A controlled trial of placebo versus real acupuncture.

We sought to determine whether a novel method of placebo acupuncture can be differentiated by subjects from real acupuncture treatment. A single-blind, randomized, controlled clinical trial with an independent observer was performed. Forty-nine healthy subjects over the age of 18 years were randomly assigned to one of 2 experimental groups: 24 subjects received real acupuncture, and 25 subjects received placebo acupuncture. Placebo acupuncture was performed by administering a blunted acupuncture needle through a foam pad at the Large Intestine 4 acupoint. The blunted needle touched but did not penetrate the skin. Real acupuncture was performed by administering an acupuncture needle through a foam pad at the Large Intestine 4 acupoint. The needle pricked and penetrated the skin to a depth of 10 to 20 mm. A simple questionnaire followed, asking whether the subject believed they received real or placebo acupuncture. Twenty-two (88%) of the 25 subjects who received placebo acupuncture believed they received real acupuncture. Nineteen (79.2%) of the 24 subjects who received real acupuncture correctly determined they received real acupuncture. The Fisher exact test showed an insignificant difference between real and placebo acupuncture treatments (P = .463). Subjects were not able to differentiate between real or placebo acupuncture, thereby validating this novel method of administering placebo acupuncture as a good control for acupuncture-naive patients. PERSPECTIVE: The method of placebo acupuncture herein described is a valid control for acupuncture research involving acupuncture-naive patients.     

An exploratory thermographic investigation of the effects of connective tissue massage on autonomic function

Objective

The purpose of this study was to measure effects of connective tissue massage (CTM) on the autonomic nervous system using thermography and physiological measurements.

Methods

A repeated-measures design was used. The setting was a university laboratory. Skin temperature at the site of massage, blood pressure, heart rate, and dorsal foot temperature were measured in 8 healthy participants before CTM, immediately after, and at 15-minute intervals for 1 hour.

Results

The effect of CTM on skin temperature was statistically significant, P = .011. Post hoc pairwise comparisons revealed that the 15-, 30-, 45-, and 60-minute data all differed significantly from the pre-CTM data (all P < .05) and also from the immediately post-CTM data (all P < .05). For diastolic blood pressure, the main analysis of variance showed a statistical significance at P = .062. For other variables, there was no evidence for an effect.

Conclusions

Evidence was seen of some effects of CTM on autonomic function. This is information that will increase our knowledge of how CTM affects the autonomic nervous system.     

Comparison of rofecoxib,celecoxib, and naproxen on renal function in elderly subjects receiving a normal-salt diet

BACKGROUND: This study compared directly the renal effects of two selective cyclooxygenase (COX)-2 inhibitors (rofecoxib and celecoxib) with naproxen (dual COX-1/COX-2 inhibitor) and placebo in healthy elderly subjects on a sodium-replete diet. METHODS: A total of 67 elderly subjects stabilized in the clinic for weight and urinary sodium on a controlled 200-mEq sodium diet were randomized in a double-blind fashion to receive rofecoxib, 25 mg daily (n = 17); celecoxib, 200 mg twice daily (n = 17); naproxen, 500 mg twice daily (n = 17); or matching placebo (n = 16) for 28 days. Subjects were sequestered in the clinic for the first 14 treatment days on the controlled diet. RESULTS: Daily urinary sodium excretion during the first 72 hours of treatment (primary endpoint) significantly decreased in rofecoxib, celecoxib, and naproxen groups compared with baseline (P < or =.05). Rofecoxib and celecoxib decreases in urinary sodium excretion rates that were comparable with each other, on the basis of predefined boundaries (-39.5 versus -27.1 mEq/d, respectively) and to naproxen (-40.6, mEq/d). Rofecoxib, celecoxib, and naproxen increased mean systolic blood pressure to a similar degree (3.4, 4.3, and 3.1 mm Hg, respectively, versus -1.3 mm Hg for placebo) after 14 days of treatment; small changes also occurred in diastolic blood pressure (0.3, 0.8, and -0.4 mm Hg, respectively, versus -1.4 mm Hg for placebo). Changes from baseline in creatinine clearance, body weight, and urinary potassium excretion among active treatments were similar. After 28 days of treatment, findings were generally consistent with those at 14 days. No subject reported edema or discontinued treatment as the result of an adverse experience. CONCLUSION: In healthy elderly subjects on a sodium-replete diet, the COX-2 inhibitors rofecoxib and celecoxib did not differ from a nonselective nonsteroidal anti-inflammatory drug (naproxen), in influencing renal function as measured by urinary sodium excretion, systolic and diastolic blood pressure, creatinine clearance, or weight change.     

