Sham Points Research Articles

The Effects of Electroacupuncture at the ST36 (Zusanli) Acupoint on Cancer Pain and Transient Receptor Potential Vanilloid Subfamily 1 Expression in Walker 256 Tumor-Bearing Rats

Several studies have addressed the expression of transient receptor potential vanilloid subfamily 1(TRPV1) playing an important role in the generation of cancer pain. Electroacupuncture (EA) is an effective method of acupuncture shown to attenuate different kinds of pain such as inflammatory, neuropathic, and cancer. In this study, we investigated the effect of EA on cancer pain caused by intraplantar injection of Walker 256 carcinoma cells and cancer-driven TRPV1 expression in the dorsal root ganglions (DRGs). Rats were randomly divided into 4 groups: the nontumor cell inoculation group (normal control, n = 8); Walker 256 carcinoma cell inoculation group (tumor control, n = 8); sham point electrical stimulation treatment with Walker 256 carcinoma cell inoculation group (SES, n = 8); EA treatment with Walker 256 carcinoma cell inoculation group (EA, n = 8). The time courses of thermal, mechanical sensitivity, and spontaneous nocifensive behavior were determined. In addition, TRPV1 expression in DRGs was observed by quantitative real-time polymerase chain reaction and Western blotting. Injection of cancer cells decreased the paw withdrawal threshold, increased spontaneous nocifensive behavior, and induced significant thermal hyperalgesia that was attenuated by EA at the ST36 acupoint (2 Hz, 0.3 ms, ≤1 mA). TRPV1 mRNA and protein in DRGs were upregulated in the cancer pain model, and EA at ST36 acupoint counteracted the cancer-driven upregulation of TRPV1 expression in the corresponding DRGs. EA at ST36 could attenuate cancer-induced pain, at least in part, through suppressing TRPV1 mRNA and protein upregulation in the DRGs.

Auricular acupuncture effectively reduces state anxiety before dental treatment—a randomised controlled trial

The objective of this study was to analyse whether auricular acupuncture, acupuncture at the outer ear, could reduce state anxiety before dental treatment. This prospective, randomised patient-blinded study with 182 patients compared anxiety before dental treatment following auricular acupuncture at the relaxation-, tranquillizer- and master cerebral points (auricular acupuncture group) versus acupuncture at sham points (finger-, shoulder- and tonsil points; sham group) and a non-intervention control group. Anxiety was assessed using the Spielberger State Trait Anxiety Inventory (German version) before auricular acupuncture and 20min thereafter, immediately before dental treatment. Auricular acupuncture reduced state anxiety score more effectively from 54.7 ± 10.8 to 46.9 ± 10.4 (mean ± SD) than sham acupuncture from 51.9 ± 10.2 to 48.4 ± 10.0. In contrast, state anxiety in the control group increased from 51.0 ± 11.7 to 54.0 ± 11.6 (mean increase +3.0; CI +4.7 to +1.2). The decrease in state anxiety in both intervention groups was statistically significant (p < 0.001) when compared to the non-intervention control group. After correcting for group differences in baseline state anxiety, the reduction in anxiety was -7.3 score points (CI -9.0 to -5.6) in the auricular acupuncture group and -3.7 score points (CI -5.4 to -1.9) in the sham group (p = 0.008). Auricular acupuncture, a minimally invasive method, effectively reduces state anxiety before dental treatment. Auricular acupuncture could be an option for patients scheduled for dental treatment, who experience an uncomfortable degree of anxiety and request an acute intervention for their anxiety.

Electroacupuncture and Moxibustion Decrease Renal Sympathetic Nerve Activity and Retard Progression of Renal Disease in Rats

