Abstracts from the Society for Acupuncture Research 2013 International Conference Impact of Acupuncture Research on 21 st Century Healthcare April 18–21,2013 The Michigan League Ann Arbor,MI

O-1 A RANDOMIZED COMPARATIVE EFFECTIVENESS CLINICAL TRIAL OF ACUPUNCTURE AS AN ADJUNCTIVE THERAPY IN PATIENTS WITH DEPRESSION

Linlin Sun, Beijing University of Chinese Medicine; Xuehong Ma, Dongfang Hospital, the second clinical medical college of Beijing University of Chinese Medicine; Xinjing Yang, Beijing University of Chinese Medicine; Sihan Wang, Beijing University of Chinese Medicine; Zhuo Guo, Beijing University of Chinese Medicine; Huifang Ma, Beijing University of Chinese Medicine; Fengxian Meng, Dongfang Hospital, the second clinical medical college of Beijing University of Chinese Medicine; Tuya, Beijing University of Chinese Medicine

Purpose: To determine whether acupuncture plus the antidepressant paroxetine is more effective than paroxetine alone in patients with depression Methods: Outpatients with depression (n=88) were randomly divided into three groups: 1) manual acupuncture plus paroxetine (n=25); 2) electroacupuncture (EA) plus paroxetine (n=28); 3) paroxetine alone (n=35). Treatments were given for 6 weeks: manual acupuncture and EA (30 minutes every other day); paroxetine (10 mg/day for the first two days, 20 mg/day from the third day onward). The Hamilton Depression (HAMD) and Zung Self-Rating Depression (SDS) scales assessed treatment effect at weeks 0, 1, 2, 4, and 6. The Side Effects Rating Scale (SERS) was given at weeks 0, 2, 4, and 6. HAMD was given at follow up in week 10. Analyses included Intention-To-Treat (ITT) and Per-Protocol subjects (PP).

Results: The scales showed no differences among the groups at baseline (P>0.05). The acupuncture groups scored significantly better on HAMD than did medicine alone at each time point (P<0.05); there were no statistically significant differences between the acupuncture groups. (See Fig. 1.) The acupuncture groups scored significantly better on SDS than did the paroxetine group at weeks 4 and 6 (P<0.05). The acupuncture groups scored significantly lower on SERS than did the paroxetine group at weeks 2, 4, and 6 (P<0.05).

Conclusions: Our small-scale comparative effectiveness clinical trial indicates that acupuncture as an adjunctive therapy for patients with depression may be both safe and more effective than pharmaceuticals alone.

O-2 ACUPUNCTURE AND OTHER PHYSICAL TREATMENTS FOR THE RELIEF OF CHRONIC PAIN DUE TO OSTEOARTHRITIS OF THE KNEE: NETWORK META-ANALYSIS

Hugh MacPherson, University of York; Mark Corbett, University of York; Stephen Rice, University of York; Vichithranie Madurasinghe, Perinatal Institute; Russell Slack, University of York; Alex J Sutton, University of Leicester; Melissa Harden, University of York; Nerys Woolacott, University of York

Purpose: To compare the effectiveness of acupuncture with other relevant physical treatments for alleviating pain due to osteoarthritis of the knee, where treatment is additional or alternative to pharmacological analgesics.

Methods: We conducted a network meta-analysis combining both direct (within-trial) and indirect (between-trial) evidence, such that all treatments were compared equally with each other, standard care, placebo, or no treatment, and which reported pain as an outcome. Data were pooled where there was sufficient clinical homogeneity. Analyses were conducted using Markov Chain Monte Carlo simulation to estimate model parameters following a Bayesian approach.

Results: Of 138 eligible studies, 87 trials covering 22 different treatments and 6753 patients provided data suitable for analysis. Results showed that only six interventions, acupuncture, aerobic exercise, interferential therapy, muscle-strengthening exercise, pulsed electrical stimulation, and TENS produced a statistically significant reduction in pain when compared with standard care. A majority of trials were rated as being of poor quality. Of the above six interventions, only acupuncture and muscle-strengthening exercise were represented by more than one trial in a sensitivity analysis of the better-quality studies; both interventions were statistically significantly better than standard care (8 trials of acupuncture, SMD: −1.01, 95% credible interval −1.42 to −0.62; 7 trials of muscle-strengthening exercise, SMD: −0.38, 95% credible interval −0.74 to −0.02) with acupuncture being statistically significantly better than muscle-strengthening exercise (SMD: 0.64, 95% credible interval 0.13 to 1.15). The results for both these interventions were consistent across both the main and sensitivity analyses.

Conclusions: The first network meta-analysis of physical interventions for knee pain due to osteoarthritis indicates that acupuncture appears to be the treatment most likely to produce a clinically relevant effect in alleviating pain in the short-term.

O-3 ACUPUNCTURE IN A MANAGED CARE PROGRAM: EVALUATING CLINICAL OUTCOMES, MEMBER SATISFACTION, AND COSTS OF CARE

Elizabeth Sommers, Boston University School of Public Health; Marilyn Moro-Carrion, Boston University School of Public Health; Maya Rauth, Boston University School of Public Health

A community health center and clinic specializing in acupuncture partnered with a large managed care organization to determine whether acupuncture treatment might influence clinical outcomes and costs of care for patients referred for the following conditions: pain, headache, menstrual or menopausal symptoms, carpal tunnel syndrome. Members of the managed care organization were referred through their physicians. Results of the project's first 5 years of this ongoing project will be presented.

Data for this observational assessment were collected on demographics, health history, clinical outcomes, satisfaction, and associated costs. All patients received individualized acupuncture treatments provided by licensed acupuncturists according to standards of care. Data were collected on 488 individuals. Three hundred eighty-two (78%) were female, 47% were Hispanic/Latino, 13% were African-American, and mean age was 39 years. Of these, 73% were referred for pain, 16% for headache, 6% for menstrual symptoms, 2% for menopausal symptoms, and 2% for carpal tunnel syndrome. Mean reduction in pain severity based on a 10-point Likert scale was 1.88 (p<0.0001). Mood, sleep, ability to work improved (p<0.0001) although quality of life as indicated by SF1 did not appreciably change (p=0.08). Headache intensity levels were significantly reduced by 2.9 on a 10-point Likert scale (p<0.0001) as was quality of life (p=0.009). Women receiving acupuncture for menstrual difficulties reported reductions in cramps (p=0.001), insomnia (p=0.018) and edema (p=0.003). Preliminary cost estimates suggest a decrease in other healthcare costs ($40/member/month) and increased likelihood that individuals who received acupuncture continued their membership in the managed care plan.

Preliminary results indicate that offering acupuncture in a community health setting is acceptable and desirable by patients and physicians. Favorable clinical and cost-of-care outcomes were observed in this ongoing project.

O-4 ACUPUNCTURE IN PATIENTS WITH SEASONAL ALLERGIC RHINITIS – RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Benno Brinkhaus, Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin; Miriam Ortiz, Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin; Claudia M Witt, Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin; Stephanie Roll, Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin; Klaus Linde, Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich; Florian Pfab, Department of Dermatology and Allergy, Technische Universität München, Munich; Bodo Niggemann, Pediatric Allergology and Pneumology, German Red Cross Hospital Westend, Berlin International; Josef Hummelsberger, Society for Chinese Medicine (Societas Medicinae Sinensis, SMS), Munich; András Treszl, Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg; Johannes Ring, Department of Dermatology and Allergy, Technische Universität München, Munich; Torsten Zuberbier, Department of Dermatology and Allergology, Charité University Medical Center, Berlin; Johannes Ring, Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg; Stefan Willich, Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin

Background: Acupuncture is widely used to treat seasonal allergic rhinitis but the scientific evidence is insufficient. The aim of this study was to investigate the efficacy of acupuncture in seasonal allergic rhinitis.

Method: Three-group randomized, controlled trial involving 422 patients suffering from seasonal allergic rhinitis (60% woman), mean (SD) age 33 (8) years, with clinical symptoms and IgE-sensitization to birch and grass pollen. Duration of follow-up was 3 months in the first and 8 weeks in the second year. The study interventions were acupuncture plus rescue medication (RM, Cetirizine) (n=212), sham acupuncture plus RM (n=102) or Rescue Medication alone (n=108). Acupuncture and sham acupuncture were administered by 46 specialized physicians in 6 hospital and 32 private outpatient clinics and consisted of 12 sessions per patient over 8 weeks. Primary outcome parameters were the Rhinitis Quality of Life Questionnaire overall score (RQLQ) and the RM Score (RMS) in weeks 7 and 8 post randomization. Duration of follow-up was 16 weeks in the first and 8 weeks in the second year without further treatment in both acupuncture groups.

Results: Compared to sham acupuncture and to RM, acupuncture was associated with improvement in RQLQ (mean differences to sham 0.5, 97.5%CI 0.2–0.8, p<0.001, and to RM 0.7, 0.4–1.0, p<0.001) and lower RMS (mean differences 1.1, 0.4–1.9, p<0.001, and 1.5, 0.8–2.2, p<0.001, respectively). There were no differences after 16 weeks in the first year. After the 8-week follow-up phase in the second year acupuncture was again superior to sham acupuncture (mean differences RQLQ 0.3, 95%CI 0.03–0.6, p=0.032; and to RMS 1.0, 95%CI 0.2–1.9, p=0.018).

Conclusion: Acupuncture led to improvements in disease-specific quality of life and antihistamine intake after 8 weeks of treatment compared to sham acupuncture and to rescue medication alone in the first and second year.

O-5 ACUPUNCTURE SENSATION WITHOUT ACUPUNCTURE - WHAT IS THE PHYSIOLOGICAL BASIS?

Florian Beissner, University Hospital Jena, Pain & Autonomics - Integrative Research; Maria Fink, University Hospital Jena, Pain & Autonomics - Integrative Research; Irene Marzolff, Goethe University, Frankfurt, Institute for Physical Geography; Franziska Brunn, University Hospital Jena, Pain & Autonomics - Integrative Research

Purpose: A central concept of TCM theory explaining the effectiveness of acupuncture is that of meridians (chin.: “jingluo”), channel-like structures that traverse the body and are believed to circulate an immaterial substance called qi. After five decades of fruitless search for a corresponding anatomical correlate of these entities, there is unlikely to be one. Still, there is one good reason to believe in meridians: The patterns of acupuncture sensation. Here, we present the results of three different studies investigating patterns of acupuncture sensation (chin.: "deqi").

Methods: In the first study, we used laser acupuncture under sensory deprivation to study the spatial aspect of sensation patterns. Using a geographic information system on subjects' drawings of their sensations, we compared these to patterns of referred pain from the literature. In the second study, we tested the importance of attention on the stimulated point, tactile stimulation and laser stimulation for the elicitation of the acupuncture sensation by manipulating each factor in a 2x2x2 single-blinded experimental design. In the third study, we tested if acupuncture sensations would also occur under pure placebo condition. For this purpose, the laser was left switched off during the whole experiment.

Results: GIS analysis showed a close similarity between acupuncture sensation patterns and those of referred pain. This was true for all three experiments. Sensations were more frequent, when actual laser stimulation was taking place, but very similar patterns, qualities and intensities of the sensation were also observed under complete placebo conditions.

Conclusions: Acupuncture sensation may be unrelated to acupuncture stimulation and may be a phenomenon of directed attention leading to perception of otherwise sub-threshold tonic activity of peripheral touch, pain and warm receptors.

O-6 ACUPUNCTURE-INDUCED MOLECULAR SIGNALING PATHWAY IN MOUSE SKIN LAYER

Ji-Yeun Park, Acupuncture and Meridian Science Research Center(AMSRC), Kyung Hee University, Republic of Korea; Songhee Jeon, Dongguk University Research Institute of Biotechnology, Republic of Korea; Jongbae Park, Department of Physical Medicine and Rehabilitation, University of North Carolina at Chapel Hill, USA; Younbyoung Chae, Acupuncture and Meridian Science Research Center (AMSRC), Kyung Hee University, Republic of Korea; Hyangsook Lee, Acupuncture and Meridian Science Research Center (AMSRC), Kyung Hee University, Republic of Korea; Hyejung Lee, Acupuncture and Meridian Science Research Center (AMSRC), Kyung Hee University, Republic of Korea; Hi-Joon Park, Acupuncture and Meridian Science Research Center (AMSRC), Kyung Hee University, Republic of Korea

Aim of Investigation: Although acupuncture has been widely used as a therapeutic intervention, it is still unclear how acupuncture causes therapeutic effects. To clarify the acupuncture mechanism scientifically, it is required to observe the molecular event at the acupuncture point on the skin after acupuncture stimulation. The objective of this study is to find a correlation between local molecular changes in the skin layer after acupuncture stimulation and the therapeutic effects of acupuncture.

Methods: Acupuncture stimulation was performed on acupuncture point of C57BL/6 mice. Molecular changes in RNA level were analyzed using cDNA microarray 1 hour after the stimulation. In addition, molecular changes after acupuncture stimulation were analyzed using western blot and histological analyses in protein level. Then, the linking between analgesic effects of acupuncture and molecular changes in the skin layer was investigated using mouse pain model.

Results: In cDNA microarray, about 200 genes were changed compared to control group after acupuncture stimulation. In up-regulated genes, some pathways were mapped significantly. After acupuncture stimulation, molecular signals related to MAPK signaling pathway were increased, and we also obtained similar result in histological analysis. In mouse pain model, acupuncture stimulation attenuated nociceptive response, and this effect was partially blocked by MAPK inhibitor.

Conclusions: Molecular signals from acupuncture stimulation in skin layer seem to play an important role for the analgesic effects of acupuncture stimulation.

O-7 ADJUVANT WHOLE SYSTEMS TRADITIONAL CHINESE MEDICINE IMPROVED FRESH, NON-DONOR IN VITRO FERTILIZATION – A RETROSPECTIVE CHART REVIEW

Lee Hullender Rubin, Oregon College of Oriental Medicine; Michael Opsahl, Northwest Center for Reproductive Sciences; Klaus Wiemer, Northwest Center for Reproductive Sciences; Angela Humphrey, Oregon College of Oriental Medicine; Patrick Allen, Oregon College of Oriental Medicine; Scott Mist, Oregon Health and Science University; Deborah Ackerman, Oregon College of Oriental Medicine

Background: Surveys suggest in vitro fertilization (IVF) patients seek unproven adjuvant treatments to their IVF cycles, including whole systems traditional Chinese medicine (TCM). TCM treatment can include acupuncture, Chinese herbs, dietary and/or lifestyle recommendations, however research is needed to evaluate these components' effects on IVF live birth outcomes. In this study, live births were compared among IVF patients who (1) received usual care, (2) elected standardized acupuncture before and after embryo transfer (ET), or (3)elected TCM pre-treatment and acupuncture the day of ET.

Methods: Data from records of 1,069 fresh, non-donor cycles from a private infertility clinic were reviewed. The main outcome measure was live birth beyond 24 weeks gestation. Live births were compared among: (1) Usual Care group (UC) received no additional treatment (N=580); (2) Acupuncture (Acu) group elected adjuvant acupuncture before and after ET(N=370); and (3) TCM group elected treatment prior to ET, which included acupuncture, Chinese herbs, dietary and/or lifestyle recommendations, and acupuncture on the day of ET(N=119). Outcomes were compared using logistic regression with covariates of FSH, age and number of embryos transferred.

Results: Live births were significantly higher in the TCM group (N=73, 61.3%) than the UC group (N=280, 48.3%, p=0.01) but not the Acu group (N=188, 50.8%, p=0.39). In the TCM group, the mean number of acupuncture visits prior to ET was 12.0±12.4 (1 – 73). TCM with acupuncture on the day of ET was associated with a 73% increased odds of live birth than either UC or Acu alone (OR=1.73, 95% CI 1.16 – 2.60, p=0.008).

Conclusion: Whole systems TCM pre-treatment prior to ET and acupuncture on the day of ET significantly improved live births in fresh, non-donor IVF cycles. This preliminary finding should be taken cautiously as adequately powered, randomized controlled trials are necessary to confirm this observation.

O-8 ALTERED BRAIN RESPONSE TO ACUPUNCTURE AFTER A COURSE OF ACUPUNCTURE THERAPY FOR CTS IS ASSOCIATED WITH ANALGESIA

Yumi Maeda, Martinos Center for Biomedical Imaging, Massachusetts General Hospital/ Logan College of Chiropractic/University Programs; Jieun Kim, Martinos Center for Biomedical Imaging, Massachusetts General Hospital; Stephen Cina, Martinos Center for Biomedical Imaging, Massachusetts General Hospital; Claire McManus, Spaulding Rehabilitation Hospital; Cristina Malatesta, Spaulding Rehabilitation Hospital; Pia Mezzacappa, Martinos Center for Biomedical Imaging, Massachusetts General Hospital; Leslie Morse, Spaulding Rehabilitation Hospital; Jessica Gerber, Martinos Center for Biomedical Imaging, Massachusetts General Hospital; Rebecca Ogn-Sutherland, Spaulding Rehabilitation Hospital; Norman Kuttner, Logan College of Chiropractic/University Programs; Joseph Audette, Harvard Vanguard Medical Associates; Vitaly Napadow, Martinos Center for Biomedical Imaging, Massachusetts General Hospital/ Logan College of Chiropractic/University Programs

Carpal tunnel syndrome (CTS) is a common entrapment neuropathy. While brain response to acupuncture stimuli has been well characterized in healthy adults, the response in patients with chronic pain disorders such as CTS is less well understood. Moreover, how this response changes after a longitudinal course of acupuncture therapy and is related to clinical outcomes are also unknown. CTS patients (N=13, 8F) were evaluated with functional MRI (fMRI) during acupuncture stimulation at baseline and after 8 weeks of 16 acupuncture treatments. FMRI data were acquired using a gradient echo T2*-weighted pulse sequence on a 3.0T Siemens Trio. Electro-acupuncture was applied at PC7 to TW5 on the affected forearm using an event-related design (2-sec stimulation with randomized ISI, 6–12 sec, total=5 min6 sec). A paired t-test contrasted acupuncture response at baseline versus after a longitudinal course of therapy. Results were voxel threshold at z>2.3, and cluster corrected for multiple comparisons at p<0.05. Short-term pain reduction at the time of scan was evaluated with VAS (0–10), while long-term pain reduction after 8weeks of therapy was evaluated with the Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ, 1–5).

Acupuncture activated bilateral insulae, S2, ACC, thalamus and NRD/PAG, and deactivated ipsilateral S1 and MPFC. Activation in ACC was significantly greater after 8weeks of therapy compared to baseline. Acupuncture produced short-term and long-term reduction of pain (−1.2±1.6, −0.9±1.0, p<0.05, respectively). Furthermore, activation in ACC at the baseline and final were negatively correlated with pain reduction (r=−0.49, −0.57, respectively). Altered ACC activation following 8weeks of therapy was correlated with long-term pain reduction (r=0.45).

A longitudinal course of acupuncture therapy increased acupuncture-associated activation in the NRD/PAG, suggesting that repeated acupuncture strengthens NRD/PAG-mediated descending pain modulation. Altered ACC activation following therapy may play a role in improved clinical outcomes following acupuncture.

O-9 BENEFITS OF COMBINED TREATMENT OF L-DOPA WITH ACUPUNCTURE ON PARKINSON'S DISEASE MOUSE MODEL

Seung-Nam Kim, AMSRC; Ah-Reum Doo, AMSRC; Ji-Yeun Park, AMSRC; Insop Shim, AMSRC; Younbyoung Chae, AMSRC; Hyejung Lee, AMSRC; Hi-Joon Park, AMSRC

Parkinson's disease is characterized by dopaminergic neuronal death and dopamine deficits in midbrain. Although it has serious adverse events, L-dopa is the gold standard to treat early Parkinson's patients for mitigating their motor dysfunction. Acupuncture treatment has been studied to be a good alternative therapy for Parkinson's disease in two aspects, dopamine neuron protection and dopamine transmission enhancement. In this study, we firstly tried to study the effectiveness of combined treatment of L-dopa with acupuncture treatment. 6-OHDA was administered to C57Bl/6 mice to develop hemi-Parkinsonian mice model. Then, we found that a 50% dose of L-dopa was needed in combination therapy to have the same efficacy on motor function recovery. In the results on L-dopa-induced dyskinesia (LID), which is one of the serious adverse events of L-dopa, combination therapy showed significant alleviation of abnormal involuntary movement induced by LID. We examined HPLC analysis of midbrain for investigating what is the mechanism of this therapeutic effect. As the results, combined therapy significantly decreased GABA contents in substantia nigra compared to L-dopa treatment. Interestingly, with the low dose, which is ineffective to motor function, combination therapy improved motor function and normalized GABA and glutamate contents. All of the results showed that combination therapy enhances the force of drug and mitigates LID by normalizing basal ganglia system. This study shows the efficacy of novel method, which is more effective and safe treatment of L-dopa, that is combined with acupuncture treatment. And the results give us the understanding therapeutic mechanism of L-dopa and acupuncture underlying basal ganglia system.

O-10 CENTRAL MECHANISM OF INSTANT ANALGESIA EFFECT OF AUPOINTS ON SHAO-YANG MERIDIANS TO MIGRAINE PATIENTS

Jie Yang, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine; Yue Feng, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine; Fang Zeng, Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine; Ji Chen, Chengdu University of Traditional Chinese Medicine; Yu-Lan Ren, Chengdu University of Traditional Chinese Medicine; Fan-Rong Liang, Chengdu University of Traditional Chinese Medicine

Objective: To observe the changes of cerebral glucose metabolism by puncturing at the acupoints on the shaoyang meridian for migraine patients in the attack stage and explore the central mechanism of instant analgesic effect of puncturing at acupoints on the shaoyang meridian for migraine patients.

Methods: 20 patients who matched the inclusion criteria were randomly divided into 2 groups: Group A: acupuncture acupoints on the shaoyang meridian once (GB20,SJ5,GB34); Group B was waiting-list group. Headache intensity grading and VAS were assessed before and after acupuncture treatment to observe instant analgesic effect of puncturing at different acupoints. Positron emission tomography-computed tomography (PET-CT) was performed to detect the cerebral glucose metabolism among 40 patients after the first administration of puncturing. Then the difference among them was analyzed by SPM2, which was used to discuss the central mechanism of instant analgesic effect of puncturing at acupoints on the shaoyang meridian for migraine patients.

Results: Compared to the GroupB, the patients in Group A showed increased glucose metabolism in Middle Temporal (BA 17), Insula (BA 13), Medial Frontal (BA 9,10), Precuneus (BA31,39), ACC (BA32), MCC (BA31) PCC (BA23 31); decreased glucose metabolism in Left Hippocampus, Parahippocampal Gyrus, Fusiform Gyrus (BA18,19), Postcentral Gyrus(BA2) and Cerebellum.

Conclusions: The effect of puncturing at the acupoints on the shaoyang meridian could influence the regions related with pain, including Middle Cingulate Gyrus, Posterior Cingulate Gyrus, Insula, Hippocampus, and Parahippocampal Gyrus, etc.

O-11 DO NEGATIVE ATTITUDES ABOUT ACUPUNCTURE ACCOUNT FOR NON-USE? FINDINGS FROM THE NATIONAL HEALTH INTERVIEW SURVEY (NHIS) 2007

Dawn Upchurch, UCLA; Bethany Wexler Rainisch, California State University, Northridge; Deborah Ackerman, Oregon College of Oriental Medicine

Purpose: National prevalence estimates of acupuncture use among adults, although increasing, are low. In 2007, 6.8% reported lifetime use and only 1.5% reported use in the past 12 months. Compared to other provider-based CAM modalities (e.g., chiropractic, massage), acupuncture is 6 times less prevalent. Clearly differences in the number of practitioners available account for some of the variability; however, little national data are available to assess people's attitudes toward acupuncture. The goal of this study was to evaluate reasons for non-use of acupuncture among a group of never and prior users. We were especially interested in understanding the extent to which negative attitudes contributed to non-use.

Methods: Data were from the 2007 NHIS, a cross-sectional, nationally representative sample of adults 18+(N=23,393). Never-users (N=21,002) and prior users (N=1,168) were asked a battery of questions regarding why acupuncture had not be used. Weighted univariate, bivariate, and multivariate analyses were performed to account for complex sample design and provide national estimates.

Results: Among never-users, the most common reasons for non-use were ‘no reason’ (32.5%) or ‘didn't need it’ (24.7%). Another third mentioned they either did not know or thought about it. Specific negative attitudes (‘don't believe in it/it doesn't work’) or concerns about safety were in single digits (only 5.5% said they did not believe it worked). Concerns about costs (2.2%) or medical proof (0.5%) were minimal. Findings were similar among prior users, although 17.7% mentioned acupuncture had not worked for them. As expected, demographic characteristics were significantly associated with acupuncture attitudes among both never and prior users.

Conclusions: Negative attitudes or scientific skepticism about acupuncture were not common reasons for non-use. These findings suggest a need for continuing outreach and education to provide the community with information on possible uses of acupuncture.

O-12 DOSES OF CAFFEINE RELEVANT TO DIETARY HUMAN INTAKE CAN INHIBIT THE ACUPUNCTURE-INDUCED ANALGESIA

Ari Ojeda Ocampo More, UFSC; Francisco Cidral-Filho, UFSC; Leidiane Mazzardo-Martins, UFSC; Daniel Martins, UFSC; Francisney Nascimento, UFSC; Shin Min Li, UFSC; Adair Santos, UFSC

The use of acupuncture in the treatment of pain conditions has been extensively investigated. However, the influence of dietary ingredients on acupuncture induced analgesia (AA) remains unexplored. Recently, the role of adenosine receptors in AA has been shown, and caffeine, one of the world's most commonly consumed dietary ingredients, is an antagonist of these receptors. In this study, the post-incisional pain model was used to investigate caffeine's influence on AA. Mice were treated with acupuncture needling after administration of acute or chronic of caffeine. Acupuncture needling was performed using two different types of stimuli, manual acupuncture and electroacupuncture bilaterally in the acupoint SP6. We found that acute pre-administration of caffeine (10 mg/kg, i.p.) completely reversed AA in both types of acupuncture. In the chronic pre-administration, we used two doses that mimicked the average daily caffeine consumption in Western countries and China. Interestingly, the “Western dose” of caffeine (70 mg/kg/day) administered during eight days in the drinking water reversed AA and the “Chinese dose” (4 mg/kg/day) administered during the same period did not. These results indicate that the use of caffeine can inhibit the analgesic effect of different forms of acupuncture. Also, our findings suggest that doses of caffeine relevant to dietary human intake levels could be a confounding factor in the context of acupuncture research.

O-13 EFFECTIVENESS OF MOXIBUSTION TREATMENT AS ADJUNCTIVE THERAPY IN OSTEOARTHRITIS OF THE KNEE: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Ling Zhao, Shanghai University of Traditional Chinese Medicine; Fan Wu, Shanghai University of Traditional Chinese Medicine; Lizhen Wang, Shanghai University of Traditional Chinese Medicine; Haimeng Zhang, Shanghai University of Traditional Chinese Medicine; Haiping Deng, Shanghai University of Traditional Chinese Medicine, China; Ke Cheng, Shanghai University of Traditional Chinese Medicine; Xueyong Shen, Shanghai University of Traditional Chinese Medicine; Lixing Lao, University of Maryland School of Medicine

Objective: To observe and assess the therapeutic effect, effectiveness, and safety of moxibustion on knee osteoarthritis (KOA) caused pain, stiffness, and physical function.

Methods: One hundred and ten patients with KOA who met the inclusion criteria were randomly allocated to receive active (n=55) or sham moxibustion (n=55). The subjects received active or sham treatment at acupoint Neixiyan (EX-LE 4), Dubi (ST 35), and Ashi points three times a week over a period of 6 weeks. For active treatment, three consecutive moxa cones were burned at each point. Sham moxa cones were similarly applied for sham control. WOMAC VA 3.1, Western Ontario and McMaster University's Osteoarthritis Scale, was used to assess the effects of treatment at weeks 3, 6, 12, and 24.

Results: There were no statistical differences in WOMAC pain, stiffness, and function scores between two groups at the baseline. WOMAC scores for pain, stiffness, and functional disabilities showed significant improvements in both groups at 3, 6, 12, and 24 wks compared to baseline (P<0.01∼P<0.001). WOMAC pain scores in the active moxibustion group at 6, 12, and 24 wks decreased more than did those in the sham group (P=0.004, P=0.03, P=0.023). WOMAC physical function score improved more in the active group than in sham at wk 12 (P=0.031), but there were no significant differences in WOMAC joint stiffness score between the two groups. No side effects were found during the trial.

Conclusion: Moxibustion is effective in relieving pain in KOA patients up to 18 weeks after the end of treatment. The procedure appears to be safe.

Funding: This study was supported by 973 Program of China (2009CB522901), National Natural Science Foundation of China (81202648), Key Program of State Administration of Traditional Chinese Medicine of China; Scientific and Technological Brainstorm Project of Shanghai (11DZ1973300, 11ZR1436700).