Electrical stimulation in exercise of the quadriceps femoris muscle

Thirty-seven healthy subjects took part in an investigation to determine if the application of electrical stimulation to normal muscle, in combination with exercise, augments strength. Subjects were divided into three groups. Grwoup A (n = 14) was a control group (no exercise, no electrical stimulation). Group B members (n = 11) engaged in 10 sessions of maximum isometric exercise, and Group C subjects (n = 12) performed 10 sessions of maximum isometric exercise while simultaneously receiving electrical stimulation. The knee extensor muscles of subjects in Groups B and C increased in strength. However, the strength gains for Groups B and C were equivalent, suggesting that electrical stimulation combined with maximum isometric contractions has no greater effect on enhancing strength than does conventional static exercise.     

心率变化测定对老年糖尿病合并心脏植物神经病变的临床意义

目的　探讨老年糖尿病合并心脏植物神经病变时心率变化及临床意义。方法　测定30例正常人和60例老年糖尿病患者的呼吸差和立卧位差。结果　老年糖尿病患者深呼吸及立卧位差与正常人相比有显著差别(P＜0.01)；两者和病程、病情控制程度及合并微血管病变和周围神经病变密切相关。结论　心率变化测定可反映老年糖尿病心脏植物神经病变的程度，有诊断意义，且和慢性并发症及病程、病情控制有关。     

The effect of preferred music genre selection versus preferred song selection on experimentally induced anxiety levels

The purpose of this study was to investigate the differences of experimentally induced anxiety levels reached by subjects listening to no music (n = 30), subjects listening to music selected by the experimenter from the subject's preferred genre or artist listed as relaxing (n = 30), and subjects listening to a specific song they listed as relaxing (n = 30). Subjects consisted of 90 individuals, male and female, randomly assigned to one of the three groups mentioned above. Subjects in either music group filled out a questionnaire prior to participating in the study indicating their preference of music used for relaxation purposes. Subjects in Experimental Group 1 marked their preferred genres and/or artists, and Experimental Group 2 marked specific songs used for relaxation purposes. While the experimenter hypothesized subjects in Experimental Group 2 would show less anxiety than both the control group and Experimental Group 1, there were no significant differences found between the 2 music groups in anxiety levels reached. However, there was a statistically significant difference between the no music control group and both music groups in the anxiety level reached by subjects. Subjects listening to music, both songs chosen by the experimenter and subject selected songs, showed significantly less anxiety than subjects not listening to music.     

The addition of thoracic mobilization to aerobic exercise did not alter autonomic function and pain pressure threshold acutely in asymptomatic young people: A randomized controlled trial

ObjectiveTo analyze the influence of acute aerobic exercise (AE) plus thoracic mobilization in pain perception and autonomic nervous system response in healthy adults.DesignRandomized clinical trial.MethodsForty-eight asymptomatic adults were allocated into one of three groups: 1) Aerobic Exercise (AE), 2) Aerobic Exercise + Mobilization (AE + M), and 3) Placebo. Participants from groups AE and AE + M ran for 5 min on a treadmill with a 75–85% of age-predicted heart rate. Participants from AE + M group also received a rotatory thoracic passive accessory intervertebral mobilization at T4 after running. Participants from the Placebo group received placebo mobilization. We mesured the autonomic system modulation through Heart Rate Variability (HRV) (time-domain, frequency-domain, and non-linear variables). We measured Pressure Pain Threshold (PPT) with a handheld digital algometer.ResultsWhile aerobic exercise increased the sympathetic outflow and reduced the HRV, the addition of vertebral mobilization to exercise had no further effect on autonomic system modulation. There was no change in PPT in any group. Besides, there was no correlation between HRV and PPT.ConclusionThoracic mobilization did not increase the sympathetic response induced by aerobic exercise. Moreover, exercise alone or exercise plus thoracic mobilization did not change the PPT.     