Background/Aim: Chronic kidney disease (CKD) is an increasing major public health problem worldwide. The sympathetic nervous system and nitric oxide play an important role in the pathogenesis of CKD. Traditional Chinese medicine has accumulated thousands of years of therapeutic experiences. Electroacupuncture (EA) and moxibustion (MO) are two such therapeutic strategies. The aim of this study was to investigate the renal and hemodynamic effects of EA-MO in an experimental model of a CKD. Methods: Male Wistar rats submitted to 5/6th nephrectomy (5/6 NX) were studied for 8 weeks. There were four groups: (1) control, normal rats; (2) NX, 5/6 NX only; (3) NX-AS, 5/6 NX and EA-MO session using sham points, and (4) NX-AM, 5/6 NX and EA-MO session using real acupoints. Biochemical and blood pressure studies, renal sympathetic nerve activity measurements, nitric oxide levels and the histopathological indices were assessed. Results: The EA- and MO-treated group presented significant improvement in all measured functional and histopathological parameters. Conclusion: These findings suggest that EA-MO had beneficial effects on CKD. This effect was probably achieved by the modulation of the renal sympathetic nerve activity and nitric oxide levels, leading to decreased blood pressure, which is associated with less proteinuria.

Bilateral Effects of 6 Weeks' Unilateral Acupuncture and Electroacupuncture on Ankle Dorsiflexors Muscle Strength: A Pilot Study

Zhou S, Huang L-P, Liu J, Yu J-H, Tian Q, Cao L-J. Bilateral effects of 6 weeks' unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study. Objectives To determine the effect of unilateral manual acupuncture at selected acupoints on ankle dorsiflexion strength of both limbs, and compare the effect with that of electroacupuncture at the same acupoints and sham points. Design Randomized controlled trial. Setting Rehabilitation laboratory of a university. Participants Young men (N=43) were randomly allocated into 4 groups: control; manual acupuncture and electroacupuncture on 2 acupoints (ST-36 and ST-39); and electroacupuncture on 2 nonacupoints. These points were located on the tibialis anterior muscle. Interventions The participants in the experimental groups received 15 to 30 minutes of acupuncture or electroacupuncture on the right leg in each session, 3 sessions per week for 6 weeks. Main Outcome Measures The maximal strength in isometric ankle dorsiflexion of both legs was assessed before and after the experimental period. Results Repeated-measures analysis of variance identified significant and similar strength gains (range, 35%–64% in the right leg and 32%–49% in the left leg; P<.01) in all acupuncture groups, but not in the control group (−2% to 2%, P>.05). Conclusions Unilateral manual acupuncture and electroacupuncture at the acupoints can improve muscle strength in both limbs, and electroacupuncture at the nonacupoints as used in this study can also induce similar strength gains.

Effects of Manual Acupuncture at GB34 on Carbon tetrachloride-induced Acute Liver Injury in Rats

Manual acupuncture at Yanglingquan (GB34) is reported to have a beneficial effect on chronic liver damage. We, therefore, studied the effect of manual acupuncture at GB34 on acute liver damage. Rats were administered carbon tetrachloride (CCl 4) or olive oil, and direct manual acupuncture was subsequently performed at GB34 or at a sham point (a nonacupoint). In rats administered with CCl 4, the serum levels of aspartate aminotransferase and alanine aminotransferase, the total cholesterol concentration, and the levels of hepatic thiobarbituric-acid-reactive substances were suppressed by acupuncture at GB34 when compared with acupuncture at the sham point. By contrast, there was little histological difference in the liver between acupuncture at GB34 and that at the sham point in rats administered with CCl 4. These results suggest that manual acupuncture at GB34 tends to improve acute liver damage but is not sufficient by itself to completely resolve the hepatic injury.

Effects of Electroacupuncture Pretreatment on Inflammatory Response and Acute Kidney Injury in Endotoxaemic Rats

This study investigated the effect of electroacupuncture pretreatment on the lipopolysaccharide (LPS)-induced inflammatory response and on acute kidney injury in adult male pathogen-free Wistar rats. Rats received electroacupuncture at the Zusanli (ST36) and Neiguan (PC6) acupoints, or electrical stimulation at sham points, for 30 min before stimulation with either 5 mg/kg LPS intravenously or normal saline. Plasma cytokines, plasma nitrite, renal inducible nitric oxide synthase (iNOS) and nuclear factor κB (NF-κB) activity were assessed 240 min after LPS or normal saline injection. Blood urea nitrogen (BUN), creatinine (Cr) and histopathological score for renal tubular damage were also measured. Electroacupuncture pretreatment significantly decreased LPS-induced plasma tumour necrosis factor-α and interleukin (IL)-1β, increased plasma IL-10, and decreased plasma nitrite, renal iNOS and NF-κB activity. It also significantly decreased LPS-induced BUN, Cr and the renal histopathological score. These findings suggest that electroacupuncture pretreatment at the ST36 and PC6 acupoints attenuated the LPS-induced inflammatory response and mitigated acute kidney injury.