O-14 EFFECTS OF A TOPICAL CHINESE HERBAL FORMULA TLSJ GEL FOR BONE CANCER PAIN IN RATS

Juyong Wang, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine; Ruixin Zhang, University of Maryland School of Medicine; Changsheng Dong, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine; Liying Jiao, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine; Ling Xu, Longhua Hospital Affiliated to the Shanghai University of Traditional Chinese Medicine; Jiyong Liu, Shanghai University of Traditional Chinese Medicine; Zhengtao Wang, Shanghai University of Traditional Chinese Medicine; Qi Liang Mao Ying, Shanghai Medical College, Fudan University; Harry Fong, University of Illinois; Lixing Lao, University of Maryland School of Medicine

Cancer pain can result from the direct effects of malignancy. Current pharmacological therapy has limited efficacy and severe side effects. The herbal analgesic gel Tong-Luo-San-Jie (TLSJ) are used in traditional Chinese medicine to manage cancer pain. However, its mechanisms are still unknown. A bone cancer pain rat model was used to investigate the effects and mechanisms of TLSJ gel on bone cancer pain. The formulated gel was analyzed with ultra performance liquid chromatography (UPLC) for quality control. The rat model was established by inoculating Walker 256 rat carcinoma cells directly into the right tibial medullary cavity of Sprague-Dawley rats (150–170 g); PBS tibial inoculation was used as control. Cancer-bearing rats were treated twice a day with external TLSJ gel (0.5 g/cm2/day) or inert gel for 21 days (n=10/group). Mechanical threshold and paw withdrawal latency (PWL) were respectively assessed with von Frey filaments and Hargreaves' Method. Osteoclastic activities, which are involved in bone metastasis-induced cancer pain, were determined and carboxyterminal pyridinoline cross-linked type I collagen telopeptides (ICTP) and bone-specific alkaline phosphatase (BAP) concentrations were detected with ELISA after treatment. Adverse effects were monitored, and biochemical and histological tests were performed in naive rats treated with local TLSJ gel for six weeks. The data demonstrate that TLSJ treatment significantly restored bone cancer-induced decrease of PWL and mechanical threshold compared to inert gel. It also decreased the level of blood serum ICTP and BAP and inhibited osteoclast activities. No adverse effects or abnormal biochemical and histological changes were detected after TLSJ treatment. The present study shows that TLSJ significantly inhibits bone cancer-induced thermal and mechanical sensitization. It suggests that the gel may be useful in managing cancer pain and that it may act by inhibiting osteoclastic activity. Supported by the NIH (No: 1R03TW008375-01A1) and the National Natural Science Foundation of China (No: 81173225).

O-15 EFFECTS OF CO2 LASER MOXIBUSTION ON DIFFERENT PATTERNS OF KNEE OSTEOARTHRITIS

Fan Wu, Shanghai University of Traditional Chinese Medicine; Ling Zhao, Shanghai University of Traditional Chinese Medicine; Lizhen Wang, Shanghai University of Traditional Chinese Medicine; Xiaoyan Liu, Shanghai University of Traditional Chinese Medicine; Haimeng Zhang, Shanghai University of Traditional Chinese Medicine; Lixing Lao, Center for Integrative Medicine, University of Maryland School of Medicine; Xueyong Shen, Shanghai University of Traditional Chinese Medicine

Objective: To compare the therapeutic effects of CO2 laser moxibustion on different patterns of knee osteoarthritis.

Methods: Eighty-four patients were allocated to three groups in accordance with TCM pattern identification, which were pattern of yang deficiency and cold coagulation (Group A, n=33), pattern of kidney essence and marrow deficiency (Group B, n=26) and pattern of stasis in tendon and bone (Group C, n=25). All patients were given CO2 laser moxibustion on ST-35 for 20 minutes' treatment, thrice a week and 4 weeks in total. WOMAC VA 3.1 were used to assess the therapeutic effects before, in the middle (2 wk), at the end (4 wk) of the treatment course and follow-up (4 weeks after the treatment).

Results: There was no significant difference among three groups in terms of WOMAC pain, stiffness and function scores before treatment (P<0.05). No significant difference was found in pain scores among three groups at 2 wk(P<0.05). At 4 wk and follow-up, Group A and Group C were equally effective (P>0.05) in pain relief and both were better than that of Group B(P<0.05). Stiffness scores were equally improved at all stages of assessment in both Group A and Group C, which were better than that of Group B(P<0.05). At 2 wk, Group A was found better in improving function scores than that of Group B and Group C (P<0.05), which were equally effective (P>0.05). At 4 wk and follow-up, there was no significant difference in function scores between Group A and Group C (P>0.05), both of which were better than that of Group B (P<0.05).

Conclusion: Based on our previous research, we found variable therapeutic effects among different TCM patterns of knee osteoarthritis. CO2 laser moxibustion is most effective in KOA patients with pattern of yang deficiency and cold coagulation and least effective in pattern of kidney essence and marrow deficiency.

O-16 EFFECTS OF ELECTROACUPUNCTURE AT NEIGUAN (PC6) ON BLOOD PRESSURE IN MYOCARDIAL INFARCTION RATS

Hai ping Deng, Shanghai University of Traditional Chinese Medicine, China, Shanghai Research Center of Acupuncture & Meridian, China; Xue Ge, Shanghai University of Traditional Chinese Medicine; Hai meng Zhang, Shanghai University of Traditional Chinese Medicine; Ling Zhao, Shanghai University of Traditional Chinese Medicine; Xue yong Shen, Shanghai University of Traditional Chinese Medicine, China, Shanghai Research Center of Acupuncture & Meridian, China; Haimeng Zhang, Shanghai University of Traditional Chinese Medicine, China, Shanghai Research Center of Acupuncture & Meridian, China

To observe the effect of electroacupuncture at Neiguan on blood pressure in myocardial infarction rats, male SD rats (weighing 250–300 g) were randomly divided into electroacupuncture group, model group and control group. In electroacupuncture group and model group, the myocardial infarction model were established by permanent ligation of the left anterior descending (LAD) of left coronary artery. In control group, rats were underwent the same operation except the ligation of LAD. In electroacupuncture group, rats were treated 30 min/d for consecutive 5d with EA at both “Neiguan” after the day of the operation. 2–15 Hz, 1–4 mA. In model group and control group, rats were placed as the same mode as the electroacupuncture group. ECG had been recorded before and after the operation and after the treatment. Using artery catheterization method for measuring femoral arterial and right carotid arterial systolic pressure, diastolic pressure, mean arterial blood pressure and pulse pressure the day after the treatment ended. Results indicate that Systolic pressure, diastolic pressure, mean arterial blood pressure and pulse pressure of the femoral artery had no statistics difference among the three groups (P>0.05), and those of the right carotid artery of model group were lower significantly than the control group (p<0.05), while those of the electroacupuncture group had no difference with the control group (P>0.05). As to the pulse pressure and the heart rate, there were no statistics significance among the three groups (P>0.05).Those results suggested that electroacupuncture at Neiguan play a role on the improvement of systolic pressure, diastolic pressure, mean arterial blood pressure of the right carotid artery in myocardial infarction rats.

This study was supported by 973 Program of China (2009CB522901), National Natural Science Foundation of China (81102635, 81202648), Key Program of State Administration of Traditional Chinese Medicine of China; Scientific and Technological Brainstorm Project of Shanghai (11DZ1973300, 11ZR1436700).

O-17 ELECTROACUPUNCTURE INHIBITS SPINAL P-CAMKII TO SUPPRESS CHEMOTHERAPY-INDUCED PAIN IN RATS

Lixing Lao, Center for Integrative Medicine, School of Medicine, University of Maryland; Lizhen Wang, Shanghai University of Traditional Chinese Medicine; Yu Zhang, Department of Neurobiology, Shanxi Medical University; Aihui Li, Center for Integrative Medicine, School of Medicine, University of Maryland; Ke Ren, Department of Neural and Pain Sciences, Dental School, University of Maryland; Brian Berman, Center for Integrative Medicine, School of Medicine, University of Maryland; Ming Tan, Division of Biostatistics, University of Maryland Greenebaum Cancer Center; Rui-Xin Zhang, Center for Integrative Medicine, School of Medicine, University of Maryland

Chemotherapy-induced pain (CIP) affects the quality of life of cancer patients, but current medical treatments are either ineffective or have adverse side effects. Acupuncture, used for millennia to treat pain, may alleviate CIP, but its effectiveness against this condition has not previously been studied. We evaluated the effects of electroacupuncture (EA) on a Paclitaxel-induced CIP rat model. Either Paclitaxel, an anti-neoplastic agent widely used to treat cancer that causes neuropathic pain in cancer patients, or vehicle was injected (2 mg/kg/ml i.p.) into respective groups of rats on alternate days (days 0, 2, 4 and 6) after baseline assessment of mechanical sensitivity with von Frey filaments. The rats were treated with 10 Hz/2 mA/0.4 ms pulse EA for 30 min at the equivalent of human acupoint GB30 (Huantiao). Compared to sham control, EA significantly alleviated Paclitaxel-induced mechanical allodynia/hyperalgesia, as shown by less frequent withdrawal responses to the filaments; the effects lasted for three weeks after treatment. EA did not significantly influence mechanical sensitivity in rats receiving vehicle. Analysis showed that EA significantly inhibited phosphorylation of Ca2+/calmodulin-dependent protein kinases II (CaMKII) in the spinal cord. KN-93, a selective inhibitor of p-CaMKII, blocked mechanical allodynia/hyperalgesia as well as the enzyme. Additionally, intrathecal pretreatment with a 5-HT1a receptor antagonist blocked EA inhibition of allodynia/hyperalgesia and p-CaMKII. These results demonstrate that EA treatment activates spinal 5-HT1a receptors to inhibit p-CaMKII and alleviate and allay allodynia and hyperalgesia for a period of at least three weeks. The data support acupuncture/EA as a complementary therapy for CIP.

Acknowledgments: The work was supported by NIH Grant # R21AT004113

O-18 FUNCTIONAL BRAIN CONNECTIVITY PREDICTS ACUPUNCTURE ANALGESIC EFFECT IN CARPAL TUNNEL SYNDROME PATIENTS

Jieun Kim, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Yumi Maeda, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Stephen Cina, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Claire McManus, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Cristina Malatesta, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Pia Hugus, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Jessica Gerber, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Rebecca Ong-Sutherland, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Leslie Morse, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital; Norman Kettner, Department of Radiology, Logan College of Chiropractic/University Programs; Joseph Audette, Department of Pain Medicine, Harvard Vanguard Medical Associates, Atrius Health; Vitaly Napadow, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital

Acupuncture relieves pain and engenders S1 neuroplasticity in carpal tunnel syndrome (CTS), a common entrapment neuropathy and neuropathic pain disorder. The aim of this study was to evaluate if an objective baseline neuroimaging biomarker, functional brain connectivity during acupuncture stimulation, can predict longitudinal changes in pain after a course of acupuncture therapy in CTS patients. CTS patients (N=25) were randomized to receive 8 weeks (16 treatments) of acupuncture therapy with either verum (ACUP, N=13) or sham (SHAM, N=12) electro-acupuncture (EA). Patients completed a baseline fMRI scan, and functional connectivity MRI data were acquired during 6-minute resting and continuous 2Hz EA. ACUP patients received EA at PC7 to TW5 on the affected forearm, while SHAM patients received non-penetrating sham acupuncture at local non-acupoints with disconnected EA electrodes. Functional connectivity to an S1 seed, localized with a separate EA event-related fMRI scan, was contrast between EA and rest and then used in a linear regression analysis to predict change in pain severity (using the Boston Carpal Tunnel Syndrome Questionnaire) after 8 weeks of therapy. Results were threshold at voxelwise z>2.3 and cluster corrected for multiple comparisons at p<0.05. Following 8 weeks of therapy, ACUP and SHAM both showed significant reduction of pain (ACUP: −0.86±0.27, SHAM: −0.62±0.19, no significant group difference, p=0.47). We found that at baseline, increasing connectivity between S1 and insula cortex during ACUP stimulation versus rest predicted greater reduction in pain following 8 weeks of ACUP therapy (r=−0.92). There was no relationship for the SHAM group (r=0.16). Our results suggest that baseline functional connectivity can be used to predict acupuncture responders for CTS. This relationship did not exist for SHAM, which involves less robust somatosensory afference during stimulation.

Greater S1-insula connectivity may reflect improved salience allocation to acupuncture stimuli in patients who go on to respond to acupuncture therapy.

O-19 HOW ACUPUNCTURISTS AND PHYSICIANS VIEW THE PRESENCE OF IN-PATIENT ACUPUNCTURE CARE AT BETH ISRAEL MEDICAL CENTER – A QUALITATIVE PHENOMENOLOGICAL STUDY

B. Basia Kielczynska, Beth Israel Medical Center NYC; Benjamin Kligler, Beth Israel Medical Center NYC

Purpose: To understand the “living experience” of acupuncturists while they provide acupuncture in-patient care and interact with medical staff in a hospital-based acupuncture fellowship program. Little is known about how acupuncturists and medical staff negotiate cooperation and how the limits of a hospital setting affect effectiveness of acupuncture care. Describing challenges of integration may provide helpful information to move the process forward.

Methods: We conducted 30–120 minute interviews with six licensed acupuncturists, two physicians and a nurse at Beth Israel Medical Center. We asked acupuncturists how it was for them to practice in a hospital setting; we solicited their experiences, thoughts, and feelings. Data was analyzed following Colaizzi's phenomenological methodology. Phenomenology allows researchers to access the meaning of participants' experience (interpretive paradigm), rather than trying to predict their behavior (empirico-analytical paradigm).

Results: Three clusters of themes have emerged from analyzing the interviews: (1) Acupuncturists were excited about integrative practice opportunities, disappointed about limited interactions with medical staff, creative in adjusting to restrictions of hospital setting, and ambivalent about clinical research opportunities; (2) Acupuncturists considered their in-patient care limited but effective and they expressed pride in holism of their practice; and (3) Physicians' support for acupuncture care depended more on the clinical results and patient satisfaction than on their understanding of the philosophy behind acupuncture or acupuncture clinical research, and different departments of the hospital represented distinct “cultures,” some of which were more receptive to acupuncture than others.

Conclusion: Understanding of the phenomenon of acupuncturists' experience as they negotiated integration in biomedical setting may (1) enrich the roadmap to how acupuncture and other non-biomedical traditions can be incorporated into our healthcare system and (2) provide an example of how current acupuncture and integrative medicine research may be informed by qualitative studies.

O-20 INCREASED NERVE GROWTH FACTOR SIGNALING IN SENSORY NEURONS OF EARLY DIABETIC RATS IS CORRECTED BY ELECTROACUPUNCTURE

Stefania Lucia Nori, Department of Pharmaceutical and Biomedical Sciences FARMABIOMED NANOMATES University of Salerno, Via Ponte don Melillo, 84084 Fisciano, Italy; Maria Luisa Rocco, Institute of Cellular Biology and Neurobiology, National Research Council (CNR), via del Fosso di Fiorano 64, 00143- Rome, Italy.; Fulvio Florenzano, Confocal Microscopy Unit, European Brain Research Institute (EBRI) - S. Lucia Foundation, via del Fosso di Fiorano 64, 00143- Rome, Italy.; Maria Teresa Ciotti, Institute of Cellular Biology and Neurobiology, National Research Council (CNR), via del Fosso di Fiorano 64, 00143- Rome, Italy.; Luigi Aloe, Institute of Cellular Biology and Neurobiology, National Research Council (CNR), via del Fosso di Fiorano 64, 00143- Rome, Italy.; Luigi Manni, 4Institute of Translational Pharmacology, National Research Council (CNR), via del Fosso del Cavaliere 100, 00133-Rome, Italy

Purpose: Diabetic polyneuropathy (DPN) is early characterized by thermal hyperalgesia and increased neurotrophism, and lately evolves in irreversible neuropathic symptoms with dramatic reduction in nerve growth factor (NGF) support to sensory neurons. For this latter reason, NGF has been proposed as a therapeutic in DPN. Electroacupuncture (EA) is the western derivate of traditional Chinese acupuncture that is widely used in the clinical therapy of neuropathic pain. We recently demonstrated that EA was able to improve thermal hyperalgesia and to modulate NGF presence in the skin and spinal cord of early diabetic rats. In the present work we investigated the involvement of NGF signaling system in the early DPN and its possible modulation by EA.

Methods: Diabetes was induced in rats by streptozotocin (STZ). One week after STZ, EA treatments were started and continued for three weeks. NGF and NGF receptors protein and mRNA, NGF signaling pathways and the presence of NGF-regulated transient receptor potential vanilloid receptor 1 (TRPV1) were analyzed in dorsal root ganglia (DRGs). NGF receptors expression and colocalization was analyzed in spinal cord and skin.

Results: We found that STZ increased NGF and NGF receptors expression, activated c-Jun N-terminal kinase (JNK) and p38 kinase and increased TRPV1 in DRG; EA in diabetic rats decreased both NGF and NGF receptors, normalized JNK and p38 activation, decreased TRPV1 and activated the transcription factor Nf-κB. Expression of p75 neurotrophin receptor was increased in diabetic skin, while receptor tyrosine kinase A was increased in the spinal cord. EA in diabetic animals counteracted both these STZ-induced deregulations.

Conclusions: The NGF could be primarily involved in DPN establishment and EA effects on DPN be mediated through the modulation of NGF signaling. Our findings point to EA, alone or in combination to NGF treatment, as a new possible therapeutic tool for DPN clinical care.

O-21 INVOLVEMENT OF PERIPHERAL ADENOSINE A1 RECEPTOR IN ELECTROACUPUNCTURE ANALGESIA

Ari Ojeda Ocampo More, UFSC; Leidiane Mazzardo-Martins, UFSC; Francisco Cidral-Filho, UFSC; Daniel Martins, UFSC; Franciscey Nascimento, UFSC; Shih Min Li, UFSC; Adair Santos, UFSC

Peripheral nervous system influences on pain signaling and different methods to investigate this component of action for pain-relieve are the focus of recent acupuncture studies. The role of peripheral adenosine receptors in acupuncture-induced analgesia (AA) has been documented using manual acupuncture stimuli. This study aimed to investigate the involvement of adenosine A1 receptor in electroacupuncture analgesia. Swiss mice were submitted to the model of postoperative pain (plantar incision) and treated with two types of stimulus: pharmapuncture (FP) and electroacupuncture (EA); the first involves the injection of drugs into acupoints and the second electrical stimulation. Both stimuli were performed in the SP6 acupoint bilaterally. Control animals receive treatment with saline injection in the SP6 bilaterally or adenosine injection in a non-acupoint. Twenty-four hours after plantar incision the animals were treated with adenosine FP or EA. After investigating different doses of adenosine in the FP treatment, and different EA treatment duration using 10 HZ frequency and 3 mA current intensity, it was found that adenosine FP doses of 30 and 100 μg as well as 5, 10, 20 and 30 minutes of EA stimulation, significantly inhibited mechanical hypersensitivity of the animals for 60 minutes after treatment. We also observed that intraperitoneal pre-administration of caffeine (a nonselective inhibitor of adenosine receptors, 10 mg/kg) reversed both adenosine FP and EA effects upon mechanical hypersensitivity. Moreover, our results demonstrate that peripheral pre-administration of DPCPX (adenosine A1 receptor antagonist, 30 mg/site), injected bilaterally in the SP6 acupoint, reversed the effects of adenosine FP and EA. On the other hand, intrathecal pre-administration of DPCPX (3 and 5 μg) reversed the effect of FP but not of EA. These findings provide evidence that peripheral adenosine A1 receptor is involved in the electroacupuncture analgesia.

O-22 MACROSTRUCTURAL PLASTICITY SUBSERVING SENSORIMOTOR SKILLS AND EMOTION REGULATION ABILITY IN PROFESSIONAL ACUPUNCTURISTS: AN FMRI STUDY

Minghao Dong, Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi 710071, China; Wei Qin, Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi 710071, China; Jie Tian, Life Sciences Research Center, School of Life Sciences and Technology, Xidian University, Xi'an, Shaanxi 710071, China

The neural substrate of expertise, such as musicians, taxi drivers and meditation experts, has fascinated major scientific attention. Acupuncturists, a pillar community of medical practitioners, have expertise in discriminating subtle tactile changes in fingers, coordinating dexterous finger movement and expertise in regulating negative emotional responses triggered by empathic pain in their daily practice. However, the neuroanatomical underpinnings supporting behavioral proficiency of acupuncturists are not yet understood. Therefore, to answer this question, the current study recruited two cohort groups of acupuncturists (N=22) and non-acupuncturists (N=22). Firstly, we aimed at verifying behavioral model of acupuncturists' skills using a set of psychophysical tasks, i.e. grating orientation task for tactile discrimination ability, a motor proficiency test for fine motor skills and a pain rating task for emotion regulation skill. Secondly, we detected structural basis of these expertise using the voxel-based morphometry technique. The results of behavioral tasks proved that acupuncturists had extraordinary sensorimotor and emotion regulation skills compared with the controls. The fMRI results revealed larger grey matter volumes in acupuncturists in several cortical and subcortical regions, such as the hand representation of the contralateral primary somatosensory cortex, facilitating tactile discrimination ability; secondary motor areas, i,e. the right Lobule V/VI supporting fine motor skills, as well as the bilateral ventral anterior cingulate cortex/ ventral medial prefrontal cortex (vACC/VMPFC) subserving emotion regulation. Grey matter volumes of Lobule V/VI and primary somatosensory cortex correlated with the duration of acupuncture practice. To our best knowledge, this study built first behavioral model of acupuncturists' expertise and provided first evidence for the neuroanatomical marker underpinning acupuncturists' tactile-motor and emotion regulation skills. Conclusively, we suggest that, our findings may facilitate occupational skill acquisition and the results in emotion-regulation domain may serve to understand how this skill was acquired and developed.

O-23 MANAGEMENT OF GULF WAR SYNDROME SYMPTOMS WITH ACUPUNCTURE: REPORT ON PRELIMINARY FINDINGS OF AN ONGOING WAIT-LIST CONTROL RCT

Lisa Conboy, New England School of Acupuncture; Meredith StJohn, New England School of Acupuncture; Rosa Schnyer, University of Texas Austin Gulf War Illness (GWI), is a complex chronic multisymptom illness characterized by a diverse clinical presentation, that may include fatigue, sleep and mood disturbances, cognitive dysfunction, and musculoskeletal pain. First defined by the Centers for Disease Control and Prevention (CDC) after the first Gulf War (Operation Desert Shield/Storm), it is commonly seen with a highly individualistic presentation, associated with clusters of symptoms and co-morbid medical diagnoses.

Purpose: To conduct a preliminary analysis of symptom improvement in GWI veterans associated with acupuncture treatment. Study Design: This wait –list controlled RCT is funded by the Department of Defense (W81 XWH). Subjects (n=104) are assigned to either 6 months of biweekly individualized acupuncture, or 2 months of wait list followed by 4 months of weekly individualized acupuncture treatments.

Methods: Because GWI is a complex illness with multiple manifestations, we offered tailored individualized treatments to target the symptoms most important to the subjects. Our main outcome is the Sf-36; we have also included validated measurements to capture changes in specific GWI symptoms as well as the patient-centered form, the MYMOP. Measurements are collected every 2 months.

Results: A preliminary analysis of symptom improvement comparing baseline scores to 6 month data collection indicates statistically significant improvements in the severity of veterans' self-reported main (p<0.01) and secondary (p<0.009) complaints as measured by items on the MYMOP, as well as self-reported overall health (p<0.007) as measured by a single item on the Sf-36, and fatigue (p<0.05) as measured by a single item on the Multidimensional Assessment of Fatigue. Patient satisfaction with care and confidence in treatment is also very high (95% rated satisfied and confident). The results of our main outcome measure, the SF-36, an 8-scale health profile, which includes measures of health-related quality of life, will be available at the completion of the study (12/2012).

O-24 MODULATION OF THE SOMATOSENSORY (MU) BACKGROUND RHYTHM IN HEALTHY VOLUNTEERS AFTER NEEDLE STIMULATION ON ST36

Daniel Pach, Charité University Medical Center Berlin; Till Nierhaus, Charité University Medical Center Berlin; Wenjing Huang, Charité University Medical Center Berlin; Stephanie Roll, Charité University Medical Center Berlin; Arno Villringer, 5Max Planck Institute for Human Cognitive and Brain Sciences; Claudia Witt, Charité University Medical Center Berlin

Background: Acupuncture can be regarded as a somatosensory stimulation. The Mu rhythm, characterized by a central topography and EEG peak frequency around 10 Hz, can be referred to as “idle rhythm” indicating resting state of the somatosensory system.

Objective: To evaluate whether the point locations chosen for a complex somatosensory stimulation with acupuncture needles have an essential impact on the change of EEG background rhythm in healthy volunteers.

Methods: Standardized manual needle stimulation was applied at three points (ST36, a non-acupuncture control point (CP1) in the same dermatome (L5) as ST36 and a non-acupuncture control point (CP2) in a different dermatome (L2)). All healthy subjects (n=20, 11 female) received manual needle stimulation at all 3 points on separate days in a randomized order. Continuous recordings before and after needle stimulation were used for evaluation of somatosensory (Mu) background rhythm modulations (main area of interest central electrode Cz). Needle sensation was measured by the Massachusetts General Hospital Acupuncture Sensation Scale (MASS) and correlated with EEG results.

Results: The EEG results showed a significant increase of the Mu rhythm power after needle stimulation for the acupuncture point ST36 compared with the two control points CP1 and CP2. The Mu rhythm power was different for the comparison of ST36 vs. CP1 (mean difference 21.02 μV² 95%CI[4.78;37.27], p=0.012) and ST36 vs. CP2 (25.38[9.12;41.65], p=0.003), but not for CP2 vs. CP1 (-4.36[-20.53;11.81], p=0.598). The MASS index as a measure of needle sensation was comparable for the points in the same dermatome (L5), but different in the other dermatome (L2). However, sensation was neither positively nor negatively correlated with changes of Mu rhythm power.

Conclusion: Our results point towards somatosensory brain activations that are specific for an acupuncture point. Results seem not to be influenced by needle sensation.

O-25 MULTISITE INTERNATIONAL STUDIES - ISSUES, CHALLENGES, OBSTACLES AND ADVANTAGES - AN EXAMPLE OF THE TEA IS CHAI (TENNIS ELBOW ACUPUNCTURE-INTERNATIONAL STUDY-CHINA, HONG KONG, AUSTRALIA AND ITALY) PROJECT

Chris Zaslawski, University of Technology, Sydney; Sergio Bangrazi, Istituto Paracelso, Italy Istituto Paracelso, Italy Istituto Paracels; Christine Berle, University of Technology, Sydney; Marcus Gadau, Hong Kong Baptist University; Tie Li, Changchun University of Chinese Medicine; Weihong Li, University of Technology, Sydney; Peter Meier, University of Technology, Sydney; Yuansheng Tan, world federation of acupuncture Moxibustion Societies; Fuchun Wang, Changchun University of Chinese Medicine; Shi Ping Zhang, Hong Kong Baptist University

International multisite trials are frequently used in pharmaceutical research but very few have been conducted for acupuncture. While there are some clear advantages to undertaking a multisite trial, such as more diverse patient populations and sharing of economic burdens and resources, there may be some challenges that need to be overcome such as language and cultural differences to assist the efficient management of the project. This presentation will examines some of the issues associated with a multisite acupuncture trial currently being conducted in four institutions (Changchun University of TCM-China, Hong Kong Baptist University, University of Technology, Sydney and Istituto Paracelso-Italy) across four countries that is being coordinated by an international association, the World Federation of Acupuncture and Moxibustion Societies (WFAS). Issues such as standardisation and monitoring of the project, ethics approval and language difficulties are only some of the issues that need to be addressed in order to complete the project. Strategies that were used to overcome these and other issues will be discussed and suggestions for those considering similar projects in the future will also be identified.

O-26 PRESSURE PAIN SENSITIVITY AND INSULAR GLUTAMATE ARE ASSOCIATED WITH SUBSEQUENT CLINICAL PAIN RESPONSE TO SHAM BUT NOT VERUM ACUPUNCTURE IN CHRONIC PAIN PATIENTS

Steven Harte, University of Michigan; Daniel Clauw, University of Michigan; Richard Harris, University of Michgan

Purpose: Clinical trials of acupuncture in chronic pain have largely failed to demonstrate efficacy of verum over sham acupuncture. However sham acupuncture is not an inert intervention. Here we explored the ability of experimental pressure pain assessment and chemical neuroimaging to identify differential responsiveness to sham as opposed to verum acupuncture.

Methods: 50 chronic pain patients diagnosed with fibromyalgia were randomized to receive either 9 treatments of verum (n=22) or non-insertive sham (n=28) acupuncture treatments over 4 weeks. Prior to treatment, pressure pain thresholds were assessed at the right thumbnail bed and a median split was used to classify patients into groups of low or high tenderness. Proton magnetic resonance spectroscopy was also performed at baseline for 34 participants to assess insular glutamate levels. Clinical pain was assessed at baseline and following treatment using the Short Form of the McGill Pain Questionnaire (SF-MPQ). Independent t-Tests were performed in SPSS for clinical pain response and baseline glutamate for low and high tenderness groups receiving either sham or verum acupuncture.