老年人冠心病易患因素分析及预防

目的 调查老年人群冠心病的危险因素。方法 同时测定1658例年龄在30-84岁体检干部的心电图、血脂、空腹血糖和血压。结果 与老年对照组(n=120,年龄60-78岁,无心脏病)相比,老年冠心病患者(n=131,年龄60-84岁)高脂血症(41.98％)、高血压(51.91)和糖尿病(10.6％)的发生率明显升高;中年人群(n=150,年龄30-59岁,无心脏病)甘油三酯和胆固醇显著增高。结论 高血脂、高血压和糖尿病是老年人群冠心病的危险因素,合理和健康的饮食结构,尤其在中年人群中,是预防冠心病的基础之一。     

太极拳运动对中老年人心理和自主神经功能的影响

目的 了解太极拳运动对中老年人心理、自主神经的影响，以推动太极拳运动的开展。方法 随机抽取中老年太极拳练习者207人，非练拳者166人，采用Zung焦虑自我评定量表(Zung Self-rating Anxiety Scale，Zung-SAS)和Zung抑郁症自我评定量表(Zung Self-rating Depression Scale，Zung-SDS)及自主神经平衡指数进行调查。结果练拳组SAS及SDS评分与对照组比较有显著差异，练拳组的自主神经平衡状况优于对照组；在SAS、SDS评分和自主神经平衡状态方面，练拳组内部无性别差异；练拳时间越长，自主神经平衡状态越好。结论 开展太极拳运动对中老年人的心理和自主神经功能有积极作用。     

Theophylline kinetics in chronic obstructive airway disease in the elderly

Theophylline kinetic studies, serial spirometric function tests, and arterial blood gas determinations were performed in 39 adult men with stable chronic obstructive airway disease (COPD). Subjects were given an intravenous aminophylline loading dose of 5.6 mg/kg and a maintenance dose of 0.9 mg/kg/hr for 6 hours. Elderly (greater than 60 years old) nonsmoking subjects had 36% lower theophylline clearance (Cl) and a 40% longer serum theophylline elimination t1/2 than did middle-aged (less than 60 years old) nonsmoking subjects (mean +/- SE; clearances of 32.6 +/- 3.2 [n = 13] and 50.7 +/- 8.5 ml/kg/hr [n = 8] and t1/2s of 11.0 +/- 0.8 and 7.4 +/- 0.8 hours, respectively). There were also differences in Cl and t1/2 between elderly and middle-aged subjects in both the smoking and nonsmoking groups: elderly group, Cl = 43.6 +/- 3.7 mg/kg/hr and t1/2 = 9.0 +/- 0.7 hours; middle-aged group, Cl = 57.6 +/- 6.0 mg/kg/hr and t1/2 = 6.7 +/- 0.6 hours). There was consistent improvement in spirometric functions in both nonsmoking and smoking elderly subjects: percent changes in forced expiratory volume in 1 second of 19% to 25%; in forced vital capacity of 25% to 31%; in forced expiratory flow at 25% to 75% of vital capacity of 59% to 67%; and in maximum mid-flow time of -25% to -30%, at serum theophylline concentrations of 10 to 13 mg/L (group mean). We conclude that elderly nonsmoking subjects with COPD cleared theophylline more slowly than did middle-aged, nonsmoking subjects with COPD.(ABSTRACT TRUNCATED AT 250 WORDS)     

Baseline heart rate variability in healthy centenarians: differences compared with aged subjects (>75 years old).

