and the levels of serum alanine aminotransferase and aspartate aminotransferase were measured. Results: In vivo multimodal imaging results intuitively and dynamically showed that indocyanine green clearance [mean ± standard deviation (SD): 30.83±14.71, 95% confidence interval (CI): 20.3 to 41.35], the fluorescence signal intensity (mean ± SD: 1,217.92±117.63; 95% CI: 1,148.38 to 1,290.84) and fluorescence aggregation area (mean ± SD: 5,855.80±1,271.81; 95% CI: 5,051.57 to 6,653.88) of Cy5.5-galactosylated polylysine targeting the asialoglycoprotein receptor, and hepatic blood perfusion (mean ± SD: 1,494.86±299.33; 95% CI: 1,316.98 to 1,690.16) in model mice were significantly lower than those in healthy mice (all P<0.001). Compared to healthy mice, the model mice exhibited a significant decline in liver asialoglycoprotein receptor expression (mean ± SD: 219.03±16.34; 95% CI: 208.97 to 230.69; P<0.001), increased serum alanine aminotransferase (mean ± SD: 149.70±47.89 U/L; 95% CI: 81.75 to 128.89; P=0.01) and aspartate aminotransferase levels (mean ± SD: 106.30±36.13 U/L; 95% CI: 122.01 to 180.17; P=0.021), hepatocyte swelling and deformation, disappearance of the hepatic cord structure, partial necrosis, and disintegration of hepatocytes. The imaging features of fluorescence signals in liver regions, hepatic blood perfusion and microstructure were biologically related to hepatic asialoglycoprotein receptor expression, serum indices of liver function, and histopathology in model mice. Conclusions: Utilizing in vivo multimodal imaging technology to assess liver function is a viable approach for experimental research, providing dynamic and intuitive visual evaluations in a rapid manner.

Effects of electroacupuncture on liver function in mice with chronic alcoholic liver injury: visual display by in vivo fluorescence imaging.

OBJECTIVE: Acupuncture can improve the symptoms of alcohol-induced bodily injury and has been accepted by the World Health Organization. In this study, in vivo fluorescence imaging (IVFI) was applied to display and evaluate the effect of electroacupuncture (EA) on liver function (LF) in mice with chronic alcoholic liver injury (cALI). METHODS: IVFI of the Cy5.5-galactosylated polylysine (Cy5.5-GP) probe targeting the liver asialoglycoprotein receptor (ASGPR) and liver indocyanine green (ICG) clearance was performed to visually evaluate the effect of EA at ST36 and BL18 on liver reserve function and hepatic metabolism in mice with cALI. In addition, changes in ASGPR expression, serum indexes of LF, and hepatic morphology were observed. RESULTS: After EA at ST36 and BL18, the ASGPR-targeted fluorescence signals (FS) in the liver increased significantly in cALI mice (p < 0.05) and exhibited relationships with liver ASGPR expression, liver ICG clearance, liver histology, and serum marker levels of LF in cALI mice undergoing EA intervention. CONCLUSIONS: As displayed by IVFI, EA at ST36 and BL18 appears to improve liver reserve function and inhibit the development of liver injury in mice with cALI. EA may have potential as a treatment strategy to protect against ALI.

[Specification and solution of the normative elements in the development of the national standard: "Pure moxa stick"].

This paper introduced the research ideas and methods for the development of the national standard, "Pure moxa stick". According to the orientation of product standard and related documents, on the basis of extensive investigation and in consultation with manufacturers and experts, the problems encountered in this standard development were solved. The general technical requirements were specified in association with the basic experimental data. The technical requirements should not only conform to the current technological status of moxa sticks production, but also present a certain of innovation. The innovation of this standard lies in the concepts of the ratio of leaves to floss, the ratio of whole plant to floss, density, etc. Besides, the main technical requirements of "Pure moxa stick" have been specified, i.e. material, shape and structure, combustion characteristics, physical and chemical characteristics. The development of national standard "Pure moxa stick" contributes to the favorable exploration and practice of the standardization of traditional Chinese medicine and provides the effective reference for the further stan-dardization of acupuncture and moxibustion.

