Characterization of the "deqi" response in acupuncture

<p>Abstract</p> <p>Background</p> <p>Acupuncture stimulation elicits <it>deqi</it>, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise <it>deqi</it>, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the <it>deqi phenomenon </it>in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the <it>deqi </it>experience.</p> <p>Methods</p> <p>Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naïve healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1–10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation.</p> <p>Results</p> <p>The <it>deqi </it>response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with <it>deqi</it>, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the <it>deqi </it>sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the <it>deqi composite</it>, is proposed and applied to explain differences in <it>deqi </it>among acupoints.</p> <p>Conclusion</p> <p>The complex pattern of sensations in the <it>deqi </it>response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the <it>'deqi' </it>response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the <it>deqi </it>phenomenon.</p

How might acupuncture work? A systematic review of physiologic rationales from clinical trials

BACKGROUND: Scientific interest in acupuncture has led numerous investigators to conduct clinical trials to test the efficacy of acupuncture for various conditions, but the mechanisms underlying acupuncture are poorly understood. METHODS: The author conducted a PubMed search to obtain a fair sample of acupuncture clinical trials published in English in 2005. Each article was reviewed for a physiologic rationale, as well as study objectives and outcomes, experimental and control interventions, country of origin, funding sources and journal type. RESULTS: Seventy-nine acupuncture clinical trials were identified. Twenty-six studies (33%) offered no physiologic rationale. Fifty-three studies (67%) posited a physiologic basis for acupuncture: 33 (62% of 53) proposed neurochemical mechanisms, 2 (4%) segmental nervous system effects, 6 (11%) autonomic nervous system regulation, 3 (6%) local effects, 5 (9%) effects on brain function and 5 (9%) other effects. No rationale was proposed for stroke; otherwise having a rationale was not associated with objective, positive or negative findings, means of intervention, country of origin, funding source or journal type. The dominant explanation for how acupuncture might work involves neurochemical responses and is not reported to be dependent on treatment objective, specific points, means or method of stimulation. CONCLUSION: Many acupuncture trials fail to offer a meaningful rationale, but proposing a rationale can help investigators to develop and test a causal hypothesis, choose an appropriate control and rule out placebo effects. Acupuncture may stimulate self-regulatory processes independent of the treatment objective, points, means or methods used; this would account for acupuncture's reported benefits in so many disparate pathologic conditions

Angle-independent and multi-dimensional myocardial elastography - From theory to clinical validation

The angle-independent myocardial elastography, which shows good performance in our proposed theoretical framework using a three-dimensional, ultrasonic image formation model based on well-established, 3D finite-element, canine, left-ventricular models in both normal and left-circumflex ischemic cases, is employed as well as validated in vivo to assess the contractility of normal and pathological myocardia. Angle-independent myocardial elastography consists of: (1) iterative estimation of in-plane and out-of-plane cumulative displacements during systole using 1D cross-correlation and recorrelation techniques in a 2D search; (2) calculation of in-plane finite strains from the in-plane cumulative motion; and (3) computation of in-plane principal strains from the finite strains by eigen decomposition with a classification strategy. The in vivo raw data of healthy and pathological human left ventricles were acquired at 136 fps in a short-axis echocardiographic view. Similar to theory, the elastographic estimates in normal clinical cases showed radial wall thickening and circumferential shortening during systole through principal strain imaging, while those in a pathological case underwent opposite strains. The feasibility of angle-independent myocardial elastography with an automated contour tracking method was hereby demonstrated through imaging of the myocardial deformation, and principal strains were proven essential in the reliable characterization and differentiation of abnormal from normal myocardia, without any angular dependence. © 2008 Elsevier B.V. All rights reserved.link_to_subscribed_fulltex

Angle-independent myocardial elastography - Theoretical analysis and clinical validation

Several methods have been introduced in the past few years to quantify left-ventricular strain in order to detect myocardial ischemia and infarction. Myocardial Elastography is one of these methods, which is based on ultrasound Radio-Frequency (RF) signal processing at high frame rates for the highest precision and resolution of strain estimation. Myocardial elastography estimates displacement and strain during the natural contraction of the myocardium using cross-correlation techniques. We have previously shown that imaging of the myocardial strain at high precision allows the correct assessment of the contractility of the cardiac muscle and thus measurement of the extent of ischemia or infarct. In this paper, for the first time in echocardiography, we show how angle-independent techniques can be used to estimate and image the mechanics of normal and pathological myocardia, both in simulations and in vivo. First, the fundamental limits of 2D normal and principal strain component estimation are determined using an ultrasound image formation model and a 2D short-axis view of a 3D left-ventricular, finite-element model, in normal and ischemic configurations. Two-dimensional (i.e., lateral and axial) cumulative displacement and strain components were iteratively estimated and imaged using ID cross-correlation and recorrelation techniques in a 2D search. Validation of these elastographic findings in one normal human subject was performed. Principal strains were also imaged for the characterization of normal myocardium. In conclusion, the feasibility of angle-independent, 2D myocardial elastography technique was shown through the calculation of the in-plane principal strains, which was proven essential in the reliable depiction of strains independent of the beam-tissue angle or the type of sonographic view used.link_to_subscribed_fulltex