Healthy centenarians have better anthropometric, endocrine, metabolic and immunological parameters than aged subjects (>75 years old). Heart rate variability (HRV) has been demonstrated to be a good index of the cardiac autonomic nervous system. It is not known whether there are any differences in cardiac autonomic nervous system activity between aged subjects and healthy centenarians. It is possible that differences in cardiac autonomic nervous system activity could represent one of a cluster of factors explaining the extreme survival of centenarians. Thus we aimed to answer the following question: is there any difference in baseline HRV parameters between aged subjects and healthy centenarians? Therefore power spectral analysis of HRV at baseline was investigated in 25 aged subjects (age > or = 75 years) and 30 healthy centenarians (age > or = 0 years). Anthropometric measurements were made in all subjects, fasting blood samples were drawn for metabolite determinations, and HRV was determined. Independent of age, gender, body mass index and fasting plasma noradrenaline and free 3,3',5-tri-iodothyronine concentrations, healthy centenarians had lower basal values for total power (1318+/-546 compared with 1918+/-818 ms(2); P<0.01) and the low-frequency component (33+/-21 compared with 50+/-11 normalized units; P<0.03) and a higher value for the high-frequency component (77+/-15 compared with 61+/-18 normalized units; P<0.05) than aged subjects. Consequently, the low-frequency/high-frequency ratio (0.43+/-0.07 compared with 0.91+/-0.05; P<0.02) was also lower in the healthy centenarians than in the aged subjects. Our study demonstrates that the basal low-frequency/high-frequency ratio, an indirect index of cardiac sympathovagal balance, is lower in healthy centenarians than in aged subjects.     

Autonomic cardiovascular responses in old age

Summary. The effect of age on autonomically mediated cardiovascular responses to certain manoeuvres was studied in 15, healthy, old men and women (60–80 years). The results were compared with groups of healthy young (about 25 years) and middle-aged (about 45 years) subjects. There was no significant reduction in cardiovascular responses between the young and middle-aged groups. Respiratory sinus arrhythmia, and heart rate, blood-pressure and contralateral forearm blood flow increases to isometric hand grip, as well as the heart rate decrease during a dive reflex test, were significantly attenuated in the old age group. The Valsalva ratio, and the heart rate and blood-pressure changes during an 8 min orthostatic test did not differ between the old and the two younger age groups. There seems to be only a moderate attenuation of autonomic cardiovascular responses to about 60 years, after which there is a more rapid decline. The difference in reduction between different responses, even those mediated by the same type of autonomic nerve, suggests that the decreased responses are not due to an isolated impaired function of the peripheral autonomic nerve. The impairment may be due to the receptor organ or a combination of defects in function of several parts of the autonomic nervous system in old age.     

How the number of learning trials affects placebo and nocebo responses

Conditioning procedures are used in many placebo studies because evidence suggests that conditioning-related placebo responses are usually more robust than those induced by verbal suggestions alone. However, it has not been shown whether there is a causal relation between the number of conditioning trials and the resistance to extinction of placebo and nocebo responses. Here we test the effects of either one or four sessions of conditioning on the modulation of both non-painful and painful stimuli delivered to the dorsum of the foot. Placebo and nocebo manipulations were obtained by pairing green or red light to a series of stimuli that were made lower or higher with respect to a yellow light associated with a series of control stimuli. Subjects were told that the lights would indicate a treatment that would reduce or increase non-painful and painful stimuli to the foot. They were randomly assigned to either Group 1 or 2. Group 1 underwent one session of conditioning and Group 2 received four sessions of conditioning. We found that one session of conditioning (Group 1) induced nocebo responses, but not placebo responses in no pain condition. After one session of conditioning, we observed both nocebo and placebo responses to painful stimulation. However, these effects extinguished over time. Conversely, four sessions of conditioning (Group 2) induced robust placebo and nocebo responses to both non-painful and painful stimuli that persisted over the entire experiment. These findings suggest that the strength of learning may be clinically important for producing long-lasting placebo effects.     