Determining the efficacy of auricular acupuncture for reducing anxiety in patients withdrawing from psychoactive drugs

Auricular acupuncture (AA) is a widely accepted treatment option for substance abuse that is used in more than 700 treatment centers worldwide. Despite claims of perceived clinical benefits by patients and treatment staff, research efforts have failed to substantiate purported benefits, and the mechanism(s) by which AA serves in the treatment of addiction remain inconclusive. Numerous studies have shown AA to be an effective treatment for perioperative anxiety. In this study, we hypothesize that AA reduces the anxiety associated with withdrawal from psychoactive drugs. The study used a randomized, controlled design and included a sample of 101 patients recruited from an addiction treatment service. Subjects were assigned to one of three treatment groups (National Acupuncture Detoxification Association [NADA] AA, AA at sham points, or treatment setting control) and were instructed to attend treatment sessions for 3 days. The primary outcome measure state anxiety was assessed using a pretest–posttest treatment design. The study hypothesis was not confirmed. The NADA protocol was not more effective than sham or treatment setting control in reducing anxiety. The widespread acceptance of AA in the treatment of addiction remains controversial.

Effects of some acupoints (Du-14, Li-11, St-36, and Sp-6) on serum TNF-α and hsCRP levels in healthy young subjects.

This study was performed to investigate the effect of immune-related acupuncture points on serum tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hsCRP) levels. Ninety (90) healthy volunteers (aged 20-30 years) were randomly assigned into five equal groups. Acupuncture needles were placed into single acupoints bilaterally in each group. The points were Da Zhui (Du-14), Qu Chi (Li-11), Zu San Li (St-36), San Yin Jiao (Sp-6) and a sham point, which is not an acupoint. Manual acupuncture treatment was performed in 6 sessions of 30 minutes each, 3 times per week for 2 weeks. Serum samples were obtained before and after the acupuncture treatments and the serum TNF-α and hsCRP levels were measured. The TNF-α values (mean ± standard deviation) in the Du-14, Li-11, St-36, Sp-6, and sham acupuncture groups at baseline were 37.63 ± 10.58, 37.36 ± 10.24, 33.83 ± 7.36, 35.73 ± 6.75, and 32.05 ± 5.66 pg/mL, respectively. After treatment, the mean TNF-α values were 35.89 ± 11.61, 34.80 ± 6.98, 35.89 ± 9.22, 33.30 ± 5.45, and 33.78 ± 5.98 pg/mL, respectively. In the serum TNF-α levels, no significant change was seen in any of the groups (p > 0.05). The mean hsCRP values in the Du-14, Li-11, St-36, Sp-6, and sham acupuncture groups at baseline were 0.90 ± 0.77, 1.07 ± 1.35, 0.77 ± 0.54, 0.75 ± 0.54, and 0.94 ± 0.68 mg/L, respectively. After treatment, they were 1.09 ± 1.17, 0.84 ± 0.43, 0.74 ± 0.49, 0.80 ± 0.53, and 0.62 ± 0.44 mg/L, respectively. In the statistical analysis, it was found that hsCRP levels were significantly reduced in the sham acupuncture group (p < 0.01). There was not any significant difference between acupuncture and sham groups in terms of serum TNF-α and hsCRP values (p > 0.05). Acupoints, which are considered to have effects on the immune system, may not mediate the immune system via TNF-α, a known inflammatory cytokine, directly in healthy young individuals. However, the changes related to hsCRP values in the sham group need future confirmation studies.