[Effect of electroacupuncture on the hemorheology and hepatic microcirculation in mice with chronic alcoholic liver injury].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the hemorheology and hepatic microcirculation in mice with chronic alcoholic liver injury (cALI), so as to explore the microcirculation mechanism of EA underlying regulating liver function in cALI mice. METHODS: Forty Kunming mice were randomly assigned to control, model, acupoint EA and non-acupoint EA groups, with 10 mice in each group. The cALI model was established by gavage with 50% ethanol (15 mL/kg，2 times per day with 8 hours' interval) for 28 d. Mice in the acupoint EA group received EA at bilateral "Zusanli" (ST36) and "Ganshu"(GB11) for 20 min, once daily for 14 d. And mice in the non-acupoint EA group received EA the spot about 1 cm lateral to GB11 and 0.5 cm lateral to ST36 respectively for 20 min, once daily for 14 d. The hepatic blood perfusion (HBP) of mice was detected by laser speckle perfusion imaging. The index of hemorheology, serum markers of liver function and hepatic histology in mice were observed by automatic blood rheometer, automatic bio-analysis machine and H.E. staining, respectively. RESULTS: Compared with the control group, the HBP of the model group was significantly decreased (P<0.05); the low-cut whole blood viscosity, plasma viscosity, and erythrocyte sedimentation level were significantly increased （P<0.05）, and the red blood cell deformation index was significantly decreased (P<0.05); serum alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) increased significantly (P<0.05) in the model group. Hepatocyte steatosis accompanied by inflammatory cell infiltration and focal necrosis was observed in the model group. After EA at ST36 and GB11, and in comparison with the model group showed that the HBP was significantly increased (P<0.05); the low-cut whole blood viscosity, plasma viscosity, erythrocyte sedimentation rate and serum GGT were significantly decreased (P<0.05), and the red blood cell deformation index was significantly increased (P<0.05）; the degree of fatty degeneration in the liver tissue was reduced, and the focal necrosis was reduced. The plasma viscosity, erythrocyte sedimentation rate were significantly decreased (P<0.05), and the red blood cell deformation index was significantly increased in the non-acupoint EA group relevant to the model group (P<0.05). The erythrocyte sedimentation rate and the red blood cell deformation index of the acupoint EA group was significantly lower than that of the non-acupoint EA group (P<0.05). CONCLUSION: EA at ST36 and GB11 could improve the hemorheological disorder and the hepatic microcirculation, and inhibit the deve-lopment of liver injury in cALI mice.

[Display of low hydraulic resistance channels along Conception Vessel by in vivo fluorography in rats].

OBJECTIVE: To display the low hydraulic resistance channel along the running course of the Conception Vessel (CV) by using in vivo fluorography, so as to provide evidence for the existence of meridians of traditional Chinese medicine from the aspect of interstitial fluid channel. METHODS: A total of 24 male SD rats were randomly divided into 3 groups, namely CV-low impedance spots (CV-LIS), CV-low hydraulic resistance points (CV-LHRP) and non-meridian points (NMP) groups (n＝8 in each group). The CV-LIS (the imaged line between the xiphoid process and symphysis pubis), CV-LHRP (lateral and parallel to LIS) and NMP (lateral and parallel to CV-LHRP) were detected by using meridian detector and biofluid resistance meter, respectively. Sodium fluorescein solution (1%) was injected into the spot (A-spot, upper 1/5 of the CV-LIS), and one of the NMP (about 1 cm lateral and parallel to the A-spot, and the mid-point between the Kidney and Stomach meridian running courses) by using a microsyringe for observing the migration trace of sodium fluorescein. RESULTS: After injection of fluorescein, the migration trace of fluorescein appeared along the CV-LIS and CV-LHRP lines, and only local diffusion was found in the NMP group. The migration trace lengths along the CV-LIS and CV-LHRP were significantly longer than that of the NMP group (P<0.01), and the migration width of CV-LIS and CV-LHRP groups was significantly smaller than that of the NMP group (P<0.01). The migration speed of CV-LIS and CV-LHRP groups was significantly higher than that of the NMP group (P<0.01). CONCLUSION: Fluorography is able to be used to display the running course of CV, possibly supporting the existence of meridians from the interstitial fluid channel and providing a new method for visualization of meridians.