Results: Patients that displayed greater tenderness at baseline, showed significantly greater clinical pain response to sham acupuncture (change in SF-MPQ, total mean [SD]: high tenderness −8.65 [7.91]; low tenderness −2.14 [6.68]; p=0.03). This relationship was not true for verum acupuncture (high tenderness −6.90 [4.51]; low tenderness −6.41 [9.25]; p=0.88). Sham treated patients that were more tender also displayed greater baseline levels of insular glutamate than those that were less tender (glutamate mean [SD]: high tenderness 7.54 [0.51]; low tenderness 6.93 [0.61]; p=0.04).

Conclusions: Pressure pain testing may identify chronic pain patients that are more likely to respond to sham but not verum acupuncture. This effect may relate to the generalized hyperalgesia that these patients display as well as elevated brain excitatory neurotransmitters.

O-27 PRE-TREATMENT μ-OPIOID RECEPTOR (MOR) AVAILABILITY IN VIVO DIFFERENTIALLY PREDICTS ANALGESIC RESPONSE TO VERUM AND SHAM ACUPUNCTURE IN CHRONIC PAIN PATIENTS

Tiffany Love, University of Michigan; Jon-Kar Zubieta, University of Michigan; Richard Harris, University of Michigan

Purpose: Previous work has demonstrated that endogenous opioid function and receptor availability are involved in acupuncture analgesic responses. However little is known about how resting pre-treatment MOR binding may predict subsequent analgesia. Here we explored the ability of baseline MOR binding, using positron emission tomography (PET), to identify differential responsiveness to verum as opposed to sham acupuncture.

Methods: 20 widespread chronic pain patients diagnosed with fibromyalgia were randomized to receive either 9 treatments of verum (n=10) or non-insertive sham (n=10) acupuncture treatments over 4 weeks. Prior to treatment, participants underwent C11-carfentanil PET to quantify resting levels of MOR binding potential (BP). Clinical pain was assessed at baseline and following treatment using the Short Form of the McGill Pain Questionnaire (SF-MPQ). MOR BP values were analyzed in SPM5 using ANCOVA with contrasts that differentially correlated baseline MOR BP and subsequent changes in clinical pain following verum and sham acupuncture. A priori significant regions of interest, identified from previous work, were extracted with MARSBAR and correlations were performed in SPSS for assessment of correlation statistics and outliers.

Results: Patients across both groups displayed a trend towards reduced clinical pain (change in SF-MPQ mean[SD]: −2.01[6.56]; p=0.17). Baseline MOR BP within the left nucleus accumbens significantly predicted differential response to verum and sham acupuncture (p<0.05 small volume corrected). Greater MOR BP within this region was associated with greater subsequent decreases in clinical pain for verum (rho=−0.88; p=0.001) but not sham (rho=0.57; p=0.09) acupuncture. No significant regions were identified which showed greater negative correlations between MOR BP and change in pain for sham as opposed to verum acupuncture.

Conclusions: Greater baseline MOR availability, together with potential increases in endogenous opioid release as a consequence of treatment may underlie response to verum acupuncture, as opposed to sham acupuncture.

O-28 SELF-ADMINISTERED ACUPRESSURE REDUCES CHRONIC PAIN IN BREAST CANCER SURVIVORS

Suzanna Zick, University of Michigan; Benjamin Wright, University of Michigan; Vinita Verma, University of Michigan; Gwen Wyatt, Michigan State University; Tohfa Khabir, University of Michigan; Richard Harris, University of Michigan

Purpose: There are nearly 3 million breast cancer (BC) survivors in the United States. Chronic pain and sensory disturbances after BC treatment is common, occurring in approximately 50% of patients, and can persist for years. Chronic pain in BC survivors is associated with fatigue, sleep disturbances, mood disorders and decreased quality of life. Current treatments for chronic cancer pain have limited efficacy and/or unacceptable side-effects, and as such there is a tremendous need for new treatments in this area.

Methods: We examined the effect of 6-weeks of the combined effects of two types of self-administered acupressure compared to standard of care (SC) in 43 (28 randomized to acupressure, 15 to standard of care) chronically fatigued BC survivors who reported ≥3 on the Brief Pain Inventory's (BPI) average pain subscale and who were from an ongoing randomized clinical trial on acupressure for persistent cancer-related fatigue. The BPI average, severity of, and interference of pain subscales were used to determine changes in pain. Independent sample t-tests were performed on mean differences of changes in pain scales by group.

Results: There was a significant decrease in pain severity (p=0.03;−1.6 acupressure vs. 0.2 SC on a 10 point scale) and pain interference (p=0.05; −1.4 acupressure vs. −0.3 SC on a 10 point scale) in the combined acupressure group compared to SC. There was also a decrease in average pain (p=0.16; −1.6 acupressure vs. −0.7 SC on a 10 point scale) in the acupressure group versus the SC group, although this did not reach significance.

Conclusion: In this preliminary analysis two types of self-administered acupressure engender a greater analgesic response for clinical pain as compared to SC in fatigued BC survivors. These findings should be interpreted with caution given our small sample size and diverse types of pain. More rigorous studies are recommended.

O-29 ‘SOCIAL CHAT’: THE ROLE OF LIFE-WORLD TALK IN TRADITIONAL ACUPUNCTURE CONSULTATIONS

Charlotte Paterson, School of Social and Community Medicine, University of Bristol, UK; Maggie Evans, School of Social and Community Medicine, University of Bristol, UK; Richard Bertschinger, Nine Springs Natural health Centre, Yeovil, Somerset, UK; Russ Chapman, The Minster Centre, Ilminster, UK; Rosemary Norton, The Minster Centre, Ilminster, UK; Jane Robinson, Nine Springs Natural health Centre, Yeovil, Somerset, UK

Objective: The lack of research into the role of ‘social chat’ in traditional acupuncture consultations leaves a knowledge gap about the relationship between talking and the other components of treatment and to what extent long consultations are necessary. Our aim was to analyse the content and meaning of social talk within the consultation.

Method: Analysis of 27 audio-recorded and transcribed traditional acupuncture consultations, involving 7 practitioners in South West England. This analysis was augmented by integrating the data from 15 patient interviews and regular practitioner discussions. The patient consultations were a convenience sample drawn from routine consultation sessions. Analysis was based on a social constructionist perspective and the theoretical approach of conversation analysis used within a mixed method design (i.e. consultations and interviews).

Results: Each consultation was analysed as a trajectory in which seven categories of talk interwove with each other and with periods of physical examination, needling and silence. The category of ‘social talk’ generated considerable debate amongst practitioners and researchers, leading to its reformulation as the ‘life-world’ talk as conceptualised by Habermas and Mishler. Life-world talk included talk of the patient's everyday life, such as activities and concerns relating to work, family, leisure and relationships. Analysis indicated that life-world talk was integral to individualising treatment and advice and key to focusing treatment on promoting self-healing. Discussions of the patient's life-world context not only built rapport, leading to more disclosure and a deeper understanding of the patient's mind, body and spirit, but the talk was also sometimes used directly in the diagnostic process to ‘test emotions’.

Conclusion: Amongst these English practitioners, life-world talk was a necessary and integral component of traditional acupuncture which influenced the diagnosis, the needling strategy and the self-care discussions and advice.

O-30 UTILIZATION OF ACUPUNCTURE FOR PAIN MANAGEMENT IN AN ACADEMIC MEDICAL CENTER FOR TRADITIONAL KOREAN MEDICINE: A RETROSPECTIVE REVIEW OF ELECTRONIC MEDICAL RECORDS

Kun Hyung Kim, Korean Medicine Hospital, Pusan National University; Yu Ri Kim, Korean Medicine Hospital, Pusan National University; Seung Hee Noh, Korean Medicine Hospital, Pusan National University; Jae Kyu Kim, School of Korean Medicine, Pusan National University; Gi Young Yang, School of Korean Medicine, Pusan National University; Byung Ryul Lee, School of Korean Medicine, Pusan National University

Background: In Korea, acupuncture is routinely used for pain management. However, little information exists about the use of acupuncture for pain management in real clinical situations.

Objective: This study aimed to identify the descriptive characteristics of patients with pain conditions who visited an academic medical center for traditional Korean medicine.

Methods: A retrospective review of the electronic medical records of patients who had received at least one session of acupuncture for pain management from March 2010 to Feb 2012 in the Korean medical hospital of Pusan National University was performed. Demographic characteristics as well as information about patients' conditions, received treatment interventions, and costs associated with acupuncture treatments were analyzed.

Results: In total, we identified 2,167 patients, consisting of 2,105 outpatients, 237 inpatients, and 175 patients who received both outpatient and inpatient care. The mean age (standard deviation; SD) of the patients was 52.0 (15.3) years, and around two-third of the patients were female (64.0%). The average number of acupuncture treatment sessions was 8.0 (6.6 for outpatients and 14.5 for inpatients). The most treated conditions were low back pain (30.5%), neck pain (23.9%), and shoulder pain (17.5%). Interventions included needle acupuncture with manual (53.2%) or electrical (48.1%) stimulation, herbal medicine (44.2%), cupping (21.2%), and moxibustion (3.5%). Over one-third of outpatients (33.5%) received at least 6 sessions of acupuncture. The mean number of treatment sessions (SD) were 15.0 (12.2) and 2.2 (1.3) for outpatients who had been treated for at least 6 sessions and less than 6 sessions, respectively. The cost for acupuncture treatments is currently being analyzed.

Conclusions: Acupuncture has mainly been used for treating low back, neck, and shoulder pain with a wide range of related interventions at an academic medical center for traditional Korean medicine. This data should inform the design of future prospective clinical researches of acupuncture.

O-31 UTILIZING A COMPUTERIZED BEHAVIORAL TESTING AND PHARMACOLOGICAL MRI TO OBJECTIVELY MONITOR THERAPEUTIC EFFECTS OF ELECTROACUPUNCTURE IN NONHUMAN PRIMATES MODELING HUMAN PARKINSON'S DISEASE

Zhiming Zhang, University of Kentucky College of Medicine

Whether electroacupuncture (EA) can be used to effectively treat Parkinson's disease has been controversial, in part due to a lack of objective methods to measure EA efficacy in patients. We have previously shown that pharmacological MRI (phMRI) could be used to objectively measure glial cell line-derived neurotrophic factor (GDNF)-induced functional changes in MPTP-lesioned monkeys (Luan et al., 2008). In the present study, we used phMRI techniques along with computerized behavioral testing to monitor EA-induced functional changes in six middle-aged rhesus monkeys with long-term hemiparkinsonism induced by unilateral administration of MPTP via the right carotid artery approximately 5 years earlier. All animals underwent a series of behavioral testing and phMRI scans before and after chronic (3–4 months) EA treatment at acupuncture points DU14 (DAZHUI) and ST36 (ZHUSANLI) with a bidirectional square wave electrical pulse (0.2 ms duration, 100 Hz). When compared to the data collected before EA treatments, significant improvements of movement speed and locomotor activity were seen after EA treatment (at DU14+ST36). More importantly, phMRI did detect functional changes after chronic EA treatment in the motor cortex, putamen and caudate nucleus. In the primary motor cortex and putamen ipsilateral to MPTP lesions, the MPTP-induced activations were reduced to levels similar to those seen pre-MPTP administration. In the MPTP-treated caudate nucleus, EA treatment significantly attenuated apomorphine-evoked activations at the end of the 3rd months of EA treatment. However, apomorphine-evoked activations were slightly increased at the end of the 4^th months. No significant changes were seen in the pre-motor areas. Overall our results support the notion that 1) chronic EA can improve PD features in monkeys modeling human PD and 2) phMRI can be used to detect EA-induced functional changes in various brain regions in PD monkeys. Since phMRI is non-invasive, sensitive and objective, it could be translated into the clinic for monitoring treatments in PD patients.

P-1 A CHART REVIEW OF PATIENTS SEEN AT AN ACUPUNCTURE COLLEGE FOR ONE HUNDRED OR MORE VISITS

Forrest Cooper, Oregon College of Oriental Medicine

The purpose of this study was to describe the characteristics of patients who were treated at the Oregon College of Oriental Medicne for one hundred or more treatments. Patient charts were located of patients who had received one hundred or more treatments at OCOM. Characteristics looked at included basic demographic information such as age, gender, total number of visits, types of visits (regular acupuncture, herbal clinic, body work clinic, group clinic, doctoral clinic), how long it took to reach, one hundred treatments, total length of time being treated, prescription drug use, supplement use, being under the care of a PCP, chief complaint, severity of chief complaint, TCM syndrome differentiation, how many bulk or granule formulas they were prescribed, variability of their chief complaint over the course of their total number of treatments. There were eighty-five charts located. Twenty-three charts were excluded on the basis of either not being treated within the last decade, or having been a student or employee of OCOM.

There are too many categories to detail all the results, however, a strong majority of the patients were female. The chief complaint varied substantially. A strong majority were under the care of a PCP. Most were taking prescriptions. Pain was a chief complaint in many, but there were many other chief complaints included leaking cerebral spinal fluid from the nose, complete paralysis from the neck down, and the conditions associated with aging, advanced early onset Alzheimer's, uncontrollable hypertension complicated with blindness. There was a wide variety of of syndroes used for differentiation.

Conclusions, include the basic demographic information, and what that means for potential patient recruitment. Many of the patients suffered from severe diseases, and had already tried other treatment modalities. In a sense, OCOM, and Oriental Medicine was the patients last resort for their conditions.

P-2 A COMPARISON OF UTILIZATION OF PRIMARY CARE SERVICES BY REFUGEES BEFORE, DURING AND AFTER SIX MONTHS OF ACUPUNCTURE TREATMENT: A DESCRIPTIVE REPORT MEASURED IN TOTAL CHARGES

Ellen Silver Highfield, BUSM/BMC; Mckenna Longacre, BUSPH; Alan Sager, BUSPH; Michael Grodin, BUSM/BMC

Refugees in the US frequently have increased health care needs, including Primary Care, due in part to the complex sequelae of trauma including chronic pain and somatization. In this work, we examined the relationship between acupuncture and utilization of Primary Care services (measured in total charges) via a cohort of refugee patients with chronic pain (n=17). We retrospectively reviewed the electronic medical records; the research was IRB-approved. We compared total charges resulting from Primary Care at BMC for the cohort 6 months before, during and after a minimum of five acupuncture treatments. Our cohort included adult refugee patients who had been seen at BMC for Primary Care for at least one year prior to initiating acupuncture, and had been referred for chronic pain. Only three of the patients had private insurers (HMOs). Our cohort demonstrated a statistically significant decrease in total charges from Before acupuncture to both During and After acupuncture (2-tailed paired t-test P=.0232 and P=.0249 respectively). On average, we found a 55.77% decrease in total charges associated with PC services at BMC and a mean difference of $3881 and $4539 During and After acupuncture respectively per patient. Our matched control group indicated no significant difference in total charges between the first six month interval and the second or third six month intervals (n1=17, n2=17, P=0.3886 and P=0.3256 respectively).

These results suggests that acupuncture may present an effective means of reducing total health care costs for patients, private insurers, and public payers. There is a need for further research of the relationship between acupuncture and utilization of Primary Care services by refugees with chronic pain. Also, further analysis of the financial implications of this relationship is warranted. Additional study is needed to explore whether this decrease in utilization is generalizable to other hospital services.

P-3 A PILOT STUDY OF CHANGES IN VISION FOLLOWING ACUPUNCTURE FOR RETINITIS PIGMENTOSA PATIENTS

Ava Bittner, Johns Hopkins University; Wilmer Eye Institute; Jeffrey Gould, Johns Hopkins University; Integrative Medicine and Digestive Center; Gislin Dagnelie, Johns Hopkins University; Wilmer Eye Institute; Alexandra Benavente, SUNY College of Optometry; Collin Rozanski, Johns Hopkins University; Wilmer Eye Institute; Robert DeJong, Johns Hopkins University; Department of Radiology; Andy Rosenfarb, Acupuncture Health Associates

Purpose: Retinitis pigmentosa(RP) is a hereditary retinal degeneration that results in a slowly progressive loss of night and peripheral vision affecting ∼1 in 4000. RP patients are motivated to try integrative therapies since treatment options are limited to nutritional supplements attempting to slow progression. Basic science, clinical research and RP patients' self-reports support the hypothesis that acupuncture may improve vision, which we explored in a case series study.

Methods: A standard electroacupuncture and acupuncture protocol was administered to 12 RP patients at 10 half-hour sessions over 2 weeks. Pre- and post-treatment tests included visual acuity(VA), contrast sensitivity(CS), Goldmann visual fields(GVF), and dark-adapted full-field stimulus test(FST)(n=9); as well as dark-adaptometry and ocular blood flow(OBF) in retrobulbar arteries with color Doppler imaging(CDI) in the last 2 subjects.

Results: Six of 12 subjects had a measurable, significant vision improvement post-treatment. Three of 9 subjects had a significant 10.3–17.5dB (i.e. 13–53 fold) FST improvement in both eyes at 1 week post-acupuncture, maintained for at least 4–6 months, well outside typical test-retest variability (95% CI: 3–3.5dB) in RP. Dark-adaptation was shortened in both subjects tested on average by 48.5% at 1 week (range 36–62% across 10–30dB), outside typical coefficients of variation <30% previously determined in RP and normals. One subject had 2 lines of VA improvement; another had 0.55 log CS improvement. Another subject developed >20% improvement in GVF retinal area in both eyes at 1–3 months post-treatment. Changes in vascular resistance index and velocity profiles in the 2 subjects who underwent CDI suggest a moderate but significant OBF increase in the central retinal artery at 1–2 weeks post-treatment. Acupuncture was well-tolerated by all, without adverse events or vision loss.

Conclusions: Acupuncture may have measurable benefits on residual vision in RP, supporting the need to explore potential mechanisms and more rigorous methodology in future studies.

P-4 A PILOT STUDY ON THE EFFICACY OF 10.6μM - 650 NM COMBINED LASER ACUPUNCTURE ON DIFFERENT TCM PATTERNS OF KNEE OSTEOARTHRITIS

Li-Zhen Wang, Shanghai University of Traditional Chinese Medicine;Center for Integrative Medicine, University of Maryland School of Medicine; Fan Wu, Shanghai University of Traditional Chinese Medicine; Xueyong Shen, Shanghai University of Traditional Chinese Medicine; Ling Zhao, Shanghai University of Traditional Chinese Medicine; Haiping Deng, Shanghai University of Traditional Chinese Medicine;Shanghai Research Center of Acupuncture and Meridian; Lixing Lao, Shanghai University of Traditional Chinese Medicine;Center for Integrative Medicine, University of Maryland School of Medicine

Introduction: Knee osteoarthritis (OA) manifests with pain, joint stiffness, and limited function. In traditional Chinese medicine (TCM), it is differentiated into three patterns: cold predominance, caused by yang deficiency; kidney deficiency; and blood stasis. In our previous studies, we found that 10.6μm-650 nm combined laser treatment, which mimics classical acupuncture-moxibustion therapy, to be effective in managing knee OA symptoms. The objective of this pilot study was to determine if certain knee OA TCM pattern differentiations respond better to this particular laser treatment than do others.

Methods: Fifty-two patients with OA were allocated to group A (yang deficiency; n=26) or group B (non yang-deficiency; n=26). All patients received laser treatment at acupoint Dubi (ST 35) for 20 minutes, three times a week for two weeks and twice a week for another four weeks, for a total of 14 treatments during the six-week period. The Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) was used for outcome assessments immediately after the first treatment and at weeks 2, 6, and 10.

Results: There were no significant differences at baseline between the two groups. For WOMAC pain and stiffness, there were no statistically significant differences between the groups. However, the yang-deficiency group had significantly better WOMAC function scores than did the non yang-deficiency group at weeks 2 (p=0.049), 6 (p=0.046), and 10 (p=0.042).

Conclusion: 10.6μm-650 nm combined laser may be more beneficial to yang deficiency pattern knee OA patients, particularly in function, than to knee OA patients with other TCM patterns. A clinical trial with a larger sample size is warranted to confirm the findings of this pilot study.

P-5 A RETROSPECTIVE CHART REVIEW COMPARING TWO ACUPUNCTURE PROTOCOLS ON THE DAY OF IN VITRO FERTILIZATION EMBRYO TRANSFER: DO THE POINTS MATTER?

Lee Hullender Rubin, Oregon College of Oriental Medicine; Michael Opsahl, Northwest Center for Reproductive Sciences; Klaus Wiemer, Northwest Center for Reproductive Sciences; LaTasha Craig, Oklahoma University Physicians Reproductive Medicine; Deborah Ackerman, Oregon College of Oriental Medicine

Background: In 2007, Craig et al reported in vitro fertilization (IVF) pregnancy rates were reduced with acupuncture. The first author (LHR) used the Craig protocol since 2005 at a private fertility clinic and modified the acupuncture protocol after the results from the Craig study were known. In this retrospective chart review, we compared the effect of original and modified Craig protocols on live births following fresh (1) non-donor or (2) donor IVF.

Methods: Live births were compared between patients who elected acupuncture treatment before and after embryo transfer (ET) at a private fertility clinic. From 2005–2007, the acupuncture group “A” (Acu A) received the original Craig protocol (Paulus protocol plus CV-6/Qihai before and KI-3/Taixi after ET) in fresh non-donor (N=199) and donor cycles (N=23). From 2008–2009, the acupuncture group “B” (Acu B) received the same protocol without KI-3/Taixi after ET, in fresh non-donor (N=188) and donor cycles (N=20). Live births after 24 weeks gestation were compared with crude risk ratios in donor cycles and logistic regression in non-donor cycles controlling for age, FSH, and number of embryos.

Results: In fresh, non-donor cycles, there were 104 (52%) live births in the Acu A group and 106 (56%) in the Acu B group (OR=1.18, 95%CI 0.79–1.76, p=0.41). In the fresh, donor group, there were 20 (87%) live births in the Acu A group, which was significantly higher than 10 (50%) in the Acu B group (RR=1.74, 95%CI 1.09–2.77, p=0.02).

Conclusion: The original Craig protocol (Acu A) was associated with more live births following donor IVF than the modified protocol (Acu B). No difference was found between the two protocols following non-donor IVF. This suggests acupoint KI-3/Taixi may be important for donor IVF. This finding should be taken cautiously as more rigorous research, including randomization and a larger sample size, is needed.

P-6 A STANDARDIZED ACUPUNCTURE PROTOCOL FOR THE TREATMENT OF WASTING SYNDROME IN HIV+ MALES: A CASE STUDY

Larry Langowski, Ph.D, SAR; Timothy Suh, L.Ac., OCAM

Wasting Syndrome, the extreme loss of lean muscle mass associated with HIV/AIDS, is commonly treated with testosterone supplementation, but there are undesirable side effects such as gynecomastia, testicular atrophy, hair loss, and various allergic reactions. Studies report disproportionately frequent cases of Erectile Dysfunction (ED) in HIV+ males on antiretroviral medications, particularly protease inhibitors. Low testosterone levels were reported in those with ED and testosterone is used in treatment for this condition as well. Since lab tests are beyond the acupuncture scope of practice in Illinois, we used the diagnosis of ED as a de facto indicator of low testosterone. Since both Wasting and ED impact HIV+ men, especially those on protease inhibitors, and low testosterone is a common symptom, stimulating natural production of testosterone should treat both without side effects via acupuncture. We used a standardized 5-needle acupuncture treatment, which appears robust to combination with other acupuncture treatments and various clinicians. The case is a study of a 54 y/o male diagnosed with AIDS, Wasting, and ED, with an antiretroviral regimen including two protease inhibitors. His viral load is undetectable and T-cell count over 500. The patient had had ED for 5 years, Wasting for 11, and uses appetite stimulation rather than testosterone for treatment. There were 6 bi-weekly treatments using the ED/Wasting protocol and a 6-month follow up assessment. There was immediate and dramatic relief from ED, lasting for a week after the initial treatment, increasing to three by the 6th. Further study will incorporate lab tests, extend the term of the investigation, and increase the number of participants to better assess the impact on Wasting.

P-7 A STUDY OF ACUTE AND CHRONIC MOXA SMOKE TOXICITY IN RATS

Li HAN, Beijing University of Chinese Medicine, Beijing, China; Ping LIU, Beijing University of Chinese Medicine,Beijing,China; Baixiao ZHAO, Beijing University of Chinese Medicine,Beijing,China; Hai HU, Beijing University of Chinese Medicine,Beijing,China; Jia YANG, Beijing University of Chinese Medicine,Beijing,China; Hong CAI, Beijing University of Chinese Medicine,Beijing,China; Huangfang XU, Beijing University of Chinese Medicine,Beijing,China; Yingxue CUI, Beijing University of Chinese Medicine,Beijing,China; Ran JIN, Beijing University of Chinese Medicine,Beijing,China; Maoxiang ZHU, Chinese Military Academy of Medical Science; Zhihua YANG, Chinese Military Academy of Medical Science; Xiujie PAN, Chinese Military Academy of Medical Science; Lixing LAO, Family & Community Medicine ; TCM Research Program ; Center for Integrative Medicine ; University of Maryland School of Medicine

Objective: Moxibustion, proven to be effective for many disorders, involves burning mugwort. This produces smoke and causes inhalable particulates. This investigation was an assessment of the acute and chronic toxicity of moxa smoke.

Methods: In the acute study, 80 rats were randomly divided into five groups, 8 males and 8 females per group, at moxa smoke dosages (opacity) of 75%, 80%, 85%, 90%, and 95%. Each rat was placed in an automatic dynamic exposure device for 2 h. In the chronic study, 144 male rats were randomly divided into four groups to evaluate the toxic effects at different dosages: control, 0%; low, 10%; middle, 40%; high, 70%. Each rat was exposed for 20 min a day for 24 weeks. Rats in each group were further divided into three subgroups and were sacrificed after 24 weeks or during follow up at 30 or 36 weeks.

Results: In the acute study, the 50% lethal dosage (LD50) for a 2 h-exposure to moxa smoke was 86.247%. There were no deaths in the chronic study. There were, however, histopathological changes in the lungs in all exposed groups although there were no functional pulmonary changes compared to control. These histopathological alterations were unchanged at 36 weeks. No significant abnormalities in body weight at the low dosage were observed when compared to control. however, the middle and high dosage produced decreases in body mass but returned to normal at 36 weeks. No significant abnormalities in blood count, blood chemistry, or routine urinalysis were observed

Conclusion: Our data suggest that long-term moxa smoke exposure at the middle dosage, which is equivalent to 50 times the exposure that would be experienced in a regular moxibustion clinic, might adversely affect the lungs and other organs. The clinical significance of this finding needs further study.

P-8 A STUDY ON THE LIFE QUALITY OF STROKE PATIENTS ACCORDING TO THE CONSTITUTION

Yun Young Kim, Korea Institute of Oriental Medicine; Jong Hyang Yoo, Korea Institute of Oriental Medicine; Ki Hyun Park, Korea Institute of Oriental Medicine; SI Woo Lee, Korea Institute of Oriental Medicine

Objectives: Stroke which ranked as the second leading cause of death for adults in South Korea has a poor prognosis after treatment, and make the rehabilitation difficulty even after restoration. It brings enormous burden to the person and the society as well. Disabilities caused by the stroke such as aphasia, ataxia, paralysis and neurologic deficit affects to the quality of personal life, and it can be appeared in different patterns depending on the constitution. In this research, we studied on the life quality of stroke patients according to the constitution and tried to provide basic data for improving the life quality of them.

Methods: This research was conducted from Aug. 1st 2009 to Jul. 31st 2011 for the patients diagnosed for acute stroke in 9 oriental medical hospital and clinic and not treated with thrombolytic agent or anticoagulant for 72 hours from occurring. The constitution of patients was diagnosed by Sasang constitution specialist with a career of more than 5 years, and life quality was analyzed with Short Form-12 Health Survey Questionnaire. The collected data were analyzed with Frequency Analysis and ANCOVA using the computer software of SPSS 17.0

Results: The life quality of stroke patients were separated to Physical Component Score(PCS) and Mental Component Score (MCS) according to Sasang constitution, and both of PCS(p<.008) and MCS(p<.019) were significant. When they were separated to male group and female group, only PCS(p<.019) was significant in male group, while both of PCS(p<.003) and MCS(p<.005) were significant in female group.

Conclusion: It was found that there is a significant difference in the life quality of stroke patients according to the constitution, and the approach related with the Sasang constitution is required to improve the life quality of stroke patients.

P-9 ACUPOINT STIMULATION FOR ACNE: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Hui-Juan Cao, Beijing University of Chinese Medicine

Background: Acupoint stimulation, including acupuncture, moxibustion, cupping, acupoint injection, and acupoint catgut embedding, has shown beneficial effect for the treatment of acne. However, comprehensive evaluation of current clinical evidence is lacking.