Folic acid does not improve endothelial function in healthy hyperhomocysteinaemic subjects

Folic acid supplementation lowers total plasma homocysteine (tHcy) and improves endothelial function in individuals with coronary artery disease (CAD) and in those with additional CAD risk factors. In the present study, we assessed whether endothelial function is impaired in healthy subjects with hyperhomocysteinaemia but without other CAD risk factors and whether folic acid supplementation improves endothelial function in these subjects. Flow-mediated dilatation (FMD) of the brachial artery was performed on 26 healthy subjects, age 49 +/- 2 years (mean +/- S.E.M.), with high tHcy (15.6 +/- 1.5 micromol/l) and 16 healthy age-matched subjects with low tHcy (7.9 +/- 0.6 micromol/l; P < 0.001). Subjects with high tHcy were then randomized to receive 5 mg/day of folic acid or placebo for 8 weeks in a double-blind cross-over trial with a 4-week washout. FMD was not associated with tHcy and was not different between high and low tHcy groups (7.0 +/- 0.6% compared with 6.6 +/- 1.2%, P = 0.76). Treatment with folic acid decreased tHcy by 34% in hyperhomocysteinaemic subjects ( P = 0.02 compared with placebo), but had no effect on FMD (+ 0.5 +/- 0.6% compared with -0.7 +/- 0.5%; P = 0.17 compared with placebo). In healthy subjects with hyperhomocysteinaemia, but without additional cardiovascular risk, endothelial function is unimpaired and folic acid supplementation has no additional effect.     

老年冠心病患者腹腔镜胆囊切除术中CO2气腹对心率变异性的影响及星状神经节阻滞对气腹的干预作用

【目的】观察老年冠心病患者在腹腔镜胆囊切除术（TVLC）中CO2气腹对心率变异性的影响以及术前经右侧星状神经节阻滞对CO2气腹的干预作用。【方法】选择2008年5月至2008年12月择期在全麻下行TVLC的老年冠心病患者60例。随机分为两组,对照组和右侧星状神经节阻滞组（R-SGB组）各30例。分别于麻醉后SGB前（T0）、SGB后（T1）、气腹后10min（T2）、20min（T3）和30min（T4）记录HR、MAP并分析患者的心率变异性（heart rate variability,HRV）。HRV通过功率谱分析：低频率（LF）,高频率（HF）,LF／HF比率,总能量（TP）。【结果】CO2气腹后老年冠心病患者LF、LF／HF、TP均升高（P〈0．05）。R-SGB组气腹后各时点LF、LF／HF、TP升高低于对照组（P〈0．05）。两组HF未见明显改变（P〉0．05）。【结论】CO2气腹使老年冠心病患者交感神经活性显著升高,右侧星状神经节阻滞可减轻CO2气腹时的心血管反应,维持CO2气腹时的交感／迷走神经张力的均衡。     

中老年抑郁症患者低动力症状与甲状腺激素的关系

目的:探讨中老年抑郁症患者低动力症状与甲状腺激素水平的关系。方法:中老年抑郁症患者,根据有无低动力症状分为低动力组(n=68例)、非低动力组(n=54例),另外将在本院体检的65例健康志愿者作为对照组(n=65例)。收集抑郁症患者的年龄、首发、自杀行为等一般情况,并抽取3组的空腹血标本检测血清FT3、FT4、TSH水平进行比较和分析。结果:低动力组FT3较非低动力组及对照组明显下降,差异均有统计学意义(P0.05);低动力组FT4/FT3较非低动力组及对照组明显升高,差异均有统计学意义(P0.05)。低动力组中,中年和老年患者甲状腺激素水平差异均无统计学意义(P0.05)。结论:伴有低动力症状的中老年抑郁症患者甲状腺激素水平存在异常,可能与疾病状态有关。     