Getting the Grip on Nonspecific Treatment Effects: Emesis in Patients Randomized to Acupuncture or Sham Compared to Patients Receiving Standard Care

BackgroundIt is not known whether or not delivering acupuncture triggers mechanisms cited as placebo and if acupuncture or sham reduces radiotherapy-induced emesis more than standard care.Methodology/Principal FindingsCancer patients receiving radiotherapy over abdominal/pelvic regions were randomized to verum (penetrating) acupuncture (n = 109; 99 provided data) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106; 101 provided data) performed with a telescopic non-penetrating needle at a sham point 2–3 times/week during the whole radiotherapy period. The acupuncture cohort was compared to a reference cohort receiving standard care (n = 62; 62 provided data). The occurrence of emesis in each group was compared after a mean dose of 27 Gray. Nausea and vomiting were experienced during the preceding week by 37 and 8% in the verum acupuncture group, 38 and 7% in the sham acupuncture group and 63 and 15% in the standard care group, respectively. The lower occurrence of nausea in the acupuncture cohort (verum and sham) compared to patients receiving standard care (37% versus 63%, relative risk (RR) 0.6, 95 % confidence interval (CI) 0.5–0.8) was also true after adjustment for potential confounding factors for nausea (RR 0.8, CI 0.6 to 0.9). Nausea intensity was lower in the acupuncture cohort (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p = 0.002). The acupuncture cohort expected antiemetic effects from their treatment (95%). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (RR 1.6; Cl 1.2–2.4).Conclusions/SignificancePatients treated with verum or sham acupuncture experienced less nausea and vomiting compared to patients receiving standard care, possibly through a general care effect or due to the high level of patient expectancy.Trial Registration ClinicalTrials.gov NCT00621660

Traditional Chinese Acupuncture was not superior to sham acupuncture for knee osteoarthritis but delivering treatment with high expectations of improvement was superior to delivering treatment with neutral expectations

What are the comparative effects of Traditional Chinese Acupuncture (TCA) and sham acupuncture for patients with knee osteoarthritis (OA) when controlling for the effect of the acupuncturists' communication styles. A nested 2-stage randomised clinical trial, where patients were randomised to 1 of 3 style groups, waiting list, high expectations, or neutral expectations, and nested within style, TCA, or sham acupuncture. A hospital general internal medicine department in Texas, USA. Men and women over 49 years with knee OA according to the American College of Rheumatology criteria. Additional inclusion criteria were pain in the knee in the preceding 2 weeks, > 3/10 on a visual analogue scale, no prior treatment with acupuncture, stable treatment with nonsteroidal anti-inflammatory drugs, analgesics, or glucosamine. Exclusion criterion was intraarticular injections in the knee in the previous 2 months. Randomisation of 560 participants allocated 238 to the high expectations group, 242 to the neutral expectations group, and 80 to the waiting list group. Six acupuncturists licensed in traditional Chinese medicine carried out the intervention. For the communication style intervention, providers conveyed high expectations of improvement, by using positive utterances such as 'I think this will work for you', while neutral expectations were conveyed with uncertainty utterances such as 'It may or may not work for you'. For the acupuncture intervention the procedure and specific points were standardised by a panel consisting of the acupuncturists in each of the 2 arms: TCA points on the basis of clinical practice, and sham points outside the relevant meridians. The primary outcomes were Joint-Specific Multidimensional Assessment of Pain (J-MAP), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, and Satisfaction with Knee Procedure (SKIP) measured at 4 weeks, 6 weeks (end of treatment), and 3 months. 527 (94%) participants completed the study. There were no significant differences between the TCA and sham groups in any of the outcome measures. Patients in the high expectations communication style group had statistically significant improvements in pain (J-MAP) and satisfaction (SKIP) compared with the neutral group. Mean differences (95% CI) at 3 months follow up were 0.4 (0.1 to 0.7) for J-MAP (1 to 7 scale), and 0.2 (0.03 to 0.3) for SKIP (1 to 5 scale). In patients with knee OA, needling of meridian points was not more effective than the use of sham points, whereas acupuncturists' communication styles had a small but statistically significant effect on pain reduction and satisfaction.