Methods: We included randomized controlled trials on acupoint stimulation for acne. Six electronic databases (China Network Knowledge Infrastructure, Chinese Scientific Journals Database, WanFang Database, Chinese Biomedicine, Cochrane Central Register of Controlled Trials, and PubMed) were searched for English and Chinese language studies. All searches ended in May 2012. Studies were selected for eligibility and assessed for quality. RevMan 5.1 software was used for data analysis with effect estimate presented as relative risk (RR) or mean difference (MD) with a 95% confidence interval (CI).

Results: Forty-three trials involving 3453 patients with acne were included. The methodological quality of trials was generally poor in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed there were significant differences in increasing the number of cured patients between acupuncture plus herbal medicine and herbal medicine alone (RR 1.60, 95%CI 1.19 to 2.14, p=0.002, random model, I2=46%, 9 trials), and between acupuncture plus herbal facial mask and herbal facial mask alone (RR 2.14, 95%CI 1.29 to 3.55, p=0.003, fixed model, I2=0%, 2 trials). Cupping therapy was significantly better than pharmaceutical medications in increasing the number of cured patients (RR 2.11, 95%CI 1.45 to 3.07, p<0.0001, fixed model, I2=6%, 4 trials). Serious adverse events were not reported in all included trials.

Conclusions: Acupoint stimulation therapies combined with other treatments appears to be effective for acne. However, further large, rigorously designed trials are needed to confirm these findings.

P-10 ACUPUNCTURE AND HEART RATE VARIABILITY: A SYSTEMS LEVEL APPROACH TO UNDERSTANDING MECHANISM

Belinda Anderson, Pacific College of Oriental Medicine; Arya Nielsen, Beth Israel Medical Center; Diane McKee, Albert Einstein College of Medicine; Ben Kligler, Beth Israel Medical Center

Recent research has elucidated several different mechanisms for acupuncture. However the inter-relationship between these mechanisms and how acupuncture affects complex physiological systems is still not understood. Heart rate Variability (HRV), the beat-to-beat fluctuations in the rhythm of the heart, results from the regulation of the heart by the autonomic nervous system (ANS). Low HRV is associated with increased risk of all-cause mortality and is a marker for a wide range of diseases. Coherent HRV patterns are associated with increased synchronization between the two branches of the ANS, and when sustained for long periods of time result in increased synchronization and entrainment between multiple body systems. We undertook a systematic review of all randomized placebo controlled trials investigating the ability of acupuncture to improve HRV. The trials were assessed with regard to acupuncture dosage and whether subjects were healthy with artificially induced stress, or diagnosed with a medical condition. Our results indicate that there is strong evidence that acupuncture improves HRV. This may represent a mechanistic pathway for global physiological regulation, which is congruent with East Asian medical theory. The conceptual parallels between these western and eastern perspectives are presented. The ability of acupuncture to improve HRV could be used as a tool in acupuncture research and practice to monitor treatment effectiveness and the impact on quality of life.

P-11 ACUPUNCTURE AND MOXIBUSTION CLINICAL TRIALS IN CHINA – AN UPDATE

Baoyan Liu, China Academy of Chinese Medical Sciences

On November 16, 2010, Chinese acupuncture was proclaimed as a Masterpiece of Intangible Cultural Heritage of Humanity at the 5th UNESCO Intergovernmental Committee for Safeguarding Intangible Cultural Heritage. This report is a summary of the development of acupuncture and moxibustion clinical trials in China. According to the former researches, we will try to explain the follow questions: a. what kinds of diseases can be treated with acupuncture and moxibustion? b. what about the therapeutic effect of acupuncture and moxibustion? Is there any high quality evidence? c. what is the effector mechanism of acupuncture and moxibustion? d. national standard for acupuncture and moxibustion in China. e. what is the problem existing in acupuncture and moxibustion clinical trials?

P-12 ACUPUNCTURE AND MOXIBUSTION FOR PERIPHERAL FACIAL PALSY AT DIFFERENT STAGES: MULTI-CENTRAL LARGE SAMPLE RANDOMIZED CONTROLLED TRIAL

Ying Li, Chengdu University of TCM, Chengdu; Yan Li, The First Affiliated Hospital of Tianjin University of TCM; Li-an Liu, Qingdao Haici Medical Group, Qingdao; Ling Zhao, Chengdu University of TCM, hengdu; Ka-ming Hu, Chengdu University of TCM, Chengdu; Xi Wu, Qingdao Haici Medical Group, Qingdao; Xiao-qin Chen, Chengdu University of TCM, Chengdu; Gui-ping Li, The First Affiliated Hospital of Tianjin University of TCM; Wei Zhang, Chengdu University of TCM, Chengdu; Qi-hua Qi, Qingdao Haici Medical Group, Qingdao

Objective: To explore the best intervention time of acupuncture and moxibustion for peripheral facial palsy(Bell's palsy), and the clinical advantage program of selective treatment with acupuncture and moxibustion.

Methods: Multi-central large-sample randomized controlled trial was carried out. 900 cases of Bell's palsy were randomized into 5 treatment groups, selective filiform needle group(group A), selective acupuncture and moxibustion group(group B), selective acupuncture and electro-acupuncture(group C), selective acupuncture and line-up needling on muscle region of meridian group(group D) and non-selective filiform needle group(group E). use eight main acupuncture-points: Yangbai(GB14), Dicang(ST4), Jiache(ST6), Xiaguan(ST7) Taiyang(EX-HN5), Quanliao(SI18), Yifeng(TE17), Hegu(LI4). Different acupuncture and moxibustion manipulations were applied according to different path-stages (acute stage, resting stage, restoration stage) in every group. After randomization, the patients would receive 20 sessions of acupuncture treatment over a period of 4 weeks and each session would last 30 min. House-Brackmann Scale (Global Score and Regional Score), Facial Disability Index Scale and Degree of Facial Nerve Paralysis were adopted for efficacy assessment. And the efficacy systematic analysis was provided in view of the intervention time and nerve localization of disease separately. The outcome measurements were all patients' completed scales mentioned above in the baseline and 1, 2, 3, 4, 8 and 16 weeks after randomization.

Results: The curative rates of intervention in acute stage and resting stage were 50.1% (223/445) and 52.1% (162/311), which were superior to recovery stage (25.9%35/135) separately. There were no statistical significant differences in efficacy in comparison among 5 treatment programs at the same stage (all p>0.05). The efficacy of intervention of group A and group E in acute stage was superior to that in recovery stage (both p<0.01). The difference was significant statistically between the efficacy on the localization above chorda tympani nerve and that on the localization below the nerve in group D(p<0.01). The efficacy on the localization below chorda tympani nerve was superior to the localization above the nerve.

Conclusions: This study finds out the best intervention time for the treatment of Bell's palsy is in acute–stage and resting stage, meaning 1 to 3 weeks after occurrence. All of 5 treatment programs are advantageous to Bell's palsy.

P-13 ACUPUNCTURE AND ORIENTAL MEDICINE (AOM) PRACTITIONERS CONDUCTING RESEARCH: PRELIMINARY FINDINGS FROM INTERVIEWS TO INFORM WORKFORCE TRAINING

Kimberly Tippens, National College of Natural Medicine; Susan Fleishman, National College of Natural Medicine; Ashley Russell, National College of Natural Medicine; Heather Zwickey, National College of Natural Medicine

Background: As the field of Complementary & Alternative Medicine (CAM) responds to a call for a stronger evidence base, it is increasingly important that alternative medicine practitioners participate in research. The relative nascency of research curricula in AOM programs and limited research that reflects clinical practice within the discipline lead to unique challenges to consider when designing research training for acupuncturists.

Purpose: This study aims to identify barriers and facilitators encountered by acupuncturists and other CAM practitioners acquiring training and experience in the design and implementation of research. Such information is of importance to guide development of mentorship and research training programs for CAM clinician-researchers.

Methods: We conducted qualitative interviews with eighteen CAM clinicians who represent different levels of engagement with research. Content analysis of the semi-structured interviews was performed by a team of four researchers using an iterative coding process.

Results: Subgroup analysis of ten interviewees (55%) with degrees in AOM revealed three key themes with particular relevance to capacity building for acupuncture research: 1) recognizing and navigating the career path for clinician researchers, 2) opportunities for training and participation in research, and 3) strong concerns for contributing to the field. Acupuncturists had varying understanding of the milestones needed to progress in research careers. Many described unique challenges to engaging in research, including professional discourse regarding the role of research within the field, limited research education, and limited funded training opportunities for those with master's degrees.

Conclusions: The educational path for acupuncturists to participate in research is not well-defined. Acupuncturists seek opportunities to contribute to research in various capacities, from research literate practitioner, to study clinician, to funded principal investigator. In order to develop a highly skilled and multidisciplinary acupuncture research workforce, it is essential to establish training, infrastructure and funding opportunities for licensed acupuncturists to engage in research.

P-14 ACUPUNCTURE FOR A VARIETY OF INDICATIONS HAS AN POSITIVE EFFECT ON ACADEMIC PERFORMANCE IN CHILDREN

Demet Taş, Department of Pediatry, Ulus State Hospital, Ankara, Turkey; H. Volkan Acar, Department of Anesthesiology and Intensive Care, Ankara Training and Research Hospital of Ministry of Health, Ankara, Turkey

Introduction: In this retrospective study, we evaluated the changes in academic performances in pediatric patients receiving acupuncture therapy for a variety of indications.

Materials and Methods: School reports of children receiving acupuncture treatment for a variety of indications were evaluated. Grades of Math, Social Science, and Literature in two-half terms were compared. Data analysis was performed by using Statistical Package for Social Sciences (SPSS) version 11.5 software (SPSS Inc., Chicago, IL). The Shapiro-Wilk test was used to test the normality of distribution for continuous variables. Data were expressed as mean±standard deviation, or median (minimum–maximum), while nominal variables were shown as the number of cases (%). Grades of two-half terms were compared with Paired Samples t test. p<0,05 was accepted as significant.

Results: A total of 40 children (22 male, 18 female) were studied. The mean age in this study was 11.1 years (range 7–16). Diagnoses were as follows: Attention deficit/hyperactivity disorder (ADHD) (25 patients), enuresis nocturna (8 patients), migraine (2 patients), obesity (2 patients), atopic dermatitis (1 patient), alopecia areata (1 patient), Tourette syndrome (1 patient). Four of 25 patients with ADHD had borderline intellectual functioning. When first-half-term and second-half-term grades of 40 children were compared for Math, Social Sciences and Literature, a statistically significant increase was noted in all lessons (p=0.002, p=0.049, and p=0.007 respectively). In 36 patients excluding the children with borderline intellectual functioning, there was still a statistically significant increase in grades (p<0.001, p=0.004, and p=0.015 respectively).

Conclusion: Acupuncture effects positively academic performance in children receiving acupuncture treatment for various reeasons. This effect is independent of diagnosis and can be attributed to general systemic effects of acupuncture.

P-15 ACUPUNCTURE FOR BEHAVIOR AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA : PHASE I CLINICAL TRIAL

Chao-Ting Zhao, Chengdu University of Traditional Chinese Medicine; Jia-Guo Luo, The 1st psycological health center of Chengdu, Sichuan Province; Hai-Yan Yin, Chengdu University of Traditional Chinese Medicine; Ling Luo, Chengdu University of Traditional Chinese Medicine; Fang Zeng, Chengdu University of Traditional Chinese Medicine; Shu-Guang Yu, Chengdu University of Traditional Chinese Medicine; Yong Tang, Chengdu University of Traditional Chinese Medicine

To evaluate the efficacy and safety of acupuncture treatment on behavior and psychological symptoms of dementia (BPSD),we conducted an open label, phase I clinical trial (NCT01055561) in which 15 BPSD patients were administrated acupuncture treatment once daily. After 7 days treatment, the efficacy was evaluated with Mini Mental Status Evaluation(MMSE), Behavioral pathology in Alzheimer's disease rating scale (BEHAVE-AD) and Activity of Daily Living Scale(ADL). In the end of this study, 11 BPSD patients were received full course of acupuncture treatment. The results showed that there were significant changes (P=0.004<0.05) in BEHAVE-AD total score although not in MMSE, ADL scores. Therefore, acupuncture could be useful for the improvement of symptoms in BPSD patients to some extent.

P-16 ACUPUNCTURE FOR LATERAL EPICONDYLITIS (TENNIS ELBOW): STUDY PROTOCOL FOR A RANDOMIZED, PRACTITIONER-ASSESSOR BLINDED, CONTROLLED PILOT CLINICAL TRIAL

Kyungmin Shin, Korea Institute of Oriental Medicine; Sunmi Choi, Korea Institute of Oriental Medicine; Kyung-Min Shin, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Joo-Hee Kim, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Seunghoon Lee, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Mi-Suk Shin, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Hyo-Ju Park, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Min-Hee Lee, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea; Seungdeok Lee, Department of Acupuncture & Moxibustion Medicine, College of Korean Medicine, Dongguk University, Gyeongju, South Korea; Sun-Mi Choi, Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, South Korea

Background: The purpose of this study is to compare the effects of ipsilateral acupuncture(IA), contralateral acupuncture(CA) and sham acupuncture(SA) on lateral epicondylitis.

Methods/design: 45 subjects with lateral epicondylitis will be randomized into 3 groups. The inclusion criteria will be as follows: (1) age between 19 and 65 years with pain due to one side lateral epicondylitis that persisted for at least 4 weeks, (2) with tenderness on pressure limited to regions around elbow joint (3) complain of pain during resistive extension of the middle finger or the wrist (4) with average pain of NRS 4 or higher during the last week and (5) voluntarily agree to this study and sign a written consent Acupuncture treatment will be given 10 times in total for 4 weeks to all groups. Follow-up observations will be conducted after the completion of the treatment, 9 weeks and 13 weeks after the random assignment. IA and CA group will receive acupuncture on LI4, TE5, LI10, LI11, LU5, LI12 and two Ashi points. The SA group will receive treatment on acupuncture points not related using a non-invasive method. The primary outcome will be differences in the numeric rating scale for elbow pain. The secondary outcome will be differences in patient-rated tennis elbow evaluation, pain-free grip strength, and the EQ-5D. The data will be analyzed with the paired t- test and ANCOVA (p<0.05).

Discussion: The results of this study will allow evaluation of contralateral acupuncture from two aspects. First, if the CA group shows the effects similar to IA group, this will establish clinical basis for contralateral acupuncture. Second, if the effects of CA group are shown to be similar to the effects of the SA group, we can establish the basis for using the same acupoints of the unaffected side as a control in acupuncture clinical studies.

P-17 ACUPUNCTURE FOR MELASMA IN WOMEN: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROLLED TRIALS

Yutong Fei, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine; Hong Yang, Graduate School, Beijing University of Chinese Medicine; Huijuan Cao, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine; Qianyun Chai, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine; Jianping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine

Background: Acupuncture is commonly used in treating women's melasma in China, and clinical studies have shown that acupuncture may have beneficial effect on melasma compared with conventional medication.

Methods: We included randomized controlled trials on acupuncture for melasma in women. We searched PubMed, the Cochrane Library, China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), China Biology Medicine (CBM) and Wan Fang Database till July 2012. Two authors extracted data and assessed the trials quality independently. RevMan 5.1.7 software was used for data analysis.

Results: 6 RCTs involving 468 women were included, and the methodological quality of the trials was generally poor in terms of randomization, blinding and intention-to-treat analysis. Meta-analyses showed acupuncture was significantly better than oral Vit C plus Vit E on increasing the number of cured patients (2 trials, fixed model, I2=17%, RR 3.13, 95%CI 1.32 to 7.43, p=0.010), and on increasing the number of women whose symptoms improved (affected area decreased more than 30%) (2 trials, fixed model, I2=22%, RR 1.38, 95%CI 1.18 to 1.62, p<0.0001). Compared with Tamoxifen plus Vit C, or 20% Azelaic acid cream, acupuncture was significant better on increasing the number of cured women (1 trial, RR 7.94, 95% 1.07 to 59.08; 1 trial, RR 7.00, 95% 2.73 to 17.98); compared with no treatment, acupuncture was better on increasing the number of women whose symptoms improved (1 trial, RR 4.50, 95% 2.18 to 9.30); compared with 2% hydroquinone cream, acupuncture plus 2% hydroquinone cream was significant better on increasing the numbers of women whose symptoms improved (1 trial, RR 1.27, 95% 1.06 to 1.52). No adverse effects related to acupuncture reported in the included trials.

Conclusions: Acupuncture appears to be beneficial to melasma in women. But the evidence is insufficient to draw a confirmative conclusion. Further high quality trials are required.

P-18 ACUPUNCTURE FOR PATIENTS WITH VERTEBRAL COMPRESSION FRACTURES: A SYSTEMATIC REVIEW

Seung Hee Noh, Department of Acupuncture & Moxibustion, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea; Kun Hyung Kim, Department of Acupuncture & Moxibustion, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea; Byung Ryul Lee, Division of clinical medicine, School of Korean medicine, Pusan National University, Yangsan, South Korea; Yuri Kim, Department of Acupuncture & Moxibustion, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea; Gi young Yang, Division of clinical medicine, School of Korean medicine, Pusan National University, Yangsan, South Korea

Vertebral compression fracture (VCF) is a common condition that causes back pain and motion limitation. Acupuncture is widely used for managing the symptoms of VCF, but its effectiveness and safety for patients with VCF is unclear. This study aimed to evaluate the current evidence for the use of acupuncture for patients with VCF. 12 databases were searched from their inception to May 2012 with no language restriction. All clinical studies of needle acupuncture with skin penetration for patients with VCF were considered for inclusion, and the risk of bias of the included studies was assessed using the Cochrane criteria. Of the total of eight studies included, one randomized controlled trial (RCT) reported benefits of abdomen acupuncture for constipation after vertebroplasty, and two non-randomized controlled trials and five uncontrolled observational studies suggested beneficial effects of acupuncture for the management of symptoms of VCF. None of these studies reported any adverse events. Because most studies including the RCT lacked sufficient description to evaluate the quality of the reports, there is insufficient evidence to suggest that acupuncture is an effective and safe treatment for patients with VCF. Further research is required to evaluate whether acupuncture has beneficial effects on this condition.

P-19 ACUPUNCTURE FOR POST-MASTECTOMY PAIN

Eduardo Guilherme D'Alessandro, The Sao Paulo Cancer Institute; Rebeca Boltes Cecatto, The Sao Paulo Cancer Institute; Maira Saul, The Sao Paulo Cancer Institute; Christina May Moran Brito, The Sao Paulo Cancer Institute; Jose Antonio Atta, The Sao Paulo Cancer Institute; Chin An Lin, Hospital da Clínicas da Faculdade de Medicina da USP

Introduction: Breast cancer is the most prevalent neoplasm in Brazil and is the main cause of death among women in the U.S, Canada and Europe. Its treatment often requires surgical procedures like mastectomy or quadrantectomy. Despite of the improvement of surgical tecniques, many complications derive from such interventions, the most common being lymphoedema, local infections and chronic post operative pain, with the last one appearing in up to 20% of women submitted to mastectomy. The State of Sao Paulo Cancer Institute is the largest public oncology center in Latin America and was established in 2008. Its acupuncture service aims to optimize the treatment of symptoms like post-operative, oncologic and neuropathic pain, nausea, vomiting, xerostomia and fatigue induced by chemotherapy. This paper describes the effects on symptom management that acupuncture may have caused on a population of women experiencing post-mastectomy pain.

Method: 39 patients treated by our service between March 2010 to March 2011 were identified through review of their medical records. Their basal and final symptoms intensity were recorded using a Visual Analog Scale (VAS), ranging from 0 to 10 cm. The paired t-test was used for statistical analysis. The average age of the patients was 58 years, 33,3% were receiving chemotherapy, 23% radiation therapy, 15,5% hormone therapy and 28,2% were considered to be in remission. The patients were submitted to an average of 7 acupunture sessions.

Results: initial VAS presented an average 6.5 pts (SD 2.0) and this was reduced to 2.35 pts (SD 2.25) (p<0.001), revealing an improvement of 63.8% in the control of pain perceived by the patients.

Conclusion: acupuncture may have improved symptom control for patients enrolled in this study. Further well-designed studies with randomized-placebo-controlled groups should be planned to provide more accurate conclusions.

P-20 ACUPUNCTURE FOR TENSION-TYPE HEADACHE IN PREGNANCY: A PROSPECTIVE, RANDOMIZED, CONTROLLED STUDY

João Bosco Guerreiro Silva, Rio Preto Medical School - Brazil; Mary Uchiyama Nakamura, Federal University of São Paulo - Brazil; José Antonio Cordeiro, Rio Preto Medical School - Brazil; Luiz Kulay Jr., Federal University of São Paulo - Brazil

Aim: This study was undertaken to test, under real-life conditions, the effects of acupuncture on headaches during pregnancy and compare this with a group of patients undergoing conventional treatment alone.

Methodology: Forty-three conventionally treated (lifestyle modifications and stretching) pregnant women were randomly allocated into two groups to routine care or acupuncture. The severity and disability caused by this pain and its affect on mood, sleep and work were assessed using a Numerical Rating Scale (NRS). The main end-point was the mean difference between the first and the last interview after eight weeks of treatment. Secondary end points were the changes over time in the NRS assessments of pain intensity, disturbances in mood, sleep and working and the use of medications. Differences between initial and final sessions were analyzed by a two-sample test. Changes over time in the NRS assessment were analyzed by the Fisher exact test. Mood's test for medians was used and a p-value<0.05 indicated a significant difference.

Results: All women completed the treatment. No important adverse effects related to acupuncture treatment or to pregnancy's outcome were reported. Significant improvements were demonstrated for pain at the end of the trial in the study group, 3.9 vs 1.7 difference in favor to acupuncture group (p<0.05). This group also used less medication and had a greater improvement in mood and sleep when compared with the control group.

Conclusions: This study suggests acupuncture alleviates tension-type headaches during pregnancy.

P-21 ACUPUNCTURE FOR THE TREATMENT OF PATIENTS IN PALLIATIVE CARE

Melissa Romeo, New England School of Acupuncture; Lisa Conboy, New England School of Acupuncture

Terminally ill patients turn to complementary and alternative medicine (CAM), of which acupuncture is the most widely used, when Western medicine fails to offer a satisfactory quality of life (QOL). The need for self-empowerment as well as physical and emotional healing attracts patients to seek out unorthodox therapy with fewer side effects than conventional medicine, or to control side effects of the disease or its treatment. The advantage of incorporating acupuncture into routine palliative care is the ability to address a multitude of symptoms with one treatment. The purpose of this study was to examine the effectiveness of acupuncture to relieve symptoms commonly observed in patients in a palliative care setting. Nine symptoms were treated with acupuncture: pain, tiredness, nausea, depression, anxiety, drowsiness, appetite, well-being and dyspnea. Twenty-six patients participated in the acupuncture trial, receiving a course of weekly treatments that ranged from 1 to 14 weeks. The average number of treatments was 5. Patients were required to complete an Edmonton Symptom Assessment System (ESAS) prior to the acupuncture treatment and directly after receiving the acupuncture treatment. A paired T test was applied to the data to compare symptom scores before and after each acupuncture treatment. All but 2 symptoms were statistically significantly improved with acupuncture, with the exceptions being drowsiness and appetite. Although the ESAS scale demonstrated a reduction in symptom severity post treatment for both drowsiness and appetite, this reduction was not found to be statistically significant. ANOVA clearly indicated that there were statistically significant differences between each of the treatments. In conclusion, acupuncture was found to be effective for the reduction and relief of symptoms that commonly affect patient QOL. Acupuncture effectively reduced symptoms of pain, tiredness, nausea, depression, anxiety, and shortness of breath, and enhanced feelings of well-being.

P-22 ACUPUNCTURE IN THE SYSTEM OF PUBLIC HEALTH OF FLORIANóPOLIS AND SOCIAL MEDICALIZATION: A STUDY ON THE EXPERIENCE OF USERS

Emiliana Silva, UFSC; Charles Tesser, UFSC; Ari Moré, UFSC

Acupuncturet has gained acceptance in the West and in the public health system (PHS) in Brazil. Given the general social process of medicalization, it is relevant to study the interaction of this treatment to patients, analyzing how its virtues recognized (more holistic approach, centering on the person's care; stimulus and the potential for self-healing participation, prevention, etc.) are present and the perceived experiences of users. The aim is to investigate the users' perception of acupuncture on treatment and investigate the process of social medicalization. It is descriptive and exploratory study with a qualitative approach in which users were asked in PHS of Florianópolis-SC in primary care (PHC) and specialized services. We carried out in-depth interviews, valuing the narrative of the subjects about their illness experience, his views on the same and on the treatments, and in particular their interaction with acupuncture. Many patients reported being referred to acupuncture when all biomedical resources failed, but some sought treatment because of the benefit obtained from the prior art. Most reported improvements in their pain conditions and decreased use of medications as well as reported improvement in other aspects such as quality of sleep, better disposition, greater emotional stability, among others. Many unaware of acupuncture, but have adapted to treatment, especially when they felt better. Few changes in the understanding of illnesses were observed, with some difference between PHC and specialized clinics. In PHC was mentioned and appreciated the provision of other resources: discussions groups, instructions massages, diet, breathing exercises and meditation, with some use of them. Relevant therapeutic outcomes and few changes in the meanings and care were perceived by users. Overall, acupuncture seems to be seen as a biomedical treatment, albeit with a less medicalized. This contributed not only for pain relief but to other aspects, reducing polypharmacy.

P-23 ACUPUNCTURE NEEDLING OF MYOFASCIAL TRIGGER POINTS VS STANDARD ACUPUNCTURE PROTOCOL IN THE TREATMENT OF FROZEN SHOULDER: A QUASI-EXPERIMENTAL STUDY

Henry Buchtel, Hunan University of TCM, P.R.China

Objective: This research compared the clinical efficacy of acupuncture needling of Myofascial Trigger Points (MTrPs) with standard acupuncture protocol in the treatment of frozen shoulder.

Method: A total of 20 patients diagnosed with frozen shoulder in the Orthopaedics and Traumatology department of the First Affiliated Hospital of the Hunan University of TCM were assigned to receive either acupuncture needling of MTrPs (Experimental Group; n=10) or standard acupuncture protocol (Control Group;n=10). Six acupuncture treatments were given; 3 per week for a total of 2 weeks. The abbreviated Constant Murley Assessment (abbreviated CMA) and visual analogue scale for pain (VAS-P) scores for each patient were recorded at baseline and at the conclusion of the final treatment.

Results: There was no statistically significant difference between the baseline data for shoulder function (abbreviated CMA score), pain (VAS-P score), age, or sex between the two groups (p>0.05). The post-treatment abbreviated CMA and VAS-P scores were significantly improved compared to baseline for both groups (p<0.05). However, the difference in improvement of scores between the two groups was not statistically significant (p>0.05).

Conclusion: Both treatment methods have obvious effect in improving the symptoms of decreased shoulder function and pain in frozen shoulder patients, and the treatment efficacy of both groups is similar. Both acupuncture needling of MTrPs and standard acupuncture protocol are effective treatment methods for frozen shoulder. In order to confirm the results, the study should be replicated in a larger study.

P-24 ACUPUNCTURE THERAPY IN AN URBAN PEDIATRIC EMERGENCY DEPARTMENT: A CASE SERIES ON PATIENTS' EXPERIENCE AND CLINICAL OUTCOME

Shiu-Lin Tsai, Columbia University; Alexander Glick, Columbia University; Yaffa Vitberg, Columbia University; Alexander Rialdi, New York University

Introduction: Acupuncture use in the pediatric emergency department (ED) has not been previously studied. We present 6 cases of children who presented to an urban pediatric ED, who received acupuncture therapy.

Design: Case series

Methods: 6 children who presented to an urban pediatric ED with differing complaints, received individualized acupuncture therapy performed by a board certified pediatric emergency medicine physician who is also a licensed acupuncturist. Consent was obtained from the families to video tape these acupuncture sessions. Comments by patients and caretakers were then transcribed from the videos. Charts were reviewed for physician's clinical observations. We report patient and families qualitative perceptions of the acupuncture experience and clinical response, as well as those of the physicians.

Results: The age of the children ranged from 4–15 years, one was male. Their ethnicities were 3 Hispanic, 2 African American, and 1 White. Chief complaints for the 6 patients were: limp, wry neck, abdominal pain, difficulty breathing, knee pain, and thumb trauma. Patients and their families were receptive to receiving acupuncture therapy. Physicians were glad that a different therapeutic modality could be offered to their patients. After receiving acupuncture, all 6 children had physician documented improvement in their clinical exam, as well as self reported improvement in their clinical symptoms. Satisfaction of both patients and their families was high.

Conclusion: 6 Children who presented with differing acute complaints to an urban pediatric emergency room experienced clinical improvement in their symptoms after receiving acupuncture, as reported by the patients, families, as well as their physicians. Acupuncture shows potential as an effective therapy in the acute setting for children. Further study is needed to validate these preliminary findings using rigorous methodologies.