Effects of high voltage pulsed electrical stimulation on blood flow

The purpose of this study was to determine whether high voltage electrical stimulation would increase blood flow to skeletal muscle in healthy subjects. Subjects were assigned to one of three groups: 1) an Electrical Stimulation (ES) Group (n = 16), 2) an Exercise (EX) Group (n = 14), or 3) a Control Group (n = 8). Isometric contractions were induced electrically at 30 Hz in the ES Group and performed volitionally in the EX Group for five minutes at intensities of 10% and 30% of predetermined maximal voluntary isometric contraction (MVC) efforts. Blood flow, heart rate, and blood pressure were unaffected in the ES Group, but blood flow and systolic blood pressure increased and decreased, respectively, for the EX Group at 30% of MVC. High voltage stimulation at a pulse rate of 30 Hz and at intensities needed to evoke contractions at 10% and 30% of MVC for plantar flexion did not increase blood flow at the popliteal artery.     

Autonomic Arousal as a Mechanism of the Persistence of Nocebo Hyperalgesia

Placebo and nocebo mechanisms can lead to clinically significant modulation of pain. Although learning is considered to be the broad mechanism underlying placebo analgesia as well as nocebo hyperalgesia, critical differences have emerged in their specific mechanisms. One of the most interesting of these is that whereas placebo analgesia seems to be relatively short-lived, nocebo hyperalgesia appears more resistant to extinction, often persisting indefinitely. The current study examined why nocebo hyperalgesia persists longer than placebo analgesia. Sixty healthy volunteers were randomized to receive placebo conditioning, nocebo conditioning, or no conditioning using an experimental pain model with surreptitious decreases (placebo group) and increases (nocebo group) in pain stimulation paired with sham treatment during training. Pain was then assessed in a test phase with and without the sham treatment at equal pain stimulation. The conditioning procedure successfully induced placebo analgesia as well as nocebo hyperalgesia in the relevant groups, with nocebo hyperalgesia outlasting placebo analgesia, confirming nocebo hyperalgesia's resistance to extinction. Most interestingly, nocebo treatment led to heightened anticipatory anxiety ratings and autonomic arousal. Further, autonomic arousal completely mediated the effect of nocebo versus placebo training on extinction, suggesting that heightened autonomic arousal may be an important mechanism in the persistence of nocebo hyperalgesia.

Hand skin blood flow in diabetic patients with autonomic neuropathy and microangiopathy.

OBJECTIVE: To determine whether changes in hand skin blood flow in diabetic men could be demonstrated with liquid crystal contact thermography and to assess the relative effects of autonomic neuropathy and microangiopathy on these changes. RESEARCH DESIGN AND METHODS: Thirty-four diabetic and 12 age-matched nondiabetic men comprised the study. The diabetic men were categorized according to standard cardiovascular autonomic function tests and the presence or absence of background or proliferative retinopathy and/or proteinuria. Bilateral hand thermograms were measured at rest and after immersion of the right hand in ice-cold water. RESULTS: Diabetic men with definite or severe autonomic neuropathy (n = 13) had a high frequency of anisothermal baseline thermograms (77 vs. 25% in nondiabetic subjects, P less than 0.05). After ice-cold water immersion, right-hand recovery was abnormally slow (514 +/- 157 arbitrary U, area under the curve) compared with nondiabetic men (685 +/- 135 arbitrary U, P less than 0.01). Diabetic men with proliferative retinopathy (n = 8) all had definite or severe autonomic neuropathy and showed the same abnormalities. Diabetic men with nor or early autonomic changes showed normal thermographic patterns. CONCLUSIONS: These results are consistent with increased palmar arteriovenous shunt blood flow or capillary closure in the hands of diabetic patients with definite or severe autonomic neuropathy. They indicate that thermoregulatory reflex changes in hand skin blood flow are controlled by the autonomic nervous system. It is possible, however, that diabetic microangiopathy, associated with the presence of proliferative retinopathy, also independently affects hand skin blood flow.