The Influence of Acupressure at Extra 1 Acupuncture Point on the Spectral Entropy of the EEG and the LF/HF Ratio of Heart Rate Variability

Acupressure applied on the Extra 1 acupuncture point results in sedation, thereby reducing bispectral index (BIS) values. Mental status and hypnotic agents influence the autonomic nervous system. We hypothesized that acupressure at the Extra 1 point would induce sedation and change sympatho-parasympathetic nerve balance. We investigated the effect of acupressure at the Extra 1 point on the EEG spectral entropy values and heart rate variability (HRV). Forty-eight volunteers (24 males and 24 females) were randomly assigned to the control or Extra 1 group. The control group received acupressure at a sham point and the Extra 1 group received acupressure at the Extra 1 point. Acupressure was applied for 5 min. The record of the EEG spectral entropy values and HRV started 5 min before acupressure and stopped 5 min after acupressure. Acupressure significantly reduced the EEG spectral entropy values in both groups, but the values of the Extra 1 group were significantly smaller than those of the control group (P < .01). Acupressure significantly decreased the LF/HF ratio of HRV in both groups (P < .05). When divided upon gender, although acupressure tended to decrease the LF/HF ratio, the ratio significantly decreased during and after acupressure only in females of the Extra 1 group (P < .05). We concluded that acupressure on the Extra 1 point significantly reduced the EEG spectral entropy in both the genders, but affected the LF/HF ratio of HRV only in females.

Pain behavior to electroacupuncture in rabbit tooth pulp

Aim: The aim of this study was to verify the pain behavior to electroacupuncture (EACP) in rabbit tooth-pulp assay. Methods: Albino rabbits weighing 1.5-2.0 kg) were pretreated with saline or morphine (5mg/kg, e.v.) 10 min before the nociceptive test (NT). In another group, EACP (rectangular pulses, f1=2 Hz, f2=0.1 s, 3 mA) was applied in acupoints and sham points, before and during the NT. After 120 min, EACP was withdrawn and the nociceptive threshold was measured every 10 min until the initial nociceptive threshold was achieved. Results: EACP, using the Yintang, ST4 and ST5 acupoints, induced an increased in the nociceptive threshold and this effect persisted for up to 2 h, even after the removal of electric stimulation. Application of EACP at sham points did not show significant analgesic activity. The present results demonstrated that males presented a higher initial level of analgesia, but a poorer maintenance of analgesic effect after the EACP procedure, while females demonstrated a long lasting analgesic effect even after discontinuation of EACP. Conclusions: EACP presented an analgesic effect in a rabbit tooth pulp assay that was probably due to the release of endogenous opioids. The duration of this analgesic effect seems to be different for males and females.

Auricular acupuncture for insomnia:a randomized controlled trial

To investigate the effect of auricular acupuncture therapy (AAT) and standardized acupoints on sleep parameters among people with insomnia. A single-blind, randomized pilot study where the treatment group AAT on active points and the control group received AAT on sham points during a 4-week treatment period. Participants were recruited from the Acupuncture Outpatient Clinics in the General Hospital of People's Liberation Army. In all, 125 patients were included in the study, with 63 in treatment group and 62 in control group. Sleep parameters were obtained by using the Pittsburgh Sleep Quality Index (PSQI). (1) Significant improvement in the PSQI total score and seven components score including sleep quality, time on falling asleep, sleeping time, efficiency and disorder of sleep, hypnotic and daytime functional disorder after treatment in both treatment group and control group (P<0.01). (2) After treatment, there was a statistically significant difference seen in the PSQI total score and six components score (P<0.01) except for hypnotic between the two groups. There were statistically significant differences in the rank differential value of total score and seven components of two groups (P<0.01). (3) There were statistically significant differences in the mean rank of PSQI seven components using Mann-Whitney test (P<0.01). Evidence was found to support the hypothesis that AAT played an effective role in improving the quantity and quality of sleep in those subjects with insomnia. A standardized AAT might help the treatment of insomnia, especially when combined with other treatments as psychological and behavioral therapies.

Acupuncture for treating dry eye: a randomized placebo‐controlled trial

To evaluate the efficacy and safety of acupuncture for ocular symptoms, tear film stability and tear secretion in dry eye patients. This is a randomized, patient-assessor blinded, sham acupuncture controlled trial. Forty-two participants with defined moderate to severe dry eye underwent acupuncture treatment three times a week for 3 weeks. Seventeen standard points (GV23; bilateral BL2, GB14, TE23, Ex1, ST1 and GB20; and unilateral SP3, LU9, LU10 and HT8 on the left for men and right for women) with 'de qi' manipulation for the verum acupuncture group and seventeen sham points of shallow penetration without other manipulation for the sham group were applied during the acupuncture treatment. Differences were measured using the ocular surface disease index (OSDI), the visual analogue scale (VAS) of ocular discomfort, the tear film break-up time (BUT) and the Schimer I test with anaesthesia. In addition, adverse events were recorded. There were no statistically significant differences between results on the OSDI, VAS, BUT or Schimer I tests from baseline between the verum and sham acupuncture groups. However, results from the within-group analysis showed that the OSDI and VAS in both groups and the BUT in the verum acupuncture group were significantly improved after 3 weeks of treatment. No adverse events were reported during this trial. Both types of acupuncture improved signs and symptoms in dry-eye patients after a 4-week treatment. However, verum acupuncture did not result in better outcomes than sham acupuncture.