P-25 ACUPUNCTURE USE FOR WELLNESS: COMPARATIVE FINDINGS FROM NATIONAL HEALTH INTERVIEW SURVEY (NHIS) 2007 AND AN AOM TEACHING CLINIC

Dawn Upchurch, UCLA; Bethany Wexler Rainisch, California State University, Northridge; Deborah Ackerman, Oregon College of Oriental Medicine

Purpose: Individuals' motivations for using acupuncture are wide-ranging. Earlier studies emphasized acupuncture for treatment of specific health conditions, but there is growing recognition of use for health and wellness. The goal of this study was to examine patterns of recent usage of acupuncture with an emphasis on characterizing those who use acupuncture for wellness, either independently or as part of managing a chronic health condition. In conjunction with investigation of motivations for use, clinical patient reported outcomes were also assessed to provide a more comprehensive and clinically relevant interpretation of national survey data.

Methods: Data were from two sources. National acupuncture data were drawn from the 2007 NHIS, a cross-sectional study (N=23,393). Recent acupuncture users (N=342) reported on reasons for use. Prospective clinical data (N=2,485), including reasons for use, were obtained from the teaching clinic at Oregon College of Oriental Medicine (OCOM). Weighted univariate and bivariate analyses were employed for NHIS data; OCOM analyses were unweighted.

Results: Nationally, almost 50% of recent users they had acupuncture for wellness or wellness and treatment combined. Few (11%) used acupuncture exclusively for wellness. There were no significant demographic differences in reason for use. Those with poorer health were more likely to use for treatment only and those with healthier lifestyles more likely to use for wellness. Wellness users had a greater number of acupuncture visits; reason for use was not associated with cost of treatment. Prospective clinical data from OCOM further elucidates these findings; patients' reason for visit (i.e., treatment vs. wellness) evolved over the course of care.

Conclusions: National data suggest acupuncture is commonly used for wellness in conjunction with treatment of health conditions. Clinical data suggest patients' rationale for visit change over time. Given only 1 in 10 reported acupuncture treatment for ‘wellness only’ there are public educational opportunities.

P-26 ACUPUNCTURE'S EFFECT ON RELIEVING SYMPTOMS FOR POST-RADIATION CYSTITIS AND PROSTATITITS

Elisabete Alves-de-Souza, PCOM

Objective: The aim of this study was to assess the response to acupuncture of patients who had moderate to-severe urinary symptoms, persisting after 12 months following the completion of radiation therapy for prostate cancer treatment.

Design: This was a pilot study to generate preliminary data concerning potential effect sizes of acupuncture and sham acupuncture in the treatment of radiation prostatitis and cystitis.

Outcomes Measures: A total of 10 subjects with cystitis and prostatitis were randomly assigned to one of three study groups. Verum acupuncture was administered twice during week 1, then performed once a week for 8 weeks to points on kidney-bladder-spleen-liver-lungs meridians expected to treat cystitis/prostatitis. The effect of acupuncture (on the lower urinary tract symptoms) was assessed (every other week) using the IPSS (International Prostate Symptom Score), to monitor results throughout the study. A paired t-test was performed to determine significant changes in IPSS before and after the 4-months treatment period in the randomized arms.

Conclusions: Both standard acupuncture and sham acupuncture treatment appear to improve the IPSS scores over the 4-month test period. Key Words: Acupuncture, radiation prostatitis, radiation cystitis, oncology, prostate cancer.

P-27 ACUPUNCTURE'S EFFECTIVENESS AT TREATING SUBCLINICAL HYPOTHYROID DISEASE VIA THE HPT/HPA AXIS: A MULTIPLE CASE SERIES

Raina Tsuda, PCOM - San Diego

Purpose: Subclinical hypothyroid disease (SHypo) is defined as having serum thyroid-stimulating hormone (TSH) concentration above the normal reference range while serum free thyroxine (FT4) and free triiodothyronine (FT3) are within reference range. It is estimated that 4–10% of the general population has subclinical hypothyroidism, increasing to 20% in women over 60 years of age. The current treatment recommendation for SHypo with TSH levels between 3–5 mIU/L is to monitor levels every 6–12 months. Studies have shown that levothyroxine is not effective for this TSH group. Based on Hans Selye's general adaption theory (GAS), it is known that acute and chronic stress can affect thyroid function via the hypothalamus-pituitary-adrenal (HPA) and the hypothalamus-pituitary-thyroid (HPT) axes. Acupuncture can reduce the body's stress response, and therefore should improve thyroid function. This research was conducted to determine if acupuncture is a viable treatment option for SHypo.

Methods: Two cases were studied for replication. The female patients, aged 34 and 44, received twelve Japanese Meridian acupuncture constitutional treatments, one per week. Serum TSH, FT4, FT3, salivary cortisol, Perceived Stress Scale – 10 (PSS-10) were measured at pre-treatment, mid-treatment and post-treatment. Number of hypothyroid symptoms present (Zulewski index) were assessed prior to each treatment. All measurements were analyzed for changes over time and cross-case comparison.

Results: Both patients had decreases in TSH and number of hypothyroid symptoms present, increases in total cortisol load and morning diurnal cortisol rhythm. Both patients reported improvements in bowel movements and menstruation. A potential adverse reaction occurred in one patient at mid-treatment with the exacerbation of her anxiety and depression.

Conclusion: From this study it can be theorized that acupuncture is a viable treatment option for SHypo, however more rigorous larger scale research studies need to be conducted to validate and extend these findings.

P-28 AIR QUALITY IN A MOXIBUSTION TREATMENT ROOM AS MEASURED THROUGH RESPIRABLE PARTICULATE (PM10) CONCENTRATION AND OXIDATIVE CAPACITY ASSAY

Baixiao Zhao, School of Acupuncture-Moxibustion and Tuina, Beijing University of CM, 100029 Beijing, PR China; Ping Liu, School of Acupuncture-Moxibustion and Tuina, Beijing University of CM, 100029 Beijing, PR China; Chaxi Huang, School of Acupuncture-Moxibustion and Tuina, Beijing University of CM, 100029 Beijing, PR China; Lixing Lao, Center For Integrative Medicine, School of Medicine, University of Maryland, HSF-2, Room S209, 20 Penn Street, Baltimore, MD 21201, USA; Longyi Shao, Key Laboratory of Coal Resources of Chinese Ministry of Education and the Department of Resources and Earth Sciences, China University of Mining and Technology, 100083 Beijing, PR China

Objective: Although moxibustion has been used for thousands of years, smoke-caused safety issues have been of concern in recent years. To assess the air quality in a typical moxibustion treatment room, PM10 mass concentration and DNA oxidative damage of PM10 were investegated.

Methods: The study was conducted in August 2011 and from November to December 2011 at a traditional chinese medicine clinic in Beijing, China, in a moxibustion treatment room. A treatment room without moxibustion and the outdoor area adjacent to the clinic were used as control sites. PM10 mass concentrations were monitored with a portable digital dust indicator. The oxidative capacity of PM10, both whole and water-soluble fractions, were detected using plasmid DNA assay, and the results were shown as TD40 values, that is, the toxic dose of PM10 causing 40% of plasmid DNA damage.

Results: Average PM10 concentrations in moxibustion room were 2.56 mg m-3 in summer and 2.78 mg m-3 in winter, much higher than those of control sites. The average TD40 values of PM10, including both fractions, collected in the moxibustion room were 791.67μg ml-1 and 876.33μg ml-1, respectively, and the winter values were 779.86μg ml-1 and 879.57μg ml-1, respectively, significantly higher (p<0.001) than the corresponding results from control sites. However, there was no statistical difference (p=0.06) between the two winter PM10 fractions from moxibustion consulting room, while there were significant differences between samples from control sites.

Conclusion: Our study shows that moxa smoke increases PM10 concentrations. However, the oxidative capacity of PM10 in the moxibustion room is much lower than that of control sites at the same dose, and its bioactivity is mainly from the water-soluble fraction; this is also different from control sites. The unexpected bioactivity is assumed to relate to the low toxicity of moxa smoke itself or to its proven antioxidant activity.

P-29 AN EVIDENCE INFORMED AOM GERIATRIC CLINICAL INTERNSHIP: WHAT STUDENT INTERNS THINK

Lori Baldwin, NWHSU; Roni Evans, NWHSU; Mark McKenzie, NWHSU; Kristine Westrom, NWHSU

Purpose: Northwestern Health Sciences University has been building an evidence informed practice (EIP) curriculum for the integrative medicine programs. The purpose of this presentation is to describe outcomes collected from AOM students enrolled in an EIP geriatric clinical internship taught within a long term care facility.

Methods: Quantitative evaluation methods are pre and post surveys administered at the onset and end of each trimester. The surveys are designed to capture intern self-evaluated values, beliefs, and behaviors related to EIP criteria. Additionally, interns keep a weekly journal and write a final paper about their internship experiences including perceptions of utilizing EIP in a clinical environment. All written material is reviewed and EIP-related portions are excerpted for qualitative analysis. Interns enrolling for a second trimester complete a self-selected EIP project which is documented and categorized by topic to reflect student incorporation of EIP concepts.

Results: The AOM EIP geriatric clinical internship is in its 6th trimester and has trained 11 interns to date. All interns not graduating have chosen to return for a second trimester for a total of 17 intern experiences. Preliminary survey results demonstrate increases in interns' EIP skills, behaviors, and openness to adopt EIP. Similarly, qualitative findings note interns express this method of healthcare delivery is an enhancement to their professional and clinical knowledge. Student projects demonstrate interns' abilities to independently utilize EIP skills practiced throughout the internship.

Conclusions: Results to date suggest AOM students' value utilizing the EIP model in a geriatric clinical internship. It is hoped educating AOM interns in the EIP model may inform their approach to care as future AOM practitioners.

P-30 “BE STILL MY BEATING HEART” EFFECTIVE ACUPUNCTURE TREATMENT FOR CARDIAC SYNDROME-X: PALPITATIONS IN PREMENOPAUSAL WOMEN, A COMPREHENSIVE REVIEW OF CLASSICAL AND MODERN LITERATURE AND RECOMMENDED THERAPY

Ineke van den Berg, Dept.of Epidemiology, Erasmus University Medical Center Rotterdam, The Netherlands; Saskia van der Schans-Toussaint, Clinic for Acupuncture's Gravenzande

Background: Modern Medicine research shows 43% of patients undergoing coronary angiograms have no evidence of coronary heart disease: “syndrome-x”. Specific patient characteristics are self-reported anxiety, female gender and age <50 years. Studies show that patients with “syndrome x” symptoms as shortness of breath, chest pain or palpitations, may actually have an anxiety disorder.

Aim: Could acupuncture be an effective additional therapy to conventional Western treatment for syndrome-x in premenopausal women, and might provide a guideline in diagnosis and treatment.

Methods: Literature review was undertaken of classical tests, next to modern studies that compared acupuncture with a control procedure for the treatment of palpitations.

Results: In the classical texts, palpitations are found in every known Heart pattern. Responsible for mental-emotional life is ‘Hearts’ functions of controlling Blood and housing the Shén. Literature mostly describes Heart-Blood deficiency with (Liver-) Blood deficiency or liver Qi stagnation due to emotions. Treatment should be focused on dealing with coexisting pathologies. Regulation of emotions, proper Blood-nourishing diet, good balance in work and rest should be pointed out to enhance acupuncture treatment. The basic-formula found: REN-17, P-6 and HE-7; combining Shén calming Du-20 and DU-24, and GB-13. Enhancing combinations add SP-6, KID-6, and SP-4. In treating women, the right body-side is considered for the principal acupuncture-points. Large randomized trials demonstrating the immediate and sustained effect of acupuncture are missing. The 6 published acupuncture-treatment studies found no adverse side effects or complications. Acupuncture has beneficial effects when treating palpitations, therefore is thought to be useful as complementary therapy or to replace generally accepted pharmacological intervention.

Conclusion: Acupuncture could provide non-cardiac chest pain patients a positively impact on their QoL, is non-invasive and safe. Diagnosed blood-deficiency in syndrome-x in premenopausal women should always be completed with the whole (complex) picture in personalized patient-care. More research is needed.

P-31 BIOMECHANICS' CHANGES OF ACUPUNCTURE TREATMENT FOR LOWER BACK PAIN: A CLINICAL STUDY TO BRIDGE THE CONCEPT OF TRADITIONAL CHINESE ACUPUNCTURE WITH WESTERN SCIENTIFIC EVIDENCE OF THE EFFACE OF ACUPUNCTURE TREATMENT

Xiao Hong Liu, School of Human kinetics and Recreation; Ping Xiao; Scott N. Dr. MacKinnon

Background of the study: Acupuncture treatment has been used worldwide for pain management and remains one of the most common treatments for lower back pain in North America. The purpose of this study is to assess the effectiveness of an acupuncture treatment protocol on lower back pain and lower back range of motion.

Method of the study: Three acupuncture treatments were provided for 21 subjects with lower back pain, within 8–12 days. A lumbar motion monitor was used to record trunk kinematics in 3-dimensions - in the sagittal (sg), lateral (lt) and twist (tw) planes - before the first and after the third treatment.

Result of the study: In total, 21 subjects, 8 males and 13 females completed the study. The average age of the subjects was 44 years with 9.52% referred by family physicians and 90.48% by family members, friends and chiropractors. The first acupuncture treatment results were compared with the results at the end of the third treatment. It was found that there was angular range of motion changes in the paired t-test at p-value less than .05 in the three planes of movement. The respective values for each of the three planes were sg: p-value=0.02, lt: p-value=0.0009 and tw: p-value=0.0174.

Conclusion: This study is the first to demonstrate the measureable effects of acupuncture treatment for lower back pain, in which the subjects showed measurable changes in trunk kinematics. This study suggests that acupuncture treatments can possibly change a subject's angular range of motion in three planes. Because the kinematics changes are greater in the third treatment than the first, this may suggest that the acupuncture treatments can have positive accumulative effects in as little as three treatments. More treatments may be required for further improvements.

P-32 BLOOD PRESSURE IS SYNCHRONIZED WITH CYCLIC VARIABILITY OF HEART RATE AND BLOOD FLOW DURING QIGONG BREATHING REGULATION

Shin Lin, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Integrated Medicine, Universit of California, Irvine; Zhongyuan Shen, Shanghai Qigong Research Institute, Shanghai University of Traditional Chinese Medicine; Payton Lin, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Integrated Medicine, Universit of California, Irvine; Christopher Amato, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Integrated Medicine, Universit of California, Irvine

Regulation of breathing is a defining characteristic of the many Chinese mind-body practices referred to as Qigong. This study investigates how conscious control of respiration can affect cardiac function. We have previously reported that regulation of breathing is accompanied by cyclic changes in heart rate variability (HRV) through the mechanism of respiratory sinus arrhythmia (J. Altn. Complem. Med. 12: 223, 2006). In this study, over 20 healthy subjects (in their 20's to 80's, male and female) participated. A Bioelectric Signals Processing System (Model SMUP-E4 from Shanghai Jia Long Educational Instrument Factory) was used to continuously record breathing rate with a belt containing an electromechanical transducer, heart rate with electrocardiogram (EKG) electrodes placed on the arm, and arterial blood pressure with an electronic pressure sensor attached to the wrist. We found that when the subjects were instructed to regulate their breathing at 5, 10, and 15 cycles per minute, heart rate (R-R interval) and blood pressure became increasingly higher during the inhalation phase and increasingly lower during the exhalation phase at all breathing rates. Next, 5 of the subjects were also monitored for blood flow at the Lao Gong (PC8) acupoint on the palm with a laser Doppler flowmetry instrument (DRT4 from Moor). We found that along with the coordinated variability of heart rate and blood pressure, cutaneous blood perfusion measured as “flux” also changed in synchrony with the inhalation and exhalation cycles at all breathing rates. This is the first documentation showing that changes in blood pressure, heart rate, and blood flow correlate with breathing rate. The data showing that conscious control of respiratory function leads to autonomic control of cardiovascular functions may have implications on how Qigong breathing exercises can be beneficial for blood pressure regulation in the prevention or treatment of high blood pressure.

P-33 CAN TCM DIAGNOSIS AND PROGNOSIS PREDICT BIOMEDICAL OUTCOMES IN THE CASE OF IRRITABLE BOWEL SYNDROME?

Carole Wyche, New England School of Acupuncture; Lisa Conboy, New England School of Acupuncture

Acupuncturists are trained to develop an individual treatment plan for each patient. That way, we can set realistic expectations specific to a particular patient, rather than base treatment solely on the presenting disease. According to TCM theory prognosis is affected by a number of factors outside of the disease including lifestyle, age of the patient, chronicity of the disease, and the TCM diagnosis. This project uses an extant data set to examine if and how these secondary factors are related to outcome following 6 weeks of manualized acupuncture. The data originate from a study previously conducted by The Osher Institute at Harvard Medical School and the Beth Israel Deaconess Medical Center, which studied, in the context of an acupuncture intervention, the placebo effect and the effects of the patient-practitioner interaction in patients with Irritable Bowel Syndrome (IBS). The purpose of the study is to examine the TCM predictors of patient outcomes, as recorded on the practitioners' treatment record, and establish whether the patient's clinical outcome, as measured by validated paper and pencil measurements, were aligned with the TCM predictors. We found clear overlap suggesting a complementary health picture when comparing the TCM and biomedical measurements across the 97 subjects examined. The authors discuss the value of adding TCM diagnostic procedures to biomedical health history.

P-34 CANCER SURVIVORS WITH LYMPHOEDEMA: PERCEPTIONS OF USING TRADITIONAL ACUPUNCTURE AS AN ADJUNCT TO USUAL CARE

Beverley de Valois, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Teresa Young, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Elaine Melsome, Mount Vernon Lymphoedema Service, Mount Vernon Cancer Centre

Background: Within a mixed-methods design to investigate using traditional acupuncture to promote wellbeing and improve quality of life in cancer survivors with lymphoedema, this qualitative study explored participants' perceptions of traditional acupuncture treatment. The study aimed to gather qualitative data about participants' experiences of traditional acupuncture treatment as an adjunct to usual care for lymphedema.

Methods: 32 lymphedema patients, who received up to 13 individualised traditional acupuncture treatments (in which needling was avoided in the affected area, and the treatment aimed to treat the person and not the lymphoedema), were invited to participate in focus groups to discuss their experiences. Transcripts were analysed using a thematic framework approach, coded iteratively using NVivo, and checked by a second researcher to ensure systematic analysis.

Results: Six head & neck and 17 breast cancer survivors (n=23) participated in six focus groups. Lymphedema, the “last straw” after cancer treatment, could leave participants disfigured, disabled and vulnerable. Despite initial scepticism, participants responded positively to the opportunity to try traditional acupuncture. They reported short-term and longer-term benefits on a range of physical and emotional conditions, including some lymphedema-related changes. Participants appreciated the therapeutic relationship and being treated as a “whole person”. Many felt more positive and confident, more in control of their lives, and better able to tolerate having lymphedema.

Conclusions: Overall, participants found traditional acupuncture acceptable. Many experienced substantial and positive impacts on various aspects of physical and emotional health, and some reported improvements in their attitude towards having lymphoedema. Data suggest that traditional acupuncture may be a useful adjunct to usual care, offering cancer survivors a non-pharmacological option to help manage a chronic condition.

P-35 CHILDREN, ADOLESCENTS AND YOUNG ADULTS (AYA) UNDERGOING TREATMENT FOR CANCER PERCEIVE BENEFITS TO ACUPUNCTURE THERAPY

Hanna Moisander-Joyce, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Michelle Bombacie, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Elena Ladas, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Katherine Taromina, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Diane Rooney, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Sagar Chokshi, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York; Kara Kelly, Division of Pediatric Oncology, Columbia University Medical Center (CUMC), New York, New York

Purpose of the Study: Previous studies have demonstrated the efficacy of acupuncture for symptom management among adults with cancer. Less is known about the role of acupuncture for supportive care among children and AYA patients with cancer. We present an interim analysis of a prospective study evaluating the feasibility and acceptance of acupuncture in this population.

Methods: All acupuncture-naïve children and AYA patients receiving cancer therapy at Columbia University Medical Center were eligible for the study. Following consent and at 3-week intervals, participants completed the Memorial Symptoms Assessment Scale (MSAS) and were offered acupuncture services which could be accepted or declined. During the six-month study period, the reasons for acceptance, chief complaints and perceptions of efficacy pre- and post-acupuncture were recorded.

Results: 42 of 74 patients (57%) received acupuncture. Patients accepting acupuncture were older, with median age 15 years (range 1–25 years, 86%≥10). 69% of patients requesting acupuncture had their first treatment during the first three weeks on study. 76% reported relief from their chief complaint after the first treatment. 90% requested >1 acupuncture session (median 3.5 sessions, range 1–13). The most common symptoms the patients sought relief for with acupuncture were pain (33%), nausea (27%), fatigue (15%) and headache (13%). Significant improvement in these symptoms was reported within 24 hours in 87%, 81%, 78% and 89% of sessions, respectively. Acupuncture was well tolerated with few adverse effects noted: minor bruising (1% of sessions), red marks (1%) and pain upon insertion (1%).

Conclusions: Children and AYA patients undergoing cancer treatment find acupuncture beneficial in addressing both cancer-related symptoms (e.g. pain) as well as side effects of chemotherapy (e.g. nausea). These results provide preliminary evidence that acupuncture may be safe in children with cancer and may be considered an aspect of supportive care to augment current symptom management therapy.

P-36 CLINICAL ACUPUNCTURE CASE STUDY: PROFOUND RESPONDERS AND HEART RATE VARIABILITY ANALYSIS

Kristen Sparrow, Private Practice

Acupuncture is a subtle intervention that can result in dramatic physical response. Considered in the context of complexity theory, acupuncture exhibits nonlinearity, i.e. the degree of response can far exceed the magnitude of the input. Heart rate is affected moment by moment by complex multiple physiological inputs and hence is also complex. Heart Rate Variability (HRV) is a problematic but potentially sophisticated measure of inputs to heart rate, most notably sympathetic and parasympathetic autonomic tone. HRV exhibits nonlinear and fractal characteristics. In this study, HRV data from a group of patients considered to be “profound responders” is evaluated retrospectively. These patients exhibited rapid and dramatic response to treatment regardless of their age or chronicity of their condition. This study focused on the HRV response during treatment to determine if there is there anything characteristic in these patients' HRV response that would predict their outsized and remarkable clinical response.

Methods: 12 patients presenting to a private acupuncture clinic were studied retrospectively after having had profound clinical response. All received body acupuncture prescribed by the tenets of Traditional Chinese Medicine, according to their presenting pattern and diagnosis. Outcome measures were patients' assessments of progress and functionality. Heart rate was measured during treatment after needles were placed. The data analysis was performed with Vivosense software with artifact management. LFR/HFR (Low frequency to high frequency ratio), Sample Entropy, pnn50, (non-normalized) HF, and SD1/SD2 readings were analyzed. These results were compared to 18 partial or non-responder patients.

Results: Data analysis showed 11 out of 12 patients exhibited an increase in HRV from the first to the second 10 minute segment. The most consistent measurement was the LFR/HFR measurement.

Conclusion: Clinical utility of HRV is limited but nonetheless provocative in its potential to provide a biomarker of effective acupuncture treatment, perhaps because of its nonlinear characteristics.

P-37 COMPARISON OF RESTRAINED AND UNRESTRAINED RAT MODELS OF ELECTRO-ACUPUNCTURE IN RATS

Haolin Zhang, Peking University; Lixing Lao, University of Maryland; Ming Yi, Peking University

Acupuncture and electro-acupuncture (EA) are widely used to treat a variety of diseases including pain. In preclinical basic science research, EA is usually applied by inserting acupuncture needles into the hindlimbs of rats restrained in small tubes or bags. This restrained model of EA may cause stress and have limitations in stimulating locations and intensities. In 2004, a novel, unrestrained rat model of EA stimulation was introduced to solve these problems. However, it was unclear whether there were any differences in the anti-nociceptive effects and intensity tolerance between the restrained and the unrestrained EA methods. To answer these questions, we measured current intensity tolerance and stress levels during restrained and unrestrained EA, and compared their anti-nociceptive effects in rats of acute inflammatory pain induced by intra-plantar injection of CFA. Our data showed similar anti-nociceptive effects of restrained and unrestrained EA. In addition, rats showed less stress-like behaviors during the unrestrained EA procedure and tolerated higher current intensity. These advantages suggest that this method can replace the restrained EA procedure and be used with novel electrophysiological techniques such as single unit and field potential recording in conscious rats.

Key words: pain, acupuncture, electro-acupuncture, restrained model, unrestrained model, rat

P-38 COPING STRATEGY FOR ELECTROACUPUNCTURE STIMULATION MODULATES PRESSURE PAIN THRESHOLD IN PASSIVE TRAIT SUBJECTS

Jeungchan Lee, Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea; Kyungmo Park, Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea

Introduction: Acupuncture stimulation including electroacupuncture (EA) is reported to modulate the pressure pain threshold (PPT). But there's no study whether the coping with acupuncture stimulation, also a noxious mechanical stimulation, affects PPT. We investigated how experimentally induced coping strategies for acupuncture needling, active and passive strategies, influenced somatosensory perceptions and autonomic activities in passive trait subjects.

Methods: Thirty-eight volunteers were screened by ‘Coping Checklist (Folkman, 1980)’ and the active trait subjects (n=13) were excluded. Only passive trait subjects (n=25) were randomized into experimentally induced active and passive coping strategy groups (AC and PC). Quantitative sensory testing (QST) was performed at left lower leg before and after EA. EA stimulation was applied at two acupoints (ST36 and GB39). To induce AC and PC groups experimentally, PC group were asked to endure the stimuli, but AC group were allowed to ask actively to reduce the stimulation intensity by pressing the button. Neither PC nor AC, stimulation intensity was not changed (95% of individual electrical pain threshold). During the EA stimulation session, heart rate and skin conductance were measured.

Results: We found the decrease only in PPT (−0.74±1.05kPa, P<0.05) in AC group after the EA stimulation whereas the PPT was slightly increased in PC (0.31±0.52kPa, P=0.07). PC group shows significant decrease in heart rate (HR, maximally in 2–4 sec, −1.41±2.50BPM, P<0.05), while in AC group, HR was increased compared to PC group in 10–12 seconds (AC=0.83±1.63BPM, PC=0.69±1.65BPM, P<0.05). The increase of skin conductance response was found in AC (0.73±0.75μS, P<0.005).

Discussion & Conclusion: We found, for the pass trait subjects, passive coping to EA stimulation increased PPT with HR decrease, while active coping decreased PPT with HR increase. It can be speculated that experimentally induced coping strategy, coupled with autonomic activity, might affect inhibitory control of pressure pain through PAG.

P-39 CORRESPONDING POINTS OF KOREAN HAND ACUPUNCTURE IS USEFUL METHOD FOR DIAGNOSIS AND TREATMENT

Kyu-Hyun Park, Pusan National University Hospital; Tae-Ho Kang, Pusan National University Hospital; Hyun-Woo Kim, Pusan National University Hospital; Tae-Woo Yoo, Korean Hand Acupuncture Institute

Background and Object: High proportion of headache patients are underdiagnosed and undertreated. There is no practical guideline to use the concept of localization practically. We need guideline to improve the diagnostic accuracy using the concept of localization mentioned as criteria of International Headache Classification.

Method: There are Meridians and Acupuncture Points on the whole body. The system is very complicated and is not easy to use in clinical practice. In Korean Hand Therapy, there is Micro-meridian and Acupuncture Points on the hand. Gold Meridian and Acupuncture Points were developed based on Micro-meridian system. We use Corresponding Points to determine the location of tender points of migraine and tension type headache. This procedure was performed as one part of physical examination at department of neurology, Pusan National University Hospital from March 2009 to Feb. 2011. The 200 patients with primary headache patients were included. We checked pain location on both sides of head and neck on Gold Acupuncture Points on the head and corresponding micro-acupuncture points on the hand.

Results: We checked tender points along the Gold Meridian and Acupuncture Points on the head and Corresponding Points on the middle finger of 200 headache patients. We analyzed them into three groups, such as migraine, tension type headache, and mixed form. The location of migraine group were divided into right, left and both side, that of tension type headache were divided right, left and both sides, and that of mixed form was various combination. The numbers of pain location pattern were 15 kinds. The numbers of pure migraine pattern was 3, of pure tension type was 3, and of mixed form was 9 demonstrated.

Conclusion: We suggest Micro-meridian System on the hand and Gold Meridian System on the head as new protocol to decide location. Pain of primary headache is closely related with meridian systems. We can improve the diagnostic value of migraine and tension type headache using Corresponding concept.

P-40 DEVELOPMENT OF TRADITIONAL CHINESE MEDICINE DIAGNOSTIC CATEGORIES FOR BREAST CANCER SURVIVORS WITH SYMPTOM DISTRESS

Lorna Lee, Won Institute of Graduate Studies; Adam Schreiber; Christina Seluzicki, University of Pennsylvania; Susan Li, University of Pennsylvania; Jun Mao, University of Pennsylvania

Background: Breast Cancer survivors experience a range of symptom side effects such as hot flashes, fatigue, joint pain, and insomnia for which conventional medication treatments are limited. Acupuncture has the potential to address these common side effects and is perceived as a natural alternative by cancer patients. The development of Traditional Chinese Medicine (TCM) diagnostic criteria is an essential step in performing epidemiology and intervention research to increase the authenticity of acupuncture treatment that is reflective of clinical practice.