[Effect of Needle Embedded in Neiguan (PC6) on Changes of ECG in Chronic Myocardial Ischemia Model Mini-pigs].

Objective To observe the effect of needle embedded in Neiguan (PC6) on electro- cardiogram (ECG) changes in model mini-pigs with chronic myocardial ischemia. Methods The protein shrink narrow ring (Ameroid Ring) was placed in the proximal part of the left coronary anterior descend- ing branch of 12 Chinese mini-pigs to prepare animal model. One died during the modeling. Chronic myo- cardial ischemia mini-pig models were established after 4 weeks. Successfully modeled 11 mini-pigs were divided into the test group (n =6) and the control group (n =5). Needle were embedded in Neiguan (PC6) of the test group and Zusanli (ST36) of the control group at week 4 after modeling. Electroacupuncture (EA) at corresponding acupoint twice (once before embedding and at week 2 after embedding) , 20 min each time. Changes of Q wave of ECG, heart rate, and ST-T interval were observed in the two groups be- fore and after modeling, before and after EA. Results Compared with before modeling in the same group, the absolute value of Q wave both increased in the two groups after modeling (P <0. 05, P <0. 01J. No statistical difference existed in heart rate in the two groups between before and after modeling (P> 0. 05). Compared with before needling in the same group, ST-T interval was prolonged in the test group (P <0. 05). Compared with the control group at the same time point, the absolute value of Q wave was re- duced before EA, ST-T interval was prolonged after EA in the test group (P <0. 05). No statistical differ- ence existed in heart rate between the control group and the test group before EA (P >0. 05). Conclusion Needle embedded in Neiguan (PC6) could arrive at therapeutic effect of myocardial ischemia possibly through improving myocardial blood supply.

[Low back pain of cold-damp pattern treated with electric-thermal Bian-stone therapy and traditional moxibustion: a randomized controlled trial].

OBJECTIVE: To compare the difference in the efficacy on low back pain of cold-damp pattern between electric-thermal Bian-stone therapy and moxibustion box therapy. METHODS: Forty-one cases of low back pain of cold-damp pattern were randomized into an electric-thermal Bian-stone therapy group (group A, 26 cases) and a box moxibustion therapy group (group B, 15 cases). In the group A, the electric-thermal Bian-stone was placed over Shenshu (BL 23) and Weizhong (BL 40). The temperature of stone was adjusted in accordance with patient's comfort. In the group B, moxibustion box was used over Shenshu (BL 23) and Weizhong (BL 40). The treatment was given once every day or every two days. Ten treatments made one session. The symptom and physical signs score of low back pain and the score of cold-damp syndrome were observed before and after treatment in the patients. RESULTS: The symptom and physical signs score of low back pain and the score of cold-damp syndrome were all improved in the two groups (all P < 0.01). The changing rate of symptom and physical signs and syndrome were (37.04 +/- 32.68)% and (22.85 +/- 29.95)% in the group A, and were (47.29 +/- 22.08)% and (23.89 +/- 22.53)% in the group B, respectively, without significant difference in comparison between the two groups (all P > 0.05). CONCLUSION: The efficacy on low back pain of cold-damp pattern treated with the electric-thermal Bian-stone therapy is similar to that of moxibustion box therapy. This therapy is characterized as more convenient, safer operation and less pollution.