The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation

BackgroundAs laser acupuncture is being increasingly used to treat mental disorders, we sought to determine whether it has a biologically plausible effect by using functional magnetic resonance imaging (fMRI) to investigate the cerebral activation patterns from laser stimulation of relevant acupoints.Methodology/Principal FindingsTen healthy subjects were randomly stimulated with a fibreoptic infrared laser on 4 acupoints (LR14, CV14, LR8 and HT7) used for depression following the principles of Traditional Chinese Medicine (TCM), and 1 control non-acupoint (sham point) in a blocked design (alternating verum laser and placebo laser/rest blocks), while the blood oxygenation level-dependent (BOLD) fMRI response was recorded from the whole brain on a 3T scanner. Many of the acupoint laser stimulation conditions resulted in different patterns of neural activity. Regions with significantly increased activation included the limbic cortex (cingulate) and the frontal lobe (middle and superior frontal gyrus). Laser acupuncture tended to be associated with ipsilateral brain activation and contralateral deactivation that therefore cannot be simply attributed to somatosensory stimulation.Conclusions/SignificanceWe found that laser stimulation of acupoints lead to activation of frontal-limbic-striatal brain regions, with the pattern of neural activity somewhat different for each acupuncture point. This is the first study to investigate laser acupuncture on a group of acupoints useful in the management of depression. Differing activity patterns depending on the acupoint site were demonstrated, suggesting that neurological effects vary with the site of stimulation. The mechanisms of activation and deactivation and their effects on depression warrant further investigation.

Validating a Nonacupoint Sham Control for Laser Treatment of Knee Osteoarthritis

The goals of the present study were to evaluate the effect and safety of combined 10.6 microm and 650 nm laser acupuncture-moxibustion on patients with knee osteoarthritis (OA) and to validate a nonacupoint sham control for assessing the effect of point specificity on the treatment. A randomized, sham-controlled clinical trial was conducted in an outpatient clinical setting on patients with knee OA (n = 40). Laser irradiation was performed on acupoint Dubi (ST35) and a sham point three times a week for 4 wk. Outcome measurements were performed at baseline and at wk 2 and 4 using Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC). At the 2-wk assessment, i.e., after 6 treatments, improvement in the WOMAC pain score of the acupoint group was significantly greater than that of the control group (49.21% vs. 11.99%, respectively; p = 0.021). However, there were no significant differences between the two groups in the WOMAC physical function score (p = 0.129) or joint stiffness score (p = 0.705). No side effects were found during the trial. Combined 10.6-mum-650-nm laser acupuncture-moxibustion on acupoint ST35 is safe to use and was effective after 2-wk treatment, but not at the 4-wk assessment, in relieving knee OA pain compared to a nonacupoint sham control. A larger clinical trial to verify our findings is warranted.

Accuracy of bedside ultrasound for the detection of soft tissue foreign bodies by emergency doctors

To assess the ability of emergency physicians and emergency trainees to detect soft tissue foreign bodies using typical ultrasound equipment. Following a 20 min interactive training session, emergency physicians and emergency trainees were assessed on ability to identify subcutaneous foreign bodies (wood, glass, plastic, gravel and metal) embedded in an experimental model containing both sham and real entry point incisions. In the second phase of the experiment accuracy of detection of multiple foreign bodies was assessed in a similar sonographic phantom. Six emergency physicians and 14 emergency trainees performed a total of 400 individual sonographic examinations. Emergency physicians correctly identified 29 of 30 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 96.7%, 70%, 76.3% and 95.5%, respectively. Trainees correctly identified 60 of 70 foreign bodies and returned sensitivity, specificity, positive predictive value and negative predictive value of 85.7%, 82.9%, 83.3% and 85.3%. Correct identification of the number of foreign bodies present, when multiple, was low (25% physician vs 36% trainee). These data suggest ultrasound in the hands of emergency doctors might be useful as an initial screening tool for detection of soft tissue foreign bodies.