Methods: We are in the process of analyzing baseline data from two acupuncture clinical trials among breast cancer survivors who finish primary care treatment (chemotherapy, surgery, radiation) and experience symptom side effects of hot flashes and arthralgia. The physician acupuncturist performed a detailed biomedical and TCM history and physical for each participant. The non-physician acupuncturists performed a TCM history and physical. The TCM diagnostic criteria were assigned by the two acupuncturists, and when there was a discrepancy, the third acupuncturist served as the tie breaker. We will perform descriptive and correlative analyses between the TCM criteria and the important socio-demographic factors and patient reported outcomes (hot flashes, pain, fatigue).

Anticipated Results: We will be presenting data from over 120 breast cancer survivors on the distribution of TCM diagnostic categories. We will also present how the TCM categories break down by key social demographic and clinical. Furthermore, we will describe the distribution of the TCM categories among individuals with the symptoms of pain, fatigue, sleep disturbance, hot flashes, anxiety and depression.

Discussion: This research presents an important first step in quantifying TCM diagnostic categories among breast cancer survivors who experience symptom distress. Data from the study may inform both TCM diagnoses and intervention development, which can then be used to create personalized integrative care for breast cancer survivors.

P-41 DISSOCIATION OF SOMATOSENSORY STIMULATION AND NEEDLING CREDIBILITY IN ACUPUNCTURE WITH SENSORY THRESHOLD AND AUTONOMIC RESPONSE

Jeungchan Lee, Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea; Jun-Hwan Lee, Acupuncture, Moxibustion & Meridian Research Group, Medical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea; Vitaly Napadow, Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital; Kyungmo Park, Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea

Introduction: In order to dissociate somatosensory stimulation from placebo effect in acupuncture, we investigated manual acupuncture stimulation (REAL) and a sham (phantom acupuncture; PHNT) using quantitative sensory testing (QST) and autonomic activity.

Methods: Thirty-eight healthy subjects were randomized into REAL and PHNT groups. In REAL, the procedure of needling and manipulation at acupoint ST36 was performed, video-recorded and simultaneously displayed to the subject. In PHNT, to create only credibility that they were getting stimulated, the video clip recorded in REAL session was replayed to the subject with pretending the acupuncturist inserts and manipulates needle. QST was performed before and after REAL or PHNT session. Heart rate (HR) and skin conductance response (SCR) were acquired during each session. Acupuncture -induced sensation was inquired after the sessions.

Results: After the manual acupuncture stimulation (REAL), vibration and mechanical detection threshold were increased with significant HR decrease and SCR increase (ΔVDT=0.61±0.24, P<0.05; ΔMDT=0.55±0.22 g, P<0.05; ΔHR−5.76±0.66 BPM, P<0.001; ΔSCR=2.15±0.67 uS/Sec, P<0.01). Increased MDT was observed after phantom acupuncture stimulation (PHNT) with HR decrease and SCR increase (ΔMDT=1.06±0.36 g, P<0.05; ΔHR=-4.53±0.41BPM, P<0.001; ΔSCR=0.67±0.28 uS/Sec, P<0.05). No significant difference between REAL and PHNT group in HR decrease, but greater SCR. Acupuncture sensation intensity in REAL group were observed (REAL=5.59±0.44, PHNT=2.25±0.56, P<0.0001).

Discussion & Conclusion: Vibration and mechanical sensation are mediated by A-beta fiber which is innervated to deep layer in dorsal horn. The deep layer is inhibited by descending pathways from periaqueductal gray (PAG) and anterior pretectal nucleus (APtN). With our result, it can be speculated that somatosensory stimulation (an ascending input to PAG/ACC and APtN) activated the descending inhibitory pathways to deep layer and then created VDT increase, which is not influenced by affection, and SCR change. Needling credibility (a descending input from cortex like ACC to PAG again to deep layer) induced MDT, HR, and partially SCR change.

P-42 EFFECT AND MECHANISM OF 10.6μM CO2 LASER AND 650 NM SEMICONDUCTOR LASER ACUPUNCTURE ON LEUCOPENIA RATS BY CYCLOPHOSPHAMIDE

Ling Zhao, Shanghai University of Traditional Chinese Medicine, China; Lanlan Liu, Shanghai University of Traditional Chinese Medicine, China; Haiping Deng, 1. Shanghai University of Traditional Chinese Medicine, China; 2. Shanghai Research Center of Acupuncture & Meridian; Ke Cheng, 1. Shanghai University of Traditional Chinese Medicine, China; 2. Shanghai Research Center of Acupuncture & Meridian; Haimeng Zhang, Shanghai University of Traditional Chinese Medicine, China; Xueyong Shen*, Shanghai University of Traditional Chinese Medicine, China

Objective: To assess the effect of 10.6μm laser and 650 nm laser simultaneously or separately irradiation on leucopenia rats caused by cyclophosphamide.

Methods: Sixty-six healthy male SD rats were randomly allocated to six groups, eleven rats in each group. Eleven rats as normal control and fifty-five rats received cyclophosphamide injection as model of leucopenia. The fifty-five rats were injected with cyclophosphamide 80 mg/kg first time and 40 mg/kg at the 4^th day and the 8th day to establish leucopenia model. Rats of the four treatment groups received either a 5-minute laser irradiation with single 10.6μm, 650 nm laser or 10.6μm-650 nm laser irradiation or a sham treatment every day for sixteen days on acupoint Dazhui (DU 14) and both Zusanli (ST 36). Rats of model control group received no treatment. The WBC in blood collected from tail end before the treatment and the 1th 5th 9th 15th 16th day after injecting cyclophosphamide the first time were taken as assess index. And the spleen index was counted on day 17.

Results: The WBC of rats decreased continually from the second day after injected cyclophosphamide, and maitain lower level on the fifth day, then began to recover. Compare with normal control group, spleen index of 650 nm laser group recovered (P=0.121>0.05). Spleen index of the single 10.6μm laser, 10.6μm-650 nm lasers, sham control and model control group were all significantly increased (P<0.05). The WBC of 10.6μm laser, 650 nm laser and 10.6μm-650 nm laser group reach the normal level after 15 days laser irradiation compared with the control group (P>0.01), while the WBC of model and sham control group were significantly lower than normal control group (P<0.001).

Conclusion: 10.6μm laser and 650 nm laser seperately or simultaneously irradiation on ST36 and DU14 can accelerate the recovery of the WBC and 650 nm laser irradiation increase the index of spleen on leucopenia rat.

P-43 EFFECT OF LOW-FREQUENCY ELECTRICAL STIMULATION OF THE ACUPUNCTURE POINTS BL62 AND KI6 ON THE QEEG OF ELDERLY WOMEN: A PILOT RANDOMIZED CONTROLLED TRIAL

Sanghun Lee, Korea Institution of Oriental Medicine; Kwang-Ho Choi, Korea Institution of Oriental Medicine; Sae-Bhom Lee, Korea Institution of Oriental Medicine; O Sang Kwon, Korea Institution of Oriental Medicine; Seong Jin Cho, Korea Institution of Oriental Medicine; Sun-Hee Yeon, Korea Institution of Oriental Medicine; Sun-Mi Choi, Korea Institution of Oriental Medicine; Kwon Eui Hong, Daejeon University Hospital; Yeon-Hee Ryu, Korea Institution of Oriental Medicine

Objective: This study aimed to investigate the effects of low-frequency electrical stimulation of the ankle joint acupuncture points (BL62 and KI6) on the brain waves of elderly women.

Methods: A randomized, controlled, double-blinded clinical trial was performed in 31 healthy women (mean age, 54.5 years) within a treatment duration of 12 sessions. In the experimental group, low-frequency electrical stimulation was applied using the maximum range of the individual insensible strength (mean current, 0.04 μA). The control group received sham stimulation. The background electroencephalographic activity was measured before and after the 12 sessions.

Result: After 12 sessions of stimulation, the relative power of the alpha wave decreased (32 of 32 channels: significant difference in 11 channels 11 channels-significantly, p<0.05); the theta (30 of 32 channels: significant difference in 10 channels, p<0.05), beta (31 of 32 channels), and gamma (30 of 32 channels: significant difference in 7 channels, p<0.05) powers were also decreased compared with the sham group.

Conclusion: Electrical stimulation on the acupuncture points (BL62 and KI6) of the ankle joint seemed to stabilize the elderly women by inducing the alpha power and reducing beta, theta, and gamma powers.

P-44 EFFECT OF MOXA SMOKE ON MONOAMINE NEUROTRANSMITTERS IN SAMP8 MICE

Huanfang Xu, Beijing University of Chinese Medicine; Yingxue Cui, Beijing University of Chinese Medicine; Ping Liu, Beijing University of Chinese Medicine; Li Han, Beijing University of Chinese Medicine; Baixiao Zhao, Beijing University of Chinese Medicine

To determine whether smoke produced by moxibustion influences brain monoamin neurotransmitters in the senescence accelerated mouse (SAM), 10 normal SAMR1 mice were used as control and 70 SAMP8 mice were randomly assigned to a model group (n=10) or to one of six moxibustion groups (n=10/group) according to a 2×3 factorial design: exposure time, 15 or 30 minutes daily, and moxa concentration, low (5∼15 mg/m3), middle (25∼35 mg/m3), or high (85∼95 mg/m3). The six moxibustion groups were exposed to moxa smoke six times a week for four weeks; the model and normal control mice were not exposed. Brain 5-HT, DA, and NE levels were determined using ELISA. Compared to normal control, the model group showed a remarkable decrease in 5-HT, DA, and NE. There was no difference between mice fumigated for 15 and 30 minutes, but a marked increase in neurotransmitter levels was observed in both of these groups when compared to the model mice. In groups fumigated at any concentration, 5-HT and NE concentrations were higher than in model control. There were no differences between the middle and low concentration groups, but those groups showed higher neurotransmitter levels than did mice in the high concentration group. DA levels were the same in all three concentration groups. Compared to model control, mice receiving both middle and low concentrations showed an increase; high concentration produced no difference. Time and concentration clearly affected outcomes: moxibustion at the middle concentration for 15 minutes was most effective in increasing brain monoamine neurotransmitters in the SAMP8 mice. Our findings suggest that moxa smoke may contribute to anti-aging by increasing monoamine neurotransmitter levels and that this effect varies according to concentration and time.

P-45 EFFECTS OF ACUPUNCTURE ON LIFE OF QUALITY IN PATIENTS WITH BREAST CANCER TREATED WITH TAMOXIFEN OR AROMATASE INHIBITORS

Jen-Hwey Chiu, Institute of Traditional Medicine, School of Medicine, National Yang-Ming University; Yi-Hsien Lin, Division of Radiotherapy, Cheng Hsin General Hospital, Taipei; Yen-Wen Peng, Center of Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Chin-Hwei Tsu, Center of Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Fang-Pei Chen, Center of Traditional Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

Patients with breast cancer are troubled with severe postmenopausal syndromes such as insomnia, hot flash and cancer-related fatigue during their treatment with tamoxifen or aromatase inhibitors. The aim of this study was to investigate the effect of acupuncture on symptoms relief and life of quality in breast cancer patients receiving hormonal therapy. 97 breast cancer patients were prospectively included from 2010-9 to 2011-9. Under the approval of IRB, the general information, degree of symptoms and quality of life (QOL) were recorded by questionnaire and SF-12 QOL analysis. Acupuncture was performed by doctors of the same institute under the guideline of traditional Chinese medicine. The results showed that the severity of symptoms were mild to moderate after acupuncture treatment compared to baseline (moderate to severe). Interestingly, the mental component scale (MCS), but not physical component scale (PCS), improved after acupuncture treatment in breast cancer patients treated with tamoxifen or aromatase inhibitors. We conclude that acupuncture provide an important non-pharmacological support in patients with breast cancer during their treatment with tamoxifen or aromatase inhibitors.

P-46 EFFECTS OF ELECTROACUPUNCTURE ON THE PAIN BEHAVIOR AND EDEMA IN THE RAT MODEL OF CARRAGEENAN-INDUCED KNEE ARTHRITIS

Bo Eun Jeong, School of Korean Medicine, Pusan National University; Heun Joo Lee, School of Korean Medicine, Pusan National University; Da Eun Song, School of Korean Medicine, Pusan National University; Minyoung Park, Division of Meridian and Structural Medicine, School of Korean Medicine, Pusan National University; Sungtae Koo, 2Division of Meridian and Structural Medicine, School of Korean Medicine, Pusan National University

We investigated the analgesic and anti-edematous effects of electroacupuncture (EA) in the rat model of carrageenan (CA) induced knee arthritis. For induction of knee arthritis, the rats were injected with 100μl of 2% lambda CA into the anterior synovial cavity of the right knee joint. EA was applied to bilateral ST36 for 30 min except for the control group. To find out the optimal condition of EA, we delivered the EA stimulation at 3 different conditions. For the 1^st group, EA was given at immediately after CA injection (EA0h). For the 2^nd group, EA was given at 2h after CA injection (EA2h). For the 3rd group, EA was given twice at immediately and 2h after CA injection (EA0h+2h). To evaluate the level of pain and the volume of swelling in the CA-induced arthritic knee, the amount of weight bearing force (WBF) of the foot and the circumference of the knee joint was measured, respectively. To elucidate the effects of EA, the level of TNF-α, IL-1β and PGE2 in synovial fluid were analyzed using ELISA. The WBF was reduced gradually after CA injection and the reduction of WBF was maximized at 4h in the control group. While the reduction of WBF was improved significantly in the EA treated group. The improvement can be interpreted as an analgesic effect and the effect was most powerful in the EA0h+2h group. And the EA also suppressed the increase of the circumference of the knee joint. Furthermore, the EA inhibited the expression of TNF-α, IL-1β and PGE2 in the affected synovial fluid. The data suggest that EA applied to bilateral ST36 produce both analgesic and anti-inflammatory effect via, at least in part, down-regulation of pro-inflammatory cytokines and PGE2 in knee joint of arthritic rats.

P-47 EFFECTS OF MOXA SMOKE EXPOSURE ON HEART RATE AND HEART RATE VARIABILITY IN HEALTHY YOUNG ADULTS

Baixiao Zhao, Shool of Acupuncture and Moxibustion, Beijing University of Chinese Medicine,Beijing,China; Yingxue Cui, Shool of Acupuncture and Moxibustion, Beijing University of Chinese Medicine, Beijing, China; Yuhai Huang, Shool of Acupuncture and Moxibustion, Beijing University of Chinese Medicine, Beijing, China; Lixing Lao, Center For Integrative Medicine, Dept. of Family and Community Medicine, School of Medicine, University of Maryland, Baltimore, MD,USA; Zhanghuang Chen, Chinese Astronaut Scientific Research Training Center, Beijing, China

Objective: To evaluate changes in human heart rate (HR) and heart rate variability (HRV) parameters during and after exposure to moxa smoke.

Methods: Fifty-five healthy young adults were randomly divided into experimental (n=28) and control (n=27) groups. Subjects in the experimental group were exposed to moxa smoke (1.8∼2.5 mg/m3) for 20 minutes twice in a single week. ECG monitoring was performed in three phases: before, during, and after the exposure. HRV analysis software was used to analyze short-term (5-min) heart rate variability parameters, including the time-domain parameters (SDNN, SDANN, RMSSD, PNN50) and the frequency-domain parameters (TP, HF, LF, LF/HF, INTP, INLF, INHF). Control group subjects were similarly placed in the same environment but not exposed to the moxa smoke. Follow-up measurements were performed in the following week. SPSS statistical software was used for data analysis.

Results: In the first test, the percentage increase of SDANN in the experimental group was significantly higher (p=0.031)than that in the control group in the third phase. In the second test, the percentage decrease in HR (p<0.001), the percentage increases in SDANN (p=0.007), RMSSD (p<0.001), TP(p=0.17), and HF(p=0.12), and increases in PNN50 (p=0.022), INTP (p<0.001), INHF (p<0.001), and INLF (p<0.001) in the experimental group were significantly greater than those in the control group in the second phase. In the third phase, the percentage increases of LF(p=0.031) and INTP (p=0.039)in the experimental group were significantly greater than those in the control group.

Conclusion: Moxa smoke exposure may improve autonomic nervous system activity to induce a relaxation in the human body.

P-48 ELECTROACUPUNCTURE AT ‘FORBIDDEN POINTS' IN PREGNANT WISTAR RATS' HEALTH

André Vilella Guerreiro Silva, Federal University of São Paulo - Brazil; João Bosco Guerreiro Silva, Rio Preto Medical School - Brazil; Mary Uchiyama Nakamura, University of São Paulo - Brazil; José Antonio Cordeiro, Rio Preto Medical School - Brazil; Luiz Lima, Rio Preto Medical School - Brazil; Gloria Elisa Mendes, Rio Preto Medical School - Brazil

Many complaints in prenatal time can be resolved by acupuncture like nauseas and vomits, low-back pain, insomnia, digestive problems and depression. Even so, many acupuncturists are afraid of using some points – so called ‘forbidden’, according traditional knowledge – in this period. In a recent paper we showed that we could not produce any harm in Wistar rats' pregnancy outcome. In this study we search for any problems in the pregnant rat's health using this ‘forbidden’ points.

Participants: Forty-eight pregnant Wistar rats randomly divide into 4 groups: total control, where the animals were left in cages without manipulation; anesthetized control, where they were manipulated and anesthetized but did not received Electroacupuncture; peripheral and sacral points, where the rats were anesthetized and received 4 acupuncture points – LI4-SP and BL27-28, respectively.

Methods: Primary end point was Maternal weight gain. Other evaluated parameters were Glucose, Creatinine, Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) rates, and the histopatological evaluation of rats' livers and kidneys.

Analysis: Analysis of variance (ANOVA) and Kruskal-Wallis weres used to compare groups. If any difference was seen, it was calculated as between-group comparisons with the Bonferroni correction. The adopted significance level was α=0.05.

Results: Total Control group gained more weight than the Anesthesia control group (p=0.0064) and Sacral Points group (p=0.0004). There was no difference, however, between the total control group and rats that received peripheral points, the most famous points commonly cited as responsible for harm in pregnancy. It is not possible, therefore, to conclude from this data that acupuncture in those points could reduce weight gain. We did not find any difference between the other parameters.

Conclusions: We found no evidence that acupuncture in LI4-SP6 and sacral points could be harmful to the health of pregnant Wistar rats.

P-49 ELECTROACUPUNCTURE FOR TREATING PAINFUL DIABETIC NEUROPATHY: STUDY PROTOCOL FOR A RANDOMIZED, PATIENT-ASSESSOR BLINDED, CONTROLLED PILOT CLINICAL TRIAL

Seunghoon Lee, Korea Institute of Oriental Medicine & Kyunghee University; Joo-Hee Kim, Korea Institute of Oriental Medicine; Tae-Hun Kim, Korea Institute of Oriental Medicine; Sun-Mi Choi, Korea Institute of Oriental Medicine

Objectives: The purpose of this study is to evaluate the feasibility of massive clinical research and to make a basic analysis on the effectiveness and safety of electroacupuncture on painful diabetic neuropathy (PDN) compared to placebo and usual care.

Methods and Results: This study is a protocol for a randomized, patient-assessor blinded, controlled pilot trial (Clinical Research information Service: KCT0000466). The study was approved by the Ethic Committee of the oriental hospital of Daejeon University in Korea. Forty-five participants will be assigned to the electroacupuncture group (EA, n=15), sham electroacupuncture group (SEA, n=15), and usual care group (UC, n=15). Participants assigned to the EA will receive electroacupuncture (retaining for 30 minutes with a mixed current of 2Hz/120Hz and 80% intensity of being able to bear) at 12 standard acupuncture points (bilateral ST36, GB39, SP9, SP6, LR3, GB41) 2 times per week for 8 weeks (total of 16 sessions). Participants in the SEA will receive sham electroacupuncture (no electrical current will be passed to needle, but the light of lamp will be seen and the sound of the pulse generator will be heard by the participants) at the non-acupuncture points. Participants in the UC will not receive electroacupuncture treatment during the study period. Follow-up will be made on the 5th, 9th, and 17th weeks after random allocation. 11-point pain intensity numerical rating scale (PI-NRS) is the primary outcome measurement used in this study. The Short-Form McGill Pain Questionnaire (SF-MPQ), sleep disturbance score (11-point Likert scale), The Short-Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI), and Patient Global Impression of Change (PGIC) will be used as outcome variables to evaluate the effectiveness of acupuncture. Safety will be assessed at every visit.

Discussions: The result of this trial will provide a basis for the effectiveness and safety of electroacupuncture for PDN.

P-50 ELECTROACUPUNCTURE PROTECTS AGAINST CEREBRAL ISCHEMIC INJURY BY INHIBITION OF GLYCOGEN SYNTHESIS KINASE 3β (GSK-3β) VIA CB1 RECEPTOR

Qiang Wang, Xijing Hospital, Fourth Military Medical University; Haidong Wei, Xijing Hospital, Fourth Military Medical University; Lize Xiong, Xijing Hospital, Fourth Military Medical University

Background and purpose: Stroke especially ischemic stroke is still threatening people's lives and costs the society and families too much. EA pretreatment has been proved effective in laboratory and some clinic practice. But the further mechanism still needed to be revealed for a better understanding. A link between EA pretreatment and GSK-3β was to be investigated to explain the molecule signal transduction.

Methods: GSK-3β activity was detected by Western blotting of p-GSK-3β(9ser) and GSK-3β in the ipsilateral penumbra at 2 hours after reperfusion induced by middle cerebral artery occlusion. Infarct volume was examined by TTC staining, and neurologic score was evaluated by Garcia score system. Apoptosis was detected by TUNEL staining and Western blotting of Bax, Bcl-2 and active caspase-3.

Results: EA pretreatment reduced the infarct volume and neurologic score at 72 hours after reperfusion. EA pretreatment increased the site 9ser phosphorylation of GSK-3β at 2 hours after reperfusion in the ipsilateral penumbra. PI3K inhibition reversed the increasing of p-GSK-3β(9ser) and the protective effect. GSK-3β inhibition induced similar effect as EA pretreatment. Apoptosis protein detection and TUNEL staining showed the same change as formers. The regulation of GSK-3β by EA pretreatment was abolished when CB1 was blocked, and CB1 activation promoted the phosphorylation of GSK-3β.

Conclusion: The data showed that EA pretreatment promote the inhibition of GSK-3β to induce the ischemic tolerance. And this effect may due to the CB1 activation induced by EA pretreatment. And the protection induced by EA may eventually attribute to the decreasing of apoptosis.

P-51 ELECTROMYOGRAPHIC STUDY ON TAI CHI'S ACTIVATION OF MUSCLES ESSENTIAL FOR FALL PREVENTION AND WEIGHTLIFTING

Shin Lin, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine; Ge Wu, Dept. of Rehabilitation and Movement Science, University of Vermont; Zhongyuan Shen, Shanghai Qigong Research Institute, Shanghai University of Traditional Chinese Medicine; Patrick Nguyen, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine; Christopher Amato, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine; Payton Lin, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine; Amy To, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine; Gabriel Orenstein, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Intergrative Medicine, University of California, Irvine

Tai Chi is effective for fall prevention in the elderly and for treatment/prevention of various muscular disorders. In this pilot study involving six healthy male and female college students, electromyography (EMG) was used to investigate these healthful benefits. A Holter-type EMG device (Pre-Ideal Company, Shanghai) was used to continuously record from pairs of electrodes placed over different muscle groups. Muscle activation levels (determined as average height of the highest EMG peaks recorded at a sampling rate of 125X/sec) for pectoralis major on the chest, anterior deltoid and posterior deltoid on the shoulder were 24/57/35 (arbitrary units for the 3 muscles) for 100-lb and 30/81/40 for 160-lb military press, and 43/25/25 for 100-lb and 65/26/26 for 160-lb bench press on a Bowflex machine. By comparison, activation levels were 13/44/22 for Chen Style Tai Chi Silk Reeling. For vastus medialis, rectus femoris, and vatus lateralis (quadriceps muscles on the upper leg), activation levels were 14/19/14 during normal walking and 27/28/27 during an 8-inch step. These levels are in comparison with 46/42/38 with or 43/39/35 without up-down motion during 70-30% front-to-back body weight shifting in Tai Chi front stance (as in “silk reeling”); 30/25/23 for cover step (as in “firecracker”); 20/21/24 for horse stance; and 37/27/13 for side stretch kick. Finally, for tensor fasciae latae at side of thigh (functions as stabilizer), retus femoris at front of thigh and tibialis anterior at front of lower leg (both function as brakes) activation levels recorded during Tai Chi forward twist steps (as in “parting wild horses mane”) were 2 to 4 times higher compared to levels recorded during normal walking. In conclusion, this study shows that certain Tai Chi movements can be effective exercises for upper body muscles for weightlifting while others are superior to walking and stepping for leg muscles essential for fall prevention.

P-52 EVALUATION OF THE NATIONAL ACUPUNCTURE DETOXIFICATION ASSOCIATION PROTOCOL TO TREAT COMBAT STRESS INDUCED INSOMNIA

Christine Cronin, Pacific College of Oriental Medicine - San Diego; Lisa Conboy, New England School of Acupuncture

Purpose: To evaluate the effectiveness of the NADA protocol on Combat Stress Induced Insomnia.

Method: Using a randomized pretest-posttest design with a delayed treatment waitlist, this study evaluated the relationship between the NADA protocol and insomnia symptoms. To determine a baseline for each participants' Combat Stress and insomnia severity, the Pre-Study Data Collection Sheet, Combat Exposure Scale (CES), Post-Traumatic Stress Disorder Military Test (PCL-M unlabeled) and Pittsburgh Sleep Quality Index (PSQI) were completed before receiving treatment. The auricular acupuncture treatment points used were shenmen, sympathetic, kidney yin, liver and lung/heart area using Seirin D-Type ear needles. Each point was needled bilaterally and retained for 45 minutes each day for five days. Each participant completed the Post-Study Data Collection Sheet, PCL-M unlabeled and PSQI as the post-test after completion of the treatment course. A follow up assessment was completed using the samemeasures one week after post-test. After the one week follow-up, the control group underwent the treatment protocol. The pre and post-tests were compared to determine if the NADA protocol effectively reduced insomnia symptoms.

Results: The NADA protocol has shown a trend with statistically significant improvements in the global scores of both the PSQI (p≤0.04 at post treatment and follow up) and PCL-M(p≤0.05 at post treatment and follow up). The PSQI showed sleep quality statistically significant post treatment (p≤0.05). Reexperiencing (p≤0.04 follow up) and hypervigilance symptoms (p≤0.003 post treatment) were statistically significant on the PCL-M.

Conclusions: If the NADA protocol continues to be effective, it would give military medical personnel a simple treatment option that could be used in any military setting. This treatment could be used preventively, shortly following combat stress and/or trauma exposure to reduce the risk of the development of future symptoms.

P-53 EXPLORING THE EFFECTS OF SELF-MANAGED ACUPRESSURE ON PAIN, FUNCTION AND OSTEOARTHRITIS BIOMARKERS AMONG POSTMENOPAUSAL WOMEN WITH OSTEOARTHRITIC KNEE PAIN: A FEASIBILITY STUDY

Yan Zhang, Texas Tech University Health Sciences Center; Chwan-Li Shen, Texas Tech University Health Sciences Center; Jean-Michel Brismée, Texas Tech University Health Sciences Center; Kim Peck, Texas Tech University Health Sciences Center; Raul Y. Dagda, Texas Tech University Health Sciences Center; Di-Fan Lo, Texas Tech University Health Sciences Center; Susan Doctolero, Texas Tech University Health Sciences Center

Purpose: The prevalence of osteoarthritis (OA) is higher in women who tend to display more severe knee OA, particularly after menopausal age. Women are more likely to seek complementary and alternative medicine (CAM) approaches. Little research has been conducted to examine the impact of acupressure on knee OA. We examined the feasibility of training self-administered acupressure exercise and assessed its effects on OA symptoms among women with knee OA.

Methods: A total 36 of eligible women aged 50 years and older were randomly assigned in the acupressure exercise group (n=15) or the control group (n=21) for 12 weeks. Two training sessions and a training kit were offered to the acupressure group. Feasibility outcomes such as compliance and adverse effects were assessed. Feedback regarding the training and self-administrated acupressure exercise was collected. Primary outcomes included Western Ontario and McMaster's University Osteoarthritis Index (WOMAC) and pain and function subscales of SF-36. Secondary outcomes were OA biomarkers (serum C-telopeptide of type II collagen, serum cartilage oligomeric matrix protein). Data were collected at baseline, 6weeks and 12weeks. Both per-protocol and intention-to-treat analysis were employed. All information was de-identified and analyzed using SPSS statistics.

Results: Although the attrition rates were high, the training materials were well received. The feedback suggested that self-administered acupressure exercise is easy to learn and safe to perform at home. No statistically significant results of the clinical outcomes and biomarkers were observed. Our findings didn't reveal superiority or inferiority of acupressure compared with usual care in terms of WOMAC, SF-36 scores or OA biomarkers.

