Moxibustion, an alternative therapy, ameliorated disturbed circadian rhythm of plasma arginine vasopressin and urine output in multiple system atrophy

Urological dysfunction in synucleinopathies: epidemiology, pathophysiology and management

OBJECTIVE

Parkinson's disease (PD) and multiple system atrophy (MSA) are major neurogenerative diseases characterized pathologically by abnormal alpha-synuclein aggregation. PD and MSA are clinically characterized by motor disorder and bladder dysfunction (mainly urinary urgency and frequency, also called overactive bladder). However, few literatures are available concerning bladder dysfunction in PD or MSA.

METHOD

A systematic review.

RESULTS

The bladder dysfunction in MSA is more severe than that in PD for large post-void residual or urinary retention. These bladder dysfunctions presumably reflect the different nervous system pathologies. Overactive bladder in PD reflects lesions in the brain, e.g., in the prefrontal-nigrostriatal D1 dopaminergic bladder-inhibitory pathway. Overactive bladder in MSA reflects lesions similar to PD and the cerebellum (bladder-inhibitory), and the urinary retention in MSA presumably reflects lesions in the pontine micturition center and the sacral intermediolateral nucleus of the spinal cord (bladder-facilitatory). Bladder dysfunction not only impairs an individual's quality of life, it can also cause emergency hospitalizations due to acute retention and early institutionalization. Anticholinergics are the first-line treatment for bladder dysfunction in PD and MSA patients, but care should be taken for the management of bladder dysfunction-particularly in MSA patients due to the high prevalence of difficult emptying, which needs clean, intermittent catheterization.

CONCLUSIONS

This review summarizes the epidemiology, pathophysiology, and management of bladder dysfunction in individuals with PD or MSA.

Case of possible multiple system atrophy with a characteristic imaging finding of open bladder neck during storage phase as an initial sign

Multiple system atrophy is a neurodegenerative disease that affects autonomic and motor systems. Patients with multiple system atrophy usually experience lower urinary tract symptoms, which sometimes appear as an initial symptom before the emergence of the generalized symptoms. An open bladder neck during the filling phase on video urodynamic study is one characteristic imaging finding after the diagnosis of multiple system atrophy, but has not previously been reported at an early phase of the disease. We report a case in which an open bladder neck was observed on several imaging modalities before generalized symptoms emerged. Because occult neurogenic bladder might exist in patients whose lower urinary tract symptoms are resistant to pharmacotherapy, we report this case to raise awareness of the importance of sufficient imaging evaluations. An open bladder neck might be an important imaging finding for diagnosing multiple system atrophy, irrespective of the presence of generalized symptoms. This finding could help avoid false diagnosis and unnecessary treatment.

Characteristics of selected indoor air pollutants from moxibustion

Concentrations and risk of monoaromatic hydrocarbons (MAHC), formaldehyde (HCHO), and polycyclic aromatic hydrocarbons (PAHs) in two moxibustion rooms were determined. The mean concentrations of MAHC, HCHO and PAHs were 535.2 μg/m(3), 157.9 μg/m(3) and 12.86μg/m(3), respectively, with notable health risks, indicating relatively serious pollution in indoor air due to the use of burning moxa. The indoor emissions of target pollutants from burning moxa in test chamber were also investigated. Toluene, benzene and xylene appeared to be dominant MAHCs, and naphthalene (NA) the dominant PAH, which were consistent with the pollution levels of the detected moxibustion rooms. The emission characteristics of smoky moxa and mild moxa were much in common and relatively close to that of tobacco; while that of smoke-free moxa showed a distinction. Though pollutants emission patterns varied within the three types of moxa, all of them had apparently higher emission intensities than other typical indoor sources, including tobacco. The results of this study can offer some references during the selection of moxa sticks and application of moxibustion.

The effectiveness of moxibustion: an overview during 10 years

Moxibustion has been used to treat various types of disease. However, there is still insufficient evidence regarding its effectiveness. This study was performed to summarize and evaluate the effectiveness of moxibustion. A search was performed for all randomized controlled trials in PubMed between January 1998 and July 2008 with no language restriction. The results yielded 47 trials in which six moxibustion types were applied to 36 diseases ranging from breech presentation to digestive disorders. Moxibustion was compared to three types of control group: general care, Oriental medical therapies or waiting list. Moxibustion was superior to the control in 14 out of 54 control groups in 46 studies. There were no significant differences among groups in 7 studies, and the outcome direction was not determined in 33 studies. Seven studies were included in a meta-analysis. Moxibustion was more effective than medication in two ulcerative colitis studies (relative risk (95% CI), 2.20 (1.37, 3.52), P = .001, I² = 0%). Overall, our results did not support the effectiveness of moxibustion in specific diseases due to the limited number and low quality of the studies and inadequate use of controls. In order to provide appropriate evidence regarding the effectiveness of moxibustion, more rigorous clinical trials using appropriate controls are warranted.

Microcirculatory changes by laser Doppler after infrared heating over acupuncture points--relevance to moxibustion

BACKGROUNDS

Moxibustion is a commonly used treatment in traditional Chinese medicine (TCM) that involves the application of local heating (LH) at acupoints.

OBJECTIVE

We used laser Doppler flowmetry (LDF) and spectrum analysis to investigate differences in the microcirculatory responses to the application of homogeneous LH at Hoku and two nearby nonacupoints.

METHODS

Thirty-four trials were performed on 10 male healthy volunteers. For each experiment, we recorded a 20-minute baseline data sequence, then applied LH by an infrared-radiation lamp and recorded another 20-minute heating-effect sequence. The relative energy contributions (RECs) for LDF periodic oscillations in five characteristic frequency regions from 0.0095 to 1.6 Hz (segmented into FR1-FR5) were calculated by wavelet analysis.

RESULTS

The flux increased significantly following LH. Decreases in RECs of FR2 and FR3, increases in RECs of FR1 and FR5, and the flux increase following LH were all largest at Hoku.

CONCLUSION

Our results suggest that the application of LH to acupoints induces larger therapeutic effects. This might partly account for the physiological mechanism of moxibustion, and could contribute to optimizing the microcirculatory improvement by applying LH treatments. Frequency-band analysis appears to be a promising tool for studying microcirculatory responses induced by various TCM treatments.

Spinal epidural abscess associated with moxibustion-related infection of the finger

OBJECTIVE

To describe a spinal epidural abscess that originated from cellulitis after moxibustion.

METHODS

Case report.

FINDINGS

A 78-year-old woman with diabetes mellitus was diagnosed with tetraplegia due to a cervical spinal epidural abscess extending to the thoracic spinal epidural space. The abscess was caused by osteomyelitis and cellulitis of the right third finger, which had been cauterized repeatedly with moxa. After surgical decompression and drainage of the spinal epidural abscess and comprehensive rehabilitation, motor strength and functional level improved.

CONCLUSIONS

This case illustrates the risk of spinal epidural abscess in persons with diabetes mellitus who present with focal cellulitis and osteomyelitis.