[Discussion on the model organism in acupuncture and meridians researches].

Using model organism to replace human subjects for experimental objects is an important part in basic research on acupuncture therapy. In the process of experimental research, the first thing is that if the animal model is suitable for revealing the underlying mechanism of acupuncture intervention, if it is relatively close to structures of the human body. In addition, some factors such as being easy to feed, larger in the volume and body-surface, lesser in fur, stable in the germline and reasonable in the cost should be considered. In current acupuncture study, most experiments were carried out in mice and rats, some were conducted in rabbits and cats, fewer conducted in larger animals like mini-pigs and monkeys. Due to being smaller in both body size and superficial area in the mouse and rat, soft and comate skin in the rabbit and cat, difficult breeding for cattle and horse, experimental studies of acupuncture-meridians are in fact not ideal in these animals. Mini-pig has a larger body size and body surface, being similar to the human body in the skin structure and easy to breed, and the monkey is mostly close to the human in the gene and body size, and is thus an ideal model organism for acupuncture research. Because acupoint and meridians have their space specificity, the usage of larger animal as the model organism is necessary.

Induction of Hyperalgesia in Pigs through Blocking Low Hydraulic Resistance Channels and Reduction of the Resistance through Acupuncture: A Mechanism of Action of Acupuncture.

According to the classic theory of Chinese medicine, pain is due to the blockage in meridian channels, and acupuncture was invented to treat pain by "dredging" the channels. To test the theory, a hyperalgesia model was made by injecting hydrogel into low hydraulic resistance channel (LHRC) in 12 anaesthetized minipigs. Tail-flick threshold and ear-flick threshold were measured using a thermal radiation dolorimeter, and relative flick threshold (RFT) was calculated. Hydraulic resistance (HR) was measured with a biological HR measuring instrument on low HR points on LHRC and on control points with higher HR located outside LHRC; readings were recorded before, during, and after acupuncture treatment. RFT decreased after blocking the LRHC and was still significantly decreased 2 days and 4 days afterwards. No significant changes occurred when injecting saline into the same points or injecting gel into points outside the channel. Subsequent acupuncture reduced HR on LRHC along meridians but had no significant effect on sites with higher HR located outside LHRC. One of the mechanisms of action of acupuncture treatment for chronic pain may be that acupuncture affects peripheral tissue by reducing the HR in LHRC along meridians, improving the flow of interstitial fluid and removing algogenic substances and thereby relieving pain.

Pathological Changes in Internal Organs after Blocking Low Hydraulic Resistance Channels along the Stomach Meridian in Pigs.

Objective. The correlation between meridians and organs (Zang-fu) is an important aspect of meridian theory. The objective of this paper is to investigate the pathological changes in the organs resulting from blocking low hydraulic resistance channel (LHRC) along the stomach meridian by injecting gel in pigs so as to offer some insight into the correlation between meridians and internal organs. Methods. Four white piglets and twelve black minipigs were divided into four batches and were observed in different periods. Each batch included two pairs of pigs and each pair matched two pigs with similar conditions among which gel was injected into 6~8 low hydraulic resistance points along the the stomach meridian in the experimental pig and the same amount of saline was injected into the same points in the control pig. The state of stomach and intestine was observed 6~10 weeks after the blocking model was developed. Results. The results showed that there were bloated stomach or/and intestine in all the experimental pigs while there were normal states in seven control pigs except one dead during the experiment. Conclusion. The findings confirmed that the blockage of LHRC along the stomach meridian can influence the state of stomach and intestine, leading to a distension on stomach or/and intestine.

Study on the Formation of Novel Threadlike Structure through Intravenous Injection of Heparin in Rats and Refined Observation in Minipigs.