Conclusion: Acupressure exercise is feasible to be trained among postmenopausal women with knee osteoarthritis. Due to the limitations of this study such as small sample size and high attrition rate, acupressure's efficacy needs to be further explored in larger scale studies with more rigorous design.

P-54 FACTORS ASSOCIATE WITH UTILIZATION OF HERBAL MEDICINE: EVIDENCE FROM 5 YEARS INPATIENT RECORDS IN TCM HOSPITALS IN CHINA SYSTEMATIC REVIEW: COMPARATIVE EFFECTIVENESS BETWEEN XIAOKE PILL AND GLIBENCLAMIDE FOR TYPE 2 DIABETES MELLITUS

Chao Liu, University of Macau

Purpose: The most popular Chinese medicinal product of type 2 Diabetes treatment in clinical practice is Xiaoke Pill(XKP). XKP is synthesized by medical herb extractives and Glibenclamide and is the only drug of this kind approved by SFDA in diabetes treatment. This study aims to provide a comprehensive systematic review and meta-analysis between XKP and Glibenclamide in clinical efficiency and safety.

Methods: Randomized clinical trails(RCTs) published before 2012 on XKP versus Glibenclamide in treating type 2 diabetes for more than 4 weeks were retrieved form major databases, including PubMed, Chinese National Knowledge Infrastructure, and WanFang database. Fasting plasma glucose(FPG), 2h postprandial plasma glucose(2hPG) and hemoglobin A1c(HbA1c) improvements were tested by meta-analysis. Sensitivity analysis was conducted on the study quality of RCTs and efficacy.

Results: 8 qualified Randomized Clinical Trails(RCTs) with 1155 participants were screened out. The pooled mean difference in FPG is −0.43 mmol/L(95%CI−0.75 mmol/L to −0.12 mmol/L; P=0.007), in 2hPG is −0.71 mmol/L(95%CI−1.25 mmol/L to −0.18 mmol/L; P=0.009) and in HbA1c is −0.30% (95% CI−0.53% to −0.08%; P=0.008).

Conclusions: The current evidences indicate that XKP improves glycemic control in type 2 diabetes treatments a little more effective than Glibenclamide. Given the limitations of available studies, further high quality, large controlled trials are warranted to verify the long-term efficacy on glycemic control and occurrence of the complications control as well.

P-55 FACTORS ASSOCIATE WITH UTILIZATION OF HERBAL MEDICINE: EVIDENCE FROM 5 YEARS INPATIENT RECORDS IN TRADITIONAL CHINESE MEDICINE HOSPITALS IN CHINA

Chao Liu, Institute of Chinese Medical Science, University of Macau; Cheng Xu, Southwestern University of Finance and Economics, School of Public Administration; Gordon Liu, Peking University; Yitao Wang, Institute of Chinese Medical Science, University of Macau

Purpose: We analyzed the pattern and factors associate with the utilization of herbal medicine in Traditional Chinese Medicine (TCM) hospitals in China.

Methods: Total number of 87248 inpatient records in 100 TCM hospitals from 2003 to 2007 was used. Use of herbal medicine are analysed by a logit model. Major factors associate with the utilization includes patients' and hospitals' characteristics.

Results: Herbal medicine use is positively related to a patient's age. Female, ethnic group, health insurance status, and disease types also associate with herbal medicine utilization. Patients in critical conditions (OR=1.27, P<0.01) are more likely to useherbal medicine than those in stable conditions. However, patients admitted from emergency department are less likely to use herbal medicine (OR=0.75, P<0.01). Patients from higher rank hospitals received more herbal medicine treatment (OR=1.12, P<0.01) than their counter parts. Use of herbal medicine is also higher (OR=2.49, P<0.01) in eastern(developed area) than in mid-western(developing area).

Conclusion: Factors associate with utilization of herbal medicine include both patient demand and herbal medicine service supply. The study calls for further investigations on availability of herbal medicine and practitioners in different geographic locations. It is also worthwhile to identify comparative advantages of herbal medicine to western medicine in treating different conditions in order to fulfill its roles with the current Chinese health care reform.

P-56 FACTORS ASSOCIATED WITH LIKELIHOOD TO USE ACUPUNCTURE AMONG CANCER PATIENTS RECEIVING RADIATION THERAPY

Jun Mao, Perelman School of Medicine at University of Pennsylvania; Eitan Frankel, Perelman School of Medicine at University of Pennsylvania; Brigitte Hurtubise, Perelman School of Medicine at University of Pennsylvania; Tiffany Tan, Perelman School of Medicine at University of Pennsylvania; Paula Morzenti, Perelman School of Medicine at University of Pennsylvania; Krupali Desai, Perelman School of Medicine at University of Pennsylvania

Background: Acupuncture has potential as a supportive care service for cancer symptom management, however, little is known about patients' preferences regarding acupuncture integration, which is critical for developing tailored, integrative services.

Methods: We conducted a cross-sectional survey study at an urban, academic cancer center. Participants included individuals with different cancer types who were recruited during their last week of Radiation Therapy (RT). The main outcome variable was self-reported ‘likely to utilize acupuncture’. Knowledge about acupuncture and pain severity were measured along with socio-demographic and clinical variables. Multivariate logistic regression was used to identify factors associated with likelihood to utilize acupuncture.

Results: Among the 305 participants, 231 (75.7 %) identified as White, 60 (19.7%) as Black, 8 (2.6%) as Asian, and 6 (2.0%) as Other. 145 (47.5%) were females. 143 (46.9%) of patients had no knowledge of acupuncture and 209 (68.5%) reported having pain. Seventy-nine (25.9%) of the subjects were likely to use acupuncture during RT if such services were offered. In multivariate analysis, non-whites (adjusted odds ratio [AOR] 1.93, 95% Confidence Interval [CI] 1.06–3.51) and those with pain (AOR 2.62, CI 1.35–5.07) were more likely to use acupuncture. In addition, patients who had knowledge about acupuncture were also more likely to use acupuncture than those without (AOR 2.27, CI 1.31–3.96).

Conclusion: Patients who identified themselves as non-white, who experienced pain, and had a greater knowledge about acupuncture were more likely to utilize acupuncture during RT. This suggests that acupuncture may play an important role in meeting the unmet symptom needs of cancer patients, particularly among minority patients. The data also suggests that half of the patients have no knowledge about acupuncture, which warrants interventions to improve patients' knowledge and facilitate the integration of acupuncture into cancer care.

P-57 FIRST STEPS: INVOLVING PEOPLE WITH LOWER LIMB LYMPHOEDEMA IN EVALUATING TRADITIONAL ACUPUNCTURE FOR IMPROVED WELLBEING

Beverley de Valois, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Teresa Young, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Elaine Melsome, Mount Vernon Lymphoedema Service, Mount Vernon Cancer Centre

Purpose: Public and patient involvement (PPI) is a prerequisite for applying for funding to the UK's NIHR Research for Patient Benefit funding programme. Following promising results from research with cancer survivors with upper body lymphoedema, we plan to apply for funding to explore the feasibility and acceptability of offering traditional acupuncture to people with lower body lymphoedema. Our initial requirement is to involve patients in developing the research proposal. Step one was to offer “taster sessions” so they could experience and evaluate traditional acupuncture.

Methods: We invited patients attending the lymphoedema service for usual care for lower limb lymphoedema to experience traditional acupuncture. Following a meeting to explain traditional acupuncture, 6 patients consented to have up to 7 treatments and to complete questionnaires including the Measure Yourself Medical Outcomes Profile (MYMOP), LYMQOL-Leg, SF-36, and semi-structured questionnaires at baseline, end-of-treatment (EOT), and 4 and 12 weeks after EOT.

Results: Two patients with primary, 2 with cancer-related, and 2 with non-cancer-related secondary lymphoedema attended for 35 treatments in total. Five had bilateral lymphoedema; none were needled below the waist. Mostly, patients found treatment relaxing and reported some reduction of symptoms. Improvements in sleep facilitated improved self-care. MYMOP scores showed clinically and statistically significant improvement at all measurement points; LYMQOL-Leg showed improved Function and Mood and SF-36 showed improved Role Emotional and Mental Health scores at EOT. Five patients would recommend acupuncture to a friend.

Conclusions: Patients were positive about traditional acupuncture. They reported benefits, despite limiting acupuncture to points on the upper body. We will continue building on these first steps to progress initiatives for service development and research into using traditional acupuncture to improve wellbeing for people with lower limb lymphoedema.

P-58 FORMATION OF SCHOLARS: DOCTORAL EDUCATION IN THE FIELD OF ACUPUNCTURE AND ASIAN MEDICINE

Carla Wilson, American College of Traditional Chinese Medicine

Purpose: Practitioners of acupuncture and Asian medicine have begun to engage in doctoral education, yet the impact of doctoral level education on this medicinal discipline and research in teh field is yet to be fully evaluated. This research examines for graduated cohorts and assesses the impact of doctoral education on clinical practice, employment, research and integrated health care settings.

Methods: This research surveys and analyzes Asian Medicine practitioners that have completed the doctoral program at the American College of Traditional Chinese Medicine (ACTCM) in San Franciso, CA ACTCM began it's first doctoral cohort in fall 2006.The graduated cohorts were surveyed to assess the impact that doctoral education is having thus far on clinical practice, employment, research,integrated health care settings and professionalism. A mixed methods approach was used to evaluate both qualitative and quantitative information.

Results: This research project indicates that practitioners of acupuncture and Asian Medicine are entering doctoral programs for a variety of reasons and pursuing research in acupuncture, herbal medicine.Graduates that were surveyed indicated that there is value in doctoral level training and that this level of training is needed in order to move ahead in clinical practice, prepare to work in integrated healthcare settings, and to develop specialties in the field.

Conclusion: The outcfomes of the study indicate the strong growing interest in inter professional medical education, integrated health care settings, and cross-disciplinary research.

P-59 “GETTING MY LIFE BACK”: A STUDY OF HOW ACUPUNCTURE TREATMENT IMPROVED QUALITY-OF-LIFE FOR ONE WOMAN WITH BREAST CANCER-RELATED LYMPHOEDEMA

Beverley de Valois, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Teresa Young, Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre; Elaine Melsome, Mount Vernon Lymphoedema Service, Mount Vernon Cancer Centre

Purpose: Acupuncture is an unusual treatment for lymphoedema patients, with fears that it might exacerbate lymphoedema and introduce infection. Furthermore, research often focuses on a single symptom, overlooking acupuncture's beneficial effects on overall wellbeing. This case study reports “Ann” who participated in research investigating the use of acupuncture as an adjunct to usual lymphoedema care to promote wellbeing and improve quality-of-life. It illustrates the range of benefits associated with acupuncture treatment.

Methods used: Data from treatment notes, questionnaires, clinical observation, and communications with the patient were drafted by the author, and sent to “Ann” for feedback and verification. Keen to share her experience, “Ann” has consented to disseminating her details.

Results: “Ann”, age 60, developed lymphoedema in her left arm soon after breast cancer surgery nine years previously. Her arm felt heavy and constantly painful; swollen fingers restricted her grip. She reported frustration, lack of control, loss of confidence, and guilt about surviving cancer. Her treatment priorities were 1) relief of arm pain, and 2) to get back “in balance”. A seamstress, she wanted to resume sewing. Ann received 13 acupuncture treatments over 16 weeks; after three treatments she reported that her arm felt less heavy, pain reduced, her grip improved and she completed a small sewing project. Sleep, energy, and bowel habits improved; nightmares and headaches reduced. Seventy pounds overweight, Ann worked with her acupuncturist to improve her dietary habits, losing 10 pounds “without dieting”. Emotionally, she reported reduced anxiety and guilt. Her confidence increased, and self-management of lymphoedema improved.

Conclusions: Ann illustrates the complex ways that acupuncture can facilitate physical and emotional healing, and influence lifestyle habits. Through treatment, Ann processed difficult emotions related to cancer and lymphoedema. She dealt with symptoms in a more positive way, an essential change for managing a chronic condition like lymphoedema.

P-60 GOLD ACUPUNCTURE MODEL AND MIRCO-MERIDIAN ACUPUNCTURE MODEL OF KOREAN HAND ACUPUNCTURE ARE USED INSTEAD OF BODY ACUPUNCTURE POINTS FOR TREATMENT

Kyu-Hyun Park, Pusan National University Hospital; Tae-Ho Kang, Pusan National University Hospital; Hyun-Woo Kim, Pusan National University Hospital; Tae-Woo Yoo, Korean Hand Therapy Institute

Modernization of acupuncture has been top issue in academic meetings in the world. It is necessary to undertake scientific studies of acupuncture. It needs to prove scientific evidence based on principles or hypothesis. For treatment, a manual acupuncture needle has been used for long time, but it cause pain for patients. Some researchers said that we consider the frequency of adverse effects from acupuncture treatment, plus the need for treatment of the adverse effects and the costs involved for treatment of side effect. To avoid this, some institutes used electric and laser acupuncture in clinics and research. These institutes published research claiming that laser acupuncture was more effective than hand-inserted acupuncture. However, there is insufficient research into issues regarding the use of electric and laser acupuncture Korean Hand Acupuncture uses numerous therapeutic methods, among them, Cyber Korean Hand Therapy Plate and Gold Meridian- Acupuncture Model has been used without manual needling. The participants did not be exposed to side-effects or danger of acupuncture. I present new therapeutic methods without manual acupuncture on Korean Hand Model and Gold Meridian Model. KHT Micro-Meridian and Gold Meridian Acupuncture have been developed since 1971. There are 14 micro-meridians and 404 corresponding acupuncture points in the hands. Gold meridians and acupuncture points are based on micro-meridians. Micro-meridians in the hands reflect the corresponding points of the body, but Gold Meridians in the body correspond to the micro-meridians of KHT. It is simple to learn and to practice without side effects. For Gold Meridian Therapy, only newly developed tools of KHT are used. I also present some important issues of usage of acupuncture in the view of Korean Hand Acupuncture. What are problems in application of acupuncture? What is the theory of acupuncture and role of acupuncture? What are diagnostic methods? What are therapeutic methods? How to study acupuncture?

P-61 GYNECOLOGY ONCOLOGY ALIMENTARY LENGTH OF STAY

Zena Kocher, Penny George Institute for Health and Healing, Abbott Northwestern Hospital; Sue Sendelbach, Abbott Northwestern Hospital; Jason Haupt, Allina Performance Resources This study, (Gynecology Oncology Alimentary Length of Stay (GOALS) was conducted at a major medical center in Minneapolis, Minnesota with an inpatient integrative therapies department.

Aims: A. Determine the difference in the length of hospitalization of women having surgery for known or suspected cervical, ovarian, and/or endometrial cancer versus usual care. (i.e., pre-intervention); B. The “bundle” approach to care includes early feeding (surgical soft dinner on the evening of surgery, increased protein), integrative therapies (acupuncture), epidural pain management, and education; C. Describe: 1. Quality of life; 2. Anxiety; 3. Knowledge, skills and self-management; and, 4. Pain, nausea, activity, time from removal of catheter to first void; D. Determine the difference between usual care and bundled care: a. Medical variables; b. Time to first ambulation; c. Time to bladder catheter discontinuation; d. Pain; e. Time to meals; f. Amount of opioid; g. Medication of nausea.

Methods:

• Study design

Analysis: Descriptive and comparative analyses were completed.

Results:

• A statistically significant 0.5 day improvement with the overall length of stay

Describe:

• Quality of life

Implications: Further analysis of data is planned to determine the specific effect of providing the integrative services, particularly the acupuncture. In this acute care real time setting, it is difficult to control for all of the confounding variables that influence patient outcomes.

P-62 HOW ARE AMERICANS USING ACUPUNCTURE? PATTERNS AND REASONS FOR USE: COMPARATIVE FINDINGS FROM NATIONAL HEALTH INTERVIEW SURVEY (NHIS) 2007 AND AN AOM TEACHING CLINIC

Dawn Upchurch, UCLA; Bethany Wexler Rainisch, California State University, Northridge; Deborah Ackerman, Oregon College of Oriental Medicine

Purpose: Researchers have articulated the need to move beyond the paradigm of experimental studies to more comprehensively characterize how acupuncture is used in the ‘real world.’ The goal of this study was to assess patterns of acupuncture use in a national sample and supplement these findings with more detailed, clinical outcomes data from a high-volume AOM clinic.

Methods: Data were from two separate sources. The 2007 NHIS (N=23,393), a cross-sectional, nationally representative sample of adults, was used to assess acupuncture user patterns (e.g., number of visits, cost, reasons for use, combined use with conventional medicine). Prospective clinical data (N=2,485), including patterns of use, were obtained from the teaching clinic at Oregon College of Oriental Medicine (OCOM). Patient oriented outcome measures (e.g., MYMOP and PROMIS) were also collected. Weighted univariate, bivariate, and multivariate analyses were performed to account for sample design and provide national estimates. OCOM analyses were unweighted.

Results: Nationally, 1.4% of Americans used acupuncture in the past 12 months. Mean number of visits was 2.3. 46.4% used acupuncture because conventional medicine did not help; 25.4% were recommended by conventional provider. The most common conditions treated were musculo-skeletal pain. Prospective clinical data from OCOM also showed musculo-skeletal pain as the most common conditions treated. Also, 4 years of data collection revealed 60% of new patients did not have a 5th visit. Global and physical health scores were 1 SD lower than the US average and pain interference ∼1 SD higher.

Conclusions: The chief complaint in both a national sample of acupuncture users and patients in AOM clinic pertained to musculo-skeletal pain. Moreover, in both samples, the number of visits was relatively small, suggesting a somewhat low ‘dose’ of acupuncture. Last, the findings demonstrate the utility of using multiple data sources to inform how acupuncture is actually used.

P-63 HOW DOES ACUPUNCTURE REGULATE THE MILIEU INTERNE OF HUMAN BODY

Wei-bo Zhang, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science; Yu-ying Tian, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science; Shu-yong Jia, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Science

Purpose: Acupuncture has been proven in clinic to have curative effects on many chronic diseases and stress related diseases. The mechanism remains to be answered.

Methods: Systematic analysis of experimental results, related clinic facts and modern biological knowledge.

Results: Many scientists agree that acupuncture can regulate milieu interne to homeostasis which can improve the function of cells, tissues and organs. Milieu interne is influenced by whole circulatory system containing vascular blood-lymph flow and non-vascular interstitial flow. Recent experiments showed that acupuncture can increase the blood perfusion. But this increasing is much smaller than the effects of moxibustion and cupping. What is the most impact of acupuncture? More recent experiments implied that acupuncture may influence the interstitial fluid flow through muscle system. One experiment showed that continuous muscle contraction induced by constant electric current can increase the hydraulic resistance of meridian channels. This result implied that stress related disease presented by a continuous, unconscious muscle contraction can cause a stasis of meridian channels. The interstitial flow will be reduced according to the Darcy's law for hydromechanics of interstitial fluid. This reduction will make milieu interne offsetting the homeostasis and cause a disease. The other experiment revealed that hydraulic resistance of meridian channels decreased after several minutes of acupuncture. Acupuncture can reduce muscle stress by tendon reflex which inhibited the activity of α motor neuron. The other mechanism concerns on the muscle-skeleton structure changes when increasing the stress of one muscle unit by positive feedback of α motor neuron during which swell feeling appears.

Conclusion: Acupuncture can change the milieu interne by regulating interstitial fluid flow through various neural-muscle reflections.

P-64 HOW EFFECTIVE ARE HINAISHIN NEEDLES AT KIDNEY 27 FOLLOWING A REGULAR ACUPUNCTURE TREATMENT IN THE TREATMENT OF MORNING SICKNESS?

Coleen Smith, Point of Origin PLLC

Research Question: How effective are hinaishin needles at Kidney 27 following a regular acupuncture treatment in the treatment of morning sickness?

Background: Morning sickness is a condition that 50–90% of women experience in varying degrees during their pregnancy. The current medicines help but there is no remedy. Women continue to suffer with nausea and vomiting and that lead to this case study research.

Methods: The embedded case study includes 4 patients over the span of 1 year. The data in the case study was compiled using multiple methods- questionnaires then direct and participatory observations.

Results: This paper may advance two insights: first, treating morning sickness with acupuncture is effective. Second, while valuing acupuncture and Chinese medicine the respondents experienced significant improvement with tiny imbedded skin needles at Kidney 27. The data will reveal that the hinaishin needle treatment had a more significant outcome than regular acupuncture treating morning sickness.

Conclusion: Hinaishin acupuncture is a Japanese approach and little to no research was available in English at the time of this study. The immediate and long-term relief resulting from the subcutaneous needle technique suggests that this area needs to be developed and more widely used. The implications of this case study propose an entirely new way of treating nausea during pregnancy and may help further the usefulness of acupuncture. Further studies could be done using Kidney 27 for all types of nausea and vomiting.

P-65 HOW EFFECTIVE IS AURICULAR ACUPUNCTURE FOR THE TREATMENT OF CERVICAL PAIN?

Wei Ling Huang; Ana Paula Huang

Introduction: Cervical pain (CP) is characterized by pain and hypersensitivity at different degrees, muscular tension and a heavy sensation of the neck. In Traditional Chinese Medicine (TCM) it is related to Cold-Wind that invades the meridians, Liver's Blood deficiency, hyperactivity of Kidney's Yang, Qi and/or Blood stagnation, internal accumulation of Cold, etc.

Aim: Retrospective investigation on Auricular Acupuncture (AA) patients with CP using a questionnaire to evaluate the effectiveness of AA treatment.

Methods: Over 1500 AA patient records analyzed: 23 (1.53%) selected (CP), Questionnaire by phone: main symptom, irradiation to superior members, male/female proportion, age, sessions for improvement, hospitalization, pain-control medication, previous treatment, previous x-ray exams, surgery, dietary restrictions, patient-evaluation, recommendation of AA.

Results: Main symptom: 23 (100%); Irradiation to superior members: 12 (52%) –Yes; 11 (48%) – No; Male/Female: 5 (22%) – M; 18 (78%) – F; Age: min. 21; max. 85; Improvement:

Session Patients %

Hospitalization: 23 (100%) – No; Medication: 9 (39%) – Yes; 14 (61%) – No; Previous treatment: 15 (65%) – Yes; 8 (35%) – No; Previous x-rays: 6 (26%) – Yes; 17 (74%) – No; Surgery: 23 (100%) – No; Dietary restrictions: 13 (57%) – Yes; 10 (43%) – No; Patient-evaluation: Excellent: 13 (57%); Good: 9 (39%); Regular: 0; Bad: 1 (4%); Recommendation of AA: 22 (96%) – Yes; 1 (4%) – No

Conclusions: Almost all patients recommended their AA treatment for CP and gave good or excellent evaluation. More than three quarters of the group were females. 10% felt improvement after the first session. Almost 80% improved after the first month of treatment. Three fifths had previous treatment and three quarters did not have any x-rays taken. More than half had not taken medication.

P-66 IMPROVEMENTS IN QUALITY OF LIFE IN ANXIOUS DEPRESSIVE SYNDROMES TREATED IN ACUPUNCTURE IN PITIGLIANO HOSPITAL CENTER OF INTEGRATED MEDICINE (TUSCANY - ITALY)

Cecilia Lucenti, Pitigliano Hospital Centre of Integrated Medicine; Franco Cracolici; Massimo Rinaldi; Roberto Pulcri; Rosaria Ferreri; Simonetta Bernardini

Improvements in Quality of life in anxious depressive syndromes treated in acupuncture in Pitigliano Hospital Center of Integrated Medicine In Europe, mental health issues account for nearly 20% of the total disease, affecting one in four persons during their lifetime. Half of those who suffer of depression is never treated, and even in countries with a developed health system 44–70% of those who suffer from mental illness is not subjected to any treatment. Among the ten countries with the highest suicide rates in the world, nine are located in Europe where the social cost of psychological diseases represents 3–4% in gross domestic product and about 20% of health expenditure. The specific investments on mental health are on average only 5.8% in government expenditures. Tuscany is among the top places in Italy for prescription anxiolytic and antidepressant drugs.Despite this often the services offered do not meet the necessity and requirements of patients and most countries recognize the need to introduce more advanced and more effective policies. The Hospital Centre of Integrated Medicine of Pitigliano (National Healtcare Service of Tuscany Region) is the first Public Italian facility providing acupuncture and homeopaty toward outpatients and inpatients. The overall approach to patient offered by traditional Chinese medicine and acupuncture allows a better interpretation of the disease and its energetics, organic, existential bases. Treatment with acupuncture permits better management of anxiety and exacerbations, a decrease in consumption of drugs and a better perception of health status. This paper reports the encouraging experience of the Public Hospital of Pitigliano evaluating the therapeutic results on anxiety, fatigue, gastrointestinal disorders.

P-67 INHIBITION OF NITRIC OXIDE SYNTHASE ATTENUATES CUTANEOUS VASODILATION DURING WARM MOXIBUSTION-LIKE THERMAL STIMULATION IN HUMANS

Kenichi Kimura, Department of Health Sciences, Kansai University of Health Sciences; Hayato Takeuchi, Department of Health Sciences, Kansai University of Health Sciences; Kuniko Yuri, Department of Health Sciences, Kansai University of Health Sciences; Ikuro Wakayama, Department of Health Sciences, Kansai University of Health Sciences

Objectives: This study investigated if nitric oxide (NO) and/or prostaglandin (PG) are responsible for cutaneous vasodilation during warm moxibustion-like thermal stimulation (WMTS).

Design: For two protocols, two microdialysis membranes were placed in the medial forearm skin. In the first protocol (n=8), the sites were randomly assigned and perfused with NG-nitro-L-arginine methyl ester hydrochloride (L-NAME), an NO synthase inhibitor or Ringer's solution (control site). Similarly, two microdialysis membranes were placed in the medial forearm skin in the second protocol (n=6). One site was perfused with ketorolac (Keto), the cyclo-oxygenase (COX) pathway inhibitor, and the other site was perfused with Ringer's solution (control site). In both protocols, cutaneous vasodilation was induced using WMTS with an electronic warm moxibustion treatment appliance. After 10 minutes of baseline recording, WMTS was applied to the forearm skin for 20 minutes and recovery was monitored over a period of 20 minutes. Skin blood flow (SkBF) at each site was measured using laser-Doppler flowmetry. Cutaneous vascular conductance (CVC) was calculated as laser-Doppler flux/mean arterial blood pressure (BP).

Settings/location: The study was conducted in a laboratory at the Kansai University of Health Sciences.

Subjects: The subjects were 14 healthy male volunteers. Interventions: WMTS was applied to the medial forearm skin using an electronic warm moxibustion treatment appliance.

Outcome measures: SkBF, skin temperature (Tsk), core body temperature (Tc), heart rate (HR), and BP were outcome measures.

Results: In the first protocol, peak CVC values during WMTS at the site perfused with L-NAME were significantly decreased, compared to those at the control site (p<0.05). In the second protocol, peak CVC values during WMTS did not differ between the control site and the Keto site (p>0.05).

Conclusions: These data demonstrate that NO is involved in the mechanism of cutaneous vasodilation induced by WMTS. Furthermore, increases in CVC despite inhibition of the COX pathway suggest that PG does not contribute to cutaneous vasodilation during WMTS.

P-68 INTEGRATIVE RESEARCH: USING MIXED METHODS APPROACH

Carla Wilson, American College of Traditional Chinese Medicine; Misha Cohen

Purpose: Anal cancer is a growing public health concern for immunocompromised people.The mainstay of customary treatment is based on ablative therapy particularly cold knife surgical removal and/or fulguration of the affected area. This research study is a phase II randomized blinded cancer integrative medicine Chinese herb efficacy trial for treatment of anal HSIL in HIV-positive people using both qualitative and quantitative methods.

Methods: This study is a 60-week, randomized placebo-controlled trial of a Chinese topical herbal medicine cream in 60 participants ( the University of California at San Francisco Cancer Research Center. Both qualitative and quantitative methods are used in the project. The Chinese traditional medicine diagnoses will be correlated with western-based bio-markers, and a qualitative survey instrument.

Results: In this study we are working to develop a model of interpreting HSIL, especially with HIV co-infection, according to Chinese traditional diagnoses in order to gain experience integrating Western and Eastern approaches. The inclusion of qualitative research methods will bring the lived experience of the research participants in to the analysis of the outcomes of this research project. While this is exploratory, it could lend credibility to the Chinese medicine paradigm and lead other CAM researchers to consider the use of blend qualitative and quantitative research methods.

Conclusion: All 60 research particpants have been recrutied and 52 have completed the study. Outome of the study have not been finalized but preliminarty results will be presented.

P-69 INTERN DELIVERED ACUPUNCTURE FOR PAIN MANAGEMENT: AN OBSERVATIONAL STUDY

Benjamin Marx, OCOM; Tom Brunagh, OCOM; Pam Johnson, OCOM; Jesse Liberty, OCOM; Grace Peters, OCOM; Jamie Varela, OCOM; Deborah Ackerman, OCOM

Background: There are 62 accredited AOM educational institutions currently in the US. Each institution maintains an intern teaching clinic delivering thousands of acupuncture treatments per year. Little has been published regarding patient characteristics and outcomes in these clinics. Since September 2009, the Oregon College of Oriental Medicine has utilized standardized data collection questionnaires to track patient outcomes in its intern clinic.