Fundamental performance assessment of 2-D myocardial elastography in a phased-array configuration

Two-dimensional myocardial elastography, an RF-based, speckle-tracking technique, uses 1-D cross-correlation and recorrelation methods in a 2-D search, and can estimate and image the 2-D transmural motion and deformation of the myocardium so as to characterize the cardiac function. Based on a 3-D finite-element (FE) canine left-ventricular model, a theoretical framework was previously developed by our group to evaluate the estimation quality of 2-D myocardial elastography using a linear array. In this paper, an ultrasound simulation program, Field II, was used to generate the RF signals of a model of the heart in a phased-array configuration and under 3-D motion conditions; thus simulating a standard echocardiography exam. The estimation method of 2-D myocardial elastography was adapted for use with such a configuration. All elastographic displacements and strains were found to be in good agreement with the FE solutions, as indicated by the mean absolute error (MAE) between the two. The classified first and second principal strains approximated the radial and circumferential strains, respectively, in the phased-array configuration. The results at different sonographic signal-tonoise ratios (SNRs) showed that the MAEs of the axial, lateral, radial, and circumferential strains remained relatively constant when the SNRs was equal to or higher than 20 dB. The MAEs of the strain estimation were not significantly affected when the acoustic attenuation was included in the simulations. A significantly reduced number of scatterers could be used to speed up the simulation, without sacrificing the estimation quality.The proposed framework can further be used to assess the estimation quality, explore the theoretical limitation and investigate the effects of various parameters in 2-D myocardial elastography under more realistic conditions. © 2009 IEEE.link_to_subscribed_fulltex

Electromechanical wave imaging for non-invasive localization and quantification of partially ischemic regions in vivo

Electromechanical Wave Imaging (EWI) has recently been introduced as a non-invasive, ultrasound-based imaging modality, which could map the electrical activation of the heart in various echocardiographic planes in mice, dogs and humans in vivo. By acquiring radio-frequency (RF) frames at very high frame rates (390-520Hz), the onset of small, localized, transient deformations resulting from the electrical activation of the heart, i.e., generating the electromechanical wave (EMW), can be mapped. In this study, we pursue the development of EWI and analysis of the EMW properties in dogs in vivo for early detection of ischemia. EWI was performed in normal and ischemic open-chested dogs during sinus rhythm. Ischemia of increasing severity was obtained by gradually obstructing the left-anterior descending (LAD) coronary artery. EWI was shown to be sensitive to the presence of intermediate ischemia. EWI localized the ischemic region when the LAD was occluded at 60% and beyond and was capable of mapping the increase of the ischemic region size as the LAD occlusion level increased. Those results indicate that EWI could be used to assess electrical conduction properties of the myocardium, and detect ischemic onset and disease progression entirely non-invasively. ©2010 IEEE.link_to_subscribed_fulltex

Clinical validation of angle-independent myocardial elastography using MRI tagging

In this paper, two-dimensional angle-independent myocardial elastography (2DME) was employed in order to assess and image myocardial deformation (or, strains) in an entire left-ventricular view and was further validated against tagged Magnetic Resonance Imaging (tMRI) in normal as well as abnormal human subjects. Both RF ultrasound and tMRI frames were acquired in a 2D short-axis (SA) view at the papillary muscle level. In 2DME, in-plane (lateral and axial) incremental displacements (i.e., between two consecutive RF frames) were iteratively estimated using 1D cross-correlation and recorrelation techniques in a 2D search with a 1D matching kernel. The incremental displacements starting from end-diastole (ED) to end-systole (ES) were then accumulated to obtain cumulative systolic displacements. In tMRI, cardiac motion was obtained using a template-matching algorithm on a 2D grid-shaped mesh. The entire displacement distribution within the myocardium was obtained by a cubic B-spline-based method. In both 2DME and tMRL 2D Lagrangian finite systolic strains were calculated from cumulative 2D displacements. Principal strains, which were angle-independent and less centroid dependent than polar (i.e., radial and circumferential) strains, were then computed from the 2D finite strains through our previously established strategy. Both qualitatively (or, full SA view) and quantitatively (or, temporal strain profiles), 2DME is shown capable of estimating myocardial deformation highly comparable to tMRI estimates in a clinical setting. © 2007 IEEE.link_to_subscribed_fulltex