Objective. To study if the novel threadlike structure (NTS) was caused by coagulation during injecting urethane intraperitoneally and the source of NTS. Methods. Twenty-two SD rats were anaesthetized by urethane injected intraperitoneally. Heparin was injected at 5 minutes before the anaesthesia from femoral vein in 11 rats, and saline was given in the other 11 rats randomly. Six Chinese minipigs were carried to look for NTS. One sample was taken to be stained by DAPI/Phalloidin and observed by a laser scanning confocal microscope. Results. In the group of heparin, 10 rats were found to have NTS with appearance rate of 90.9%, and 9 rats were found to have NTS with the appearance rate of 80.1%. Both groups have 1.81 average numbers of NTS in each rat without significant difference (P > 0.05). In the observation of pigs, the NTS was found to prolong from the serous membranes of abdominal wall and organ surface. Histological observation showed elongated nuclei and alignment which is similar to the characteristics of PVS. Conclusion. There is no strong evidence to say that the NTS on organ surface was caused by coagulation of blood. The source of NTS might be a prolonged structure from serous membrane in abdominal cavity during the development and more or less retained after birth.

[Impacts on skin blood flow under moving cupping along meridians in different directions].

OBJECTIVE: To compare the impacts on skin blood flow between moving cupping following the meridian running direction and that against the running direction. METHODS: JLG-2 meridian cupping drainage instru ment was used for moving cupping on the back along the Bladder Meridian running course in either single direction for 20 times. The cupping device was Bian stone cup, 44 mm in inner diameter, negative pressure from -0.03 to -0.04 MPa. PeriScan PIM II laser Doppler perfusion imager was used to observe the changes in skin blood flow on the running course of the Bladder Meridian with cup moved up and down and in the same region on the contralateral Bladder Meridian. Blood flow was measured before cupping, at the immediate time after cupping and 10 min after cupping separately. Fourteen healthy volunteers received the test. The measuring region was subdivided into a moving cupping area, an upstream area, a downstream area, a contralateral moving cupping area, a contralateral upstream area and a contralateral downstream area. The mean blood flow was calculated in each area. RESULTS: Blood flow was increased significantly in each area and was more apparently increased in the moving cupping area. In comparison of the changing rate of blood flow between cupping following the meridian running direction and that against the running direction, it was only found that the changing rate in the upstream area of moving cupping against the running direction was significantly higher than that following the running direction (P < 0.05). The differences were not statistically significant in comparison among the other areas. Additionally, the changing rates of blood flow in the upstream and downstream area of the Bladder Meridian were increased significantly as compared with the contralateral Bladder Meridian. CONCLUSION: The local effects are similar between moving cupping following the meridian running direction and that against the running direction. The abscopal effect of moving cupping against the running direction is superior to that following the running direction. It is suggested that the dual-directional moving cupping is applicable for the treatment of local disorders and the abscopal effect is better with moving cupping against the meridian running direction.

Observation of Microvascular Perfusion in the Hegu (LI4) Acupoint Area after Deqi Acupuncture at Quchi (LI11) Acupoint Using Speckle Laser Blood Flow Scanning Technology.

The aim of this study was to investigate the traditional meridian theory using speckle laser blood flow scanning technology to observe microcirculation of the Hegu acupoint area after acupuncture stimulation on distant points. An observational study was conducted to observe the microvascular perfusion of Hegu (LI4) and control points after acupuncturing Quchi (LI11). Thirty healthy volunteers (mean age 31.6 ± 8.7 years) received deqi acupuncture on Quchi (LI11, right side), and simultaneously changes in microvascular perfusion of Sanjian (LI3), Hegu (LI4), Yangxi (LI5), and two control points were observed before, during, and after needling using a MOOR speckle laser. The results showed that the changes in microvascular perfusion of the observed points are not regular. After correction, the experiment showed that the blood perfusion on 3 meridian acupoints was increased while the perfusion on 2 control points was decreased following acupuncture stimulation, the changes at Hegu (LI4) being the statistically most significant ones. Deqi acupuncture can help in regulating the body's blood flow, with a certain degree of meridian specificity.