922 THE EFFECT OF ACUPRESSURE AT THE EXTRA 1 POINT ON SUBJECTIVE AND AUTONOMIC RESPONSES TO NEEDLE INSERTION

Kyoko Watakabe† BACKGROUND: Premedication with sedatives can decrease the discomfort associated with invasive anesthetic procedures. Some researchers have shown that acupressure on the acupuncture extra 1 point is effective for sedation. We investigated whether acupressure on the extra 1 point could alleviate the pain of needle insertion. METHODS: We investigated the effect of acupressure at the extra 1 point or a sham point on needle insertion using verbal rating scale (VRS) pain scores and heart rate variability (HRV). Twenty-two healthy female volunteers were randomly allocated to two groups: the extra 1 group received acupressure at the extra 1 point, and the sham group received acupressure at a sham point. After starting the electrocardiogram record, a 27-gauge needle was inserted into the skin of a forearm. Thereafter, another needle was inserted into the skin of the other forearm during acupressure. RESULTS: Acupressure at the extra 1 point significantly reduced the VRS, but acupressure at the sham increased the VRS. Acupressure at the extra 1 significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion. CONCLUSIONS: Acupressure at the extra 1 point significantly reduced needle insertion pain compared with acupressure at the sham point. Also, acupressure at the extra 1 point significantly reduced the low frequency/high frequency ratio of HRV responding to needle insertion, which implies a reduction in sympathetic nervous system activity. (Anesth Analg 2008;107:661–4)

An fMRI study of neuronal specificity of an acupoint: Electroacupuncture stimulation of Yanglingquan (GB34) and its sham point

The neuronal specificity of acupoints has not been entirely supported by the results of fMRI studies. The objective of this study was to investigate the neuronal specificity of an acupoint with electroacupuncture stimulation (EAS) using functional magnetic resonance imaging (fMRI). Functional MR imaging of the entire brain was performed in 12 normal healthy subjects during EAS of GB34 (Yanglingquan) and its sham point over the left leg in counter-balanced order. Anatomically, both GB34 and its sham point belong to the L5 spinal segment. EAS at the left GB34 specifically activated the right putamen, caudate body, claustrum, thalamus, cerebellum, as well as the left caudate body, ventral lateral thalamus, and cerebellum, all related to motor function. EAS at the sham point of the left GB34 specifically activated the right BA6, BA8, BA40, BA44, thalamus, as well as the left thalamus and cerebellum. Taken together, these findings suggest that EAS at an acupoint and its sham point, in the same spinal segment, induced specific cerebral response patterns. These findings support neuronal specificity of the acupoint studied. EAS at GB34 appears to be more related to motor function than EAS at its sham point, suggesting specificity of the GB34 acupoint. The results of this study provide neurobiological evidence for the existence of acupoint specificity, although further studies are necessary to better understand this phenomenon.

Partial correlation investigation on the default mode network involved in acupuncture: An fMRI study

Certain clinical reports and researches have shown that acupuncture effects can sustain a period during the post-stimulation state, and modulate the default mode network (DMN). In this study, partial correlation approach was utilized to investigate whether or not electro-acupuncture stimulation (EAS) at the three acupoints (GB37 (Guangming), BL60 (Kunlun) and KI8 (Jiaoxin)) and one sham point on the left leg modulated the DMN and how to change the intrinsic connectivity of the DMN. The results indicated that DMN could be modulated after EAS, and there existed different modulation patterns of the four points. Meanwhile, we found that the posterior cingulate cortex and precuneus (PCC/pC) strongly interacted with other nodes during the pre- and post-stimulation states. The correlation was interrupted between the PCC/pC and anterior cingulate cortex (ACC). The orbital prefrontal cortex (OFC) negatively interacted with the left medial temporal cortex (lMTC) at the acupoints. We suggested that the distinct modulation patterns to the DMN attributed to the different effects evoked by the three acupoints and one sham point.