Objective: To investigate patient characteristics and outcomes of five consecutive acupuncture treatments for pain management in an intern clinic, and to analyze patient reported changes in medication use.

Methods: Demographic and outcomes data were analyzed on patients who received five consecutive acupuncture treatments at the OCOM intern clinic between November 2009 and September 2011 for musculoskeletal pain. On intake and at fifth visit, patients completed several questionnaires including the Measure Yourself Medical Outcome Profile (MYMOP) and the Patient Reported Outcomes Measurement Information System (PROMIS) Pain Severity Scale. The MYMOP asks patients to indicate their condition and score its severity on a seven point scale. The PROMIS assesses pain severity on a 0 to 10 scale.

Results: A total of 159 patients received five consecutive acupuncture treatments. The majority (108, 68%) were female. The mean age was 54 (SD=16.34). One hundred sixteen (74%) reported chronic pain (>3 months), while 40 (26%) reported acute pain. At fifth visit, MYMOP symptom scores decreased by a mean of 1.55 points (SD=1.67), and PROMIS Pain Severity Scores decreased by a mean of 1.91 points (SD=2.68). At visit one, 48 patients (30%) reported using medication for their condition. At fifth visit, 22 (46%) had discontinued medication, 11 (23%) reduced medication use, and 15 (31%) reported no change.

Conclusions: On average, patients who received at least 5 consecutive acupuncture treatments, report clinically important reductions in symptom scores, pain levels, and medication use.

P-70 IS AURICULAR ACUPUNCTURE EFFECTIVE IN THE TREATMENT OF HEADACHES?

Wei Ling Huang, Medical Acupuncture and Pain Clinic; Ana Paula Huang

Introduction: A headache or cephalalgia is pain anywhere in the region of the head or neck. According to Traditional Chinese Medicine (TCM), headaches can be caused by Liver energy disturbances but can also stem from Wind, Cold, Summer Heat, Humidity, Fire, Accumulation of Humidity and Mucous, and Blood stagnation.

Aim: A retrospective investigation of the effectiveness of Auricular Acupuncture (AA) on patients who had suffered from headaches. A questionnaire was used by phone: How many sessions were necessary to show relief from headaches using AA, How each patient evaluated the effectiveness of AA, History of hospitalization, Treatment before AA, Recommending AA, Felt cured or not.

Methods: Research of over 1500 patient records: 160 (10.66%) had headaches; 78 (48.75%) phone contact, A questionnaire was filled. How many AA sessions? How many sessions to notice improvement? How would you evaluate it? Hospitalization? Previous treatments? Would you recommend AA? Did you feel cured?

Results: Improvements: 5 (7.25%) after 1 session; 63.78% (44 patients) showed improvement in the first month of treatment. 19 (27.54%) after 2 sessions. 16 (23.19%) after 3. 4 (5.80%) after 4. 21 (30.43%) after more than 4. 4 (5.80%) felt no improvement. Their evaluation: Excellent/good: 65 (94.20%); Regular: 3 (4.35%); Unsatisfactory: 1 (1.45%); Hospitalization: Yes: 10 (14.49%); No: 59 (85.51%); Previous neurological treatment: Yes: 36 (52.17%); Recommending AA: Yes: 65 (94.20%); No: 4 (5.80%); Felt cured: Completely cured: 14 (20.29%); Not cured: 14 (20.29%); Significant improvement: 41 (59.42%)

Conclusions: Two thirds improved in the first month of treatment. One seventh had previous hospitalization, and more than half had previous neurological treatment. Four fifths of the patients felt completely cured or significant improvement. The majority of the patients in this study had improvement with AA treatment and evaluated their treatment as excellent or good, and recommended AA to others.

P-71 IS THE BASIC EMOTIONAL STRUCTURING TEST A VALID INSTRUMENT FOR EARLY IDENTIFICATION OF PROBLEMATIC COPING STYLES AND PSYCHOPATHOLOGY IN ELEMENTARY SCHOOL AGE CHILDREN?

Ineke van den Berg, Dept. Epidemiology Erasmus University MC, Rotterdam, The Netherlands; Marion Giesberts, Erasmus University MC, Rotterdam, The Netherlands

Background: Behavioral problems in elementary school age children are common. Not only the child, also fellow students, teachers and parents suffer discomfort because of these problems. Through early recognition and applying certain coping mechanisms, problem behaviors can be reduced, for instance by providing adjusted education. In practice, the diagnostic route for conditions such as ADHD and autism time-consuming, hindered by language skill problems, which causes impressive delays before children receive proper care and counseling. The Basic Emotional Structuring Test (BEST) is based on the TCM five-element system. This projective test, with ten colored dolls, is completed within minutes, and requires no language-related skills of child or parent. The main coping style can be diagnosed from two dolls, designated by the child.

Aim: To validate the BEST for diagnosing coping style, and to assess prevalence of defined coping styles in children of adapted education compared to children of regular education at elementary school level. Furthermore, the BEST-coping style will be compared with regular psychological tests at elementary school students of adapted education.

Method: Children with behavioral problems of a special educational school (C-SES) will be enrolled, and 100 children of a regular school (C-REG). Socio-demographic data of both groups will be recorded. The psychological diagnoses of the C-SES will be compared to the BEST coping styles.

Results: 100 C-SES and 100 C-REG students will enroll the study in October 2012. The preliminary results will be discussed. The results of a pilot study to test the feasibility and acceptability of the BEST were promising.

Concusion: In April we can show the conclusion of this validation study.

P-72 MANUAL AND ELECTROACUPUNCTURE FOR LABOUR PAIN. STUDY DESIGN OF A LONGITUDINAL RANDOMIZED CONTROLLED TRIAL

Linda Vixner, Karolinska Institutet, University of Dalarna; Erica Schytt, Karolinska Institutet; Lena Mårtensson, University of Skövde; Elisabet Stener Victorin, University of Gothenburg

Introduction: Results from previous acupuncture studies for labour pain are contradictory and lack important information on methodology. The sample sizes are in general small, information about the intervention such as needle placement, number of acupuncture points, type of stimulation, and duration of treatment, is often sparse or lacking However, studies indicate tha acupuncture has a positive effect on women's experiences of labour pain.

Aim: The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain. Our hypothesis is that acupuncture with manual or electrical stimulation is more effective than standard care in the relief of labor pain, and that acupuncture with electrical stimulation is the most effective.

Outcome measures: Primary outcome: Labour pain measured with visual analogue scale (VAS). Secondary outcomes are use of epidural analgesia, experience of relaxation, labour outcomes and infant outcomes. Biochemical markers of proinflammatory cytokines, memory of labour pain and overall childbirth experience.

Methods: The study was designed as a randomized controlled trial based on Western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. VAS was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. At the conference, information on the design of the study will be presented and the considerations of whether to use placebo controls or not will be discussed. ClinicalTrials.gov: NCT01197950

P-73 METHODOLOGY FOR CONDUCTING A MULTI-CENTER RANDOMIZED ACUPUNCTURE AND SHAM ACUPUNCTURE STUDY TO REDUCE AROMATASE INHIBITORS INDUCED ARTHRALGIA IN WOMEN WITH EARLY STAGE BREAST CANCER

Jillian Capodice, Columbia; Anne Jeffres, Columbia; Heather Greenlee, Columbia; Katherine Crew, Columbia; Danielle Awad, Columbia; Joseph Unger, Fred Hutchinson Cancer Research; Danica Lew, Fred Hutchinson Cancer Research; Jo Anne Hartline, Cancer Research And Biostatistics; Lisa Hansen, Legacy Health; Dawn Hershman, Columbia

Aromatase inhibitors (AIs) prolong breast cancer survival but often cause debilitating musculoskeletal pain and joint arthralgias leading to discontinuation of this life-extending treatment. Single center clinical trials have shown that acupuncture improves AI-induced joint arthralgias. The S1200 trial is a multi-center randomized blinded sham- and waitlist-controlled trial of a standardized and manualized full body and auricular acupuncture protocol to treat AI-related joint symptoms in women with early stage breast cancer (n=228). The trial is funded by NCI/NCCAM and will be conducted within SWOG, one of the NCI's cancer clinical trial cooperative groups. Briefly, postmenopausal women with a history of stage I-III breast cancer currently taking a third-generation AI, who report a worst pain of at least 5 out of 10, and who report that the pain has started or increased since initiating AIs, will be enrolled at pre-selected SWOG sites (n=7) with a minimum of two acupuncturists on staff. As the lead site, we have devised, tested and implemented methods specific to conducting a multi-center trial of acupuncture including 1) methods to create standardized true and sham acupuncture point protocols using expert opinion, clinical experience, and pilot data; 2) methods to train multiple acupuncturists at multiple sites using a combination of online training videos, slide presentations, testing and live centralized and onsite training; and 3) methods to blind participants and study staff to randomization assignment. These methodological and quality assurance issues, challenges and solutions will be presented.

P-74 MINDING THE GAP: USING PRINCIPLES OF PARTICIPATORY ACTION RESEARCH TO DEVELOP CLINICALLY ROBUST ACUPUNCTURE TREATMENT MANUALS FOR PRAGMATIC TRIALS

Claudia Citkovitz, Lutheran Medical Center, Brooklyn, NY; Belinda Anderson, Pacific College of Oriental Medicine, New York, NY; Kell Julliard, Lutheran Medical Center, Brooklyn, NY; Volker Scheid, University of Westminster, London, England

Manualization of acupuncture treatment aims to bridge the gap between research and clinical practice. However, manuals developed for efficacy trials by consensus as to best practice provide little flexibility and may lack clinical adequacy for conditions that are widely heterogenous or changeable in presentation. This paper presents a method of practice-based manual development that was used in labor and delivery and acute stroke rehabilitation. Manuals were developed for four studies at a community hospital between 2006 and 2012 (see Table 1). Development was conducted by a team of 3–6 acupuncturists with relevant experience, using principles of participatory action research (the practitioners undertake cyclic revision of their own practice based on experience). In a 3- to 12-month development period before each study, the manual evolved from a flexible exploratory document to a more standardized experimental manual, through practitioners cyclically observing and operationalizing their own clinical decision-making, and reassessing clinical adequacy in weekly meetings. The reassessment process itself evolved across projects, from informal talks to anonymous email surveys. Evaluation criteria included clinical validity of the manual's strategies and sense of constraint within its protocols, as well as ease of use and perceived effectiveness. Verbal self-evaluation conducted in early studies shows a steep decline in perceived effectiveness when a manual strongly associated with positive outcomes in a general population was used in a specific subgroup. After extensive revision, the manual is currently associated with high perceived effectiveness and positive early interim results. Acupuncturists' self-reported level of compliance with manual protocol appears to decrease when acupuncturists feel constrained by the protocol and when the manual is perceived as difficult to use. Practice-based manual development is a process of iterative revision based on self-assessment that may be useful in pragmatic trials, to improve protocol compliance and stabilize experimental exposure while maximizing treatment effect.

P-75 MUSCULOSKELETAL HIGH RESOLUTION ULTRASONOGRAPHY IN ACUPUNCTURE PRACTICE

Vinay Varma, Anand Pain Relief & Rehabilitation Institute; Anand Varma, Anand Pain Relief & Rehabilitation Institute; Shyamsunder Joshi, SDM College of Medical Sciences & Hospital

Introduction: High Resolution Ultrasonography (HRUSG) is a versatile imaging modality that allows real-time imaging of joint structures and may be used to complement clinical examination in musculoskeletal diseases and is more sensitive than clinical examination. Three decades of acupuncture practice has taught me to improve my simple acupuncture practice to Evidence Based Medical Acupuncture which led me into investigating pre and post acupuncture treatment HRUSG in knee and shoulder pains.

Aim: To study the effect of acupuncture in musculoskeletal disorders by HRUSG and to generate preliminary clinical evidence to support acupuncture in musculoskeletal disorders. Instilling an optimistic attitude amongst medical professionals and public was also intended.

Material and Methods: The study comprised of 60 patients of either gender presenting with knee & shoulder pain who were clinically examined and for whom HRUSG of the affected region was performed followed by acupuncture therapy supported by therapeutic exercises.

Clinical Results: Amongst the knee cases, 28 (56%) patients reported with good response (80 –100% pain relief). Satisfactory response (50% pain relief but less than 80%) was seen in 16 (32%) patients. Five (10%) patients demonstrated poor response (overall less than 50% pain relief). No improvement, i.e. failure was observed in 01 (02%) patient. HRUSG analysis of knee showed 35 cases with significant positive outcome, 10 cases with insignificant outcome and 04 cases showed a worsened picture. Positive clinical correlation was seen in 40 (80%) cases and no correlation in 10 (20%) cases. Similar encouraging results were found in shoulder cases also.

Conclusion: This study concludes that acupuncture induced changes in musculoskeletal disorders were radiographically documented in HRUSG with a positive clinical correlation. The frequent use of HRUSG in musculoskeletal disorders may be beneficial in exhibiting clinical changes following acupuncture therapy to boost confidence and should be employed in practice when indicated.

Keywords: Acupuncture, High resolution Ultrasonography (HRUSG), Musculoskeletal disorders

P-76 NEEDLE TORQUE TEST: A POTENTIAL TOOL FOR EXPLORING CONNECTIVE TISSUE CHARACTERISTICS IN HUMANS

Robert Davis, Stromatec, Inc.; Helene Langevin, University of Vermont; David Churchill, Stromatec, Inc.; Carrie Barron, Stromatec, Inc.; Gary Badger, University of Vermont; Chris Coulter, Stromatec, Inc.; Brian Gagne, Stromatec, Inc.

This study explored needle torque (measured by rotating an acupuncture needle in connective tissue, CT) as a biomarker for CT abnormalities. Test-retest reliability was estimated and variability measured across location, individuals, and groups. 165 subjects were tested: 99 healthy(CTL), 21 low back pain(LBP), 15 restricted hamstring(RHS), 15 joint hyperlaxity(HYPL), 15 scleroderma(SCL). Twelve sites on legs and back were located using ultrasound. Acupuncture needles were inserted (depth=30 mm), attached to an automated torque sensor, and rotated 1 rev/sec until 300 uNm or 20 rotations. Retests occurred 30-minutes and 1-week later. Primary outcome was torque at 3 revolutions. Torque was log transformed to normalize. Intraclass correlations (ICC) associated with repeated measurements were calculated at individual sites and for subjects' average across sites. ICC for subject's average torque repeated at 30 minutes was 0.78, ranging from 0.17 to 0.38 for individual sites. ICC for average torque repeated 1-week apart was 0.58. Needle torque can be reliably measured as a subject-specific characteristic when multiple measurements are made in one session. Needle Torque discriminated between CTL and SCL subjects (torque significantly higher) and RHS subjects (torque significantly lower), but did not discriminate LBP or HYPL subjects from CTLs. Decreased ICCs for average torque 1-week apart may be due to lower reliability or systemic factors (metabolic/hormonal fluctuations) which result in real heterogeneous changes in subjects over time. Group differences suggest average needle torque may be affected by stable CT characteristics (genetic factors, tissue composition). Further investigation may illuminate tissue or systemic characteristics that influence individual responses to acupuncture.

P-77 PARTICIPATING IN AN ACUPUNCTURE CLINICAL TRIAL FOR HOT FLASHES: PERSPECTIVES OF BREAST CANCER SURVIVORS

Jun Mao, Perelman School of Medicine at University of Pennsylvania; Elizabeth Mackenzie, University of Pennsylvania; Christina Seluzicki, University of Pennsylvania; Fran Barg, Perelman School of Medicine at University of Pennsylvania

Purpose: Evidence-based decisions about acupuncture use rests on outcomes of randomized clinical trials, but little is known about cancer patients' attitudes and beliefs about participating in clinical trials involving acupuncture. We conducted this study to understand how breast cancer survivors make decisions regarding participation in an acupuncture clinical trial for hot flashes.

Methods: 25 breast cancer survivors (12 African-Americans/13 Caucasian) were interviewed and verbatim transcripts were made. These transcripts were analyzed with NVivo software, and major recurring themes were identified. Multiple readers independently verified the results.

Results: Five major themes emerged: 1) symptom appraisal (e.g. determining if/when symptoms become bothersome enough to necessitate intervention), 2) practical barriers (e.g. distance, travel), 3) beliefs about the interventions (e.g. fear of needles, dislike of medications), 4) comfort with clinical trials (e.g. randomization, blinding, placebo), 5) trust and altruism. Breast cancer survivors weighed benefits and costs associated with the decision to participate in a clinical trial involving acupuncture. Symptom appraisal was weighed against practical barriers to determine whether the potential benefits outweighed the costs (in time and effort) involved. Women also reflected on the nature of the interventions. Some favored acupuncture due to concerns about taking additional medications; others favored medication due to their fear of needles and/or skepticism about acupuncture's effectiveness. Finally, women were more likely to express willingness to participate in a clinical trial if they had some understanding of the purpose of trial design (e.g. randomization, placebo, blinding); suspicions about placebo, blinding and randomization were barriers to participation. However, the presence of trust and altruism mitigated these concerns.

Conclusions: Breast cancer survivors expressed specific attitudes about perceived barriers and facilitators to participating in acupuncture research. Incorporating patients' perspectives in study design and recruitment strategies may facilitate conducting rigorous clinical trials of acupuncture t guide evidence-based care.

P-78 PATTERN DIFFERENTIATION FOR CHRONIC INSOMNIA IN TRADITIONAL CHINESE MEDICINE: AN INVESTIGATION INTO THE PREVAILING EPISTEMOLOGY

Michael Barr, Pacific College of Oriental Medicine; Steven Carrasco, UCLA School of Public Health; Kimberly Zimmerman, Loma Linda University Medical Center

Background: Traditional Chinese medicine invokes its application of individualized pattern differentiation as evidence of its greater sophistication and sensitivity vis-à-vis biomedicine with regard to diagnosis and treatment. In the case of pattern differentiation for the treatment of chronic insomnia, however, it has been noted that different institutions and curricula propose varying and oftentimes conflicting interpretations of insomnia symptoms.

Methods: Four commonly used textbooks in U.S. schools of Traditional Chinese medicine (Chinese Acupuncture and Moxibustion (Cheng), Foundations of Chinese Medicine (Maciocia), Herbal Formulas & Strategies (Bensky), Practical Therapeutics of TCM (Fischer)) were consulted for their respective interpretations of insomnia presentations commonly used for the purpose of pattern discrimination and diagnosis in Traditional Chinese medicine: trouble falling asleep (initial insomnia), restless sleep (nocturnal awakening), dream disturbed sleep (nocturnal awakening), early waking (matitudinal insomnia), and total insomnia. Findings were tabulated for ease of comparison.

Results: While overlap of the basic patterns was considerable among the texts consulted, causal relationships between any of the five clinical presentations and a proposed, corresponding TCM pattern identification varied considerably. Initial insomnia, for example, was variously attributed to Heart blood deficiency (Maciocia), Liver blood deficiency (Bensky), Heart and Spleen qi deficiency (CAM), and Kidney yin deficiency (Fischer). Matitudinal insomnia was explained to be a result of Gallbladder qi deficiency in the Maciocia text, Spleen qi deficiency in Fischer, and Liver blood deficiency in Bensky.

Conclusions: This analysis identified an inconsistency among commonly used Traditional Chinese medicine texts in the interpretation of various insomnia presentations and the subsequent attribution to a particular Zang Fu organ pathology. This incoherence is likely to confuse students and new practitioners alike and otherwise diminish or delay the probability of successful resolution of symptoms in patients. Implications for the use and misuse of both Chinese herbal formulas and acupuncture point prescriptions will be discussed.

P-79 PATTERNS OF ACUPUNCTURE LICENSURE IN THE UNITED STATES: GROWTH AND CHANGE 1976–2011

Tim Chapman, Oregon College of Oriental Medicine

Purpose: To survey patterns of growth in the supply of licensed acupuncturists in the USA over the period since the states began licensing practitioners in the mid-1970's.

Methods: Complete acupuncture practitioner licensing history on all individual ever-licensed practitioners was collected from the 23 US states that make this data publicly available. For each state included in the sample, individual licensure data were aggregated into year-by-year state-level statistics. Annual patterns of change in numbers of active licenses, per-capita supply of active licenses, and active license attrition, were calculated.

Results: For the 23 states in the sample, N=28,413 acupuncture licenses were issued from 1976 to 2011. By 2011 more than 70% of all ever-issued licenses (N=19,977) were still currently in active status. Growth in the number of active licenses was strongest in the 1980s and 1990's, with 12% annual growth rates not atypical. By 2000, practitioner supply was growing at 14% per year. Starting in 2000, growth began to slow conspicuously. Current 2011 data show an annual 2.8% rate of increase. Persistent variations exist among the sample states in per-capita supply of actively licensed practitioners, even after many years of legal licensure. Annual active license attrition rates are generally low (<3%), particularly in California.

Conclusions: The acupuncture profession has seen dramatic growth in the supply of licensed practitioners, with growth rates in excess of 12% per year for most of the first three decades after licensure was introduced. Growth slowed consistently over the past decade, but is nevertheless continuing. Lingering differences in per-capita practitioner supply exist among the sampled states, even after many years of available licensure. This pattern may suggest the existence of between-state variations in the acceptance of the medicine. Low annual active license attrition rates do not support the theory that the acupuncture profession sees conspicuously high turnover.

P-80 PERCEPTIONS OF ACUPUNCTURE STUDENTS IN RESEARCH METHODS COURSE REGARDING RESEARCH DEBATES

Sivarama Vinjamury, So Cal Univ of Hlth Sciences; Gina Hamilton, So Cal Univ of Hlth Sciences

Background: Research Methods is an essential course for all professional degrees including in Acupuncture programs. It is important that acupuncture students are taught “Research literacy” so that they are able to find, understand, and critically evaluate research evidence for application in professional practice. Recent survey of AOM students by Wayne et al (2010) indicates that self interest and importance of staying current with clinical research and perceived value of research to the AOM profession diminishes as the students progress through the programs. We adopted Research debates as an active learning tool to encourage students learn and retain research skills such as retrieving articles, critically appraising them, and applying the results of a study in a simulated clinical setting.

Purpose: To describe the perceptions of acupuncture students in Research Methods Course regarding an educational approach (Research Debates) that encourages active learning and helps comprehend the topics better.

Methods: An informal survey questionnaire was administered to all the students in the research methods course for three consecutive trimesters after the research debates at the end of the trimester. The students were asked to reflect anonymously on what they liked most about the debate project and what they learned from the project. Additionally, there were also asked to provide suggestions for improving the project.

Results and Conclusion: The debates helped promote greater student-faculty and student-student interaction and discussions on the topics and research methodologies. Based on the student involvement and the qualitative feedback, the research debates appear to motivate the students and make them understand the value of research literacy. The following feedback from a student summarizes the general perception among students –“The debates consolidated for me what I learned in the rest of the class. Very useful, both listening and giving them and coming up with questions etc. Grueling and great activity.”

P-81 PRIMARY HYPERTENSION TREATMENT USING PLUM BLOSSOM NEEDLE HAMMER THERAPY

Frank Yurasek, AOM Chair, NUHS; Brett Martin, Instructor, NUHS

The purpose of this study is to evaluate the efficacy of seven star plumb blossom needle hammer therapy on a patient with primary hypertension.

Method: A disposible seven star plum blossom needle hammer was used to stimulate specific acupunctue points twice a week for 6 weeks. A sphygmomanometer was used to evaluate the patient's blood pressure before and after each treatment. The patient's blood pressure was also monitored at home by a nurse for the 6 week treatment duration, and then monitored for 19 days following treatment.

Results: Blood pressure values changes were variable throughout the 6 week treatment period. However, a majority of the time a reduction of both systolic and diastolic blood pressure was observed after treatment. The most drastic changes can be seen in the decrease of systolic blood pressure, with the average before the start of treatment being 141.1 mmHg, and the average at the end of the course of treatment being 128.9 mmHg. The therapy did not have a remarkable affect on diastolic blood pressure, with the average drop following treatment being 6 mmHg.

The seven star plum blossom needle therapy may be an effective alternative treatment for primary hypertension. Throughout the study, the blood pressure became more stable and consistent. Although the patient's blood pressure was not below prehypertensive values until the end of the therapeutic period, it was in predominantly normal values during the follow-up period.

P-82 PROGRESS OF BRAZILIAN ACUPUNCTURE RESEARCH OVER THE TWO PAST DECADES: A BIBLIOMETRIC ANALYSIS

Ari Ojeda Ocampo Moré, UFSC; Shih Min Li, UFSC; João Bosco Guerreiro da Silva, FAMERP; Charles Dalcanale Tesser, UFSC

Acupuncture research has been the subject of increasing interest in the past two decades in Brazil. Considering that scientific publications are valuable markers of research activity, this study was designed to evaluate the scientific output of acupuncture-related publications written by Brazilian authors. The analyzed data was retrieved from the online version of Science Citation Index Expanded (SCI-E) database. The keywords “electroacupuncture” or “electro-acupuncture” or “acupoint*”, “acupunctur*” or “percutaneous electrical nerve stimulation” were searched in the SCI-E from 1991 to 2011. In addition, to analyze the Brazilian publication outputs the country/territory “filter” was added to the search strategy. Documents were assessed by distribution of document types, times cited, journals, subject categories, source countries and source institutes. Results showed that Brazil, with 151 acupuncture-related publications, is in the twelfth position in the rank of the world's top 20 producing countries. Moreover it is the only Latin American country present in that rank. The average of citation Brazilian documents was 4.84 per document. Article is the most common document type, comprises 111 (73.5%) of the total production and was followed by reviews (9.2%), meeting abstracts (8.3%) letters (7.2%) and editorial materials (1.3%). The main subject categories of Brazilian acupuncture publication were integrative & complementary medicine (21%), clinical neurology (16%) and neurosciences (15%). Acupuncture in Medicine and Journal of Alternative and Complementary Medicine are the two leading journals in number of Brazilian acupuncture-related documents. Universidade de São Paulo and Universidade Federal de São Paulo are the most productive universities in number of acupuncture publications. The six most cited articles include four systematic reviews, one randomized control trial and one basic science study. Taken together these data demonstrate the performance of acupuncture research in Brazil over the past two decades and the contributions of the Brazilian authors to the global acupuncture research community.

P-83 REGULATION OF CEREBRAL REGIONAL HOMOGENEITY EXERTED BY PUNCTURING HAO-YANG ACUPOINTS FOR MIGRAINE PATIENTS

Lei Lan, Chengdu University of Traditional Chinese Medicine; Fan-rong Liang, Chengdu University of Traditional Chinese Medicine

Aims: To investigate central mechanisms of acupoint specificity by puncturing Shao-yang acupoints for migraineurs.

Methods: 13 migraine patients were enrolled. The experiment duration was 8 weeks. Week 1 to 4 was baseline. Week 5 to 8 was treatment period, in which GB40 (Qiu-xu), SJ5 (Wai-guan) and GB34 (Yang Ling-quan) were punctured five times per week, totally 20 times. Functional magnetic resonance imaging (fMRI) and efficacy assessment (days off work, pain intensity, average headache duration and the Migraine-Specific Questionnaire (MSQ)) were performed respectively before and after acupuncture treatment. Regional homogeneity (ReHo) analysis was applied to detect central responses of migraineurs by puncturing Shao-yang acupoints.

Results: After the treatment, days off work, pain intensity, and average headache duration and MSQ were all improved with a statistic significance (p<0.05). Regions with increased regional consistency after the treatment: left insula, left amygdale, left hippocampus, left superior temporal cortex, left inferior temporal gyus, left superior parietal lobule, left caudate. Regions with decreased regional consistency after the treatment: bilateral precuneus, bilateral cerebella, bilateral orbital gyri, left supramarginal gyrus, right temporal pole, right posterior cingulate cortex and right middle cingulate cortex. After acupuncture treatment, ReHo value of bilateral cerebella (r=0.567, p=0.043), bilateral gyri orbitales (r=0.595, p=0.032) and bilateral posterior cingulate cortex(r=0.582, p=0.037) were all positively correlated with days off work due to headache.

Conclusions: Puncturing acupoints along Shaoyang meridians could improve days off work due to headache, pain intensity, average headache duration and MSQ (p<0.05), indicating acupuncture is effective in improving migraine symptoms. And acupuncture works due to its regulation of homogeneity of pain-related cerebral regions.

P-84 RESEARCH ABOUT THE EXPRESSION OF BDNF, SYN IN FMR1 GENE KNOCKOUT MOUSE HIPPOCAMPAL BY ACUPUNCTURE DU1

Wu Qiang, 86-059122861866; Han Ping, 86-059122861866; Lin Dong, 86-059122861889

Objectives: The study of expression of upstream activator BDNF, downstream synaptophysin illustrates the mechanisms of plasticity on Fmr1 knocking out mice synapse by puncturing, and provides theoretical basis for mechanisms of modifying cognitive function of mental retardated children by puncturing Chang qiang point.

Methods: We Select the age of 28-day FMR1 knockout mice (KO) and wild type (WT) mice, each were 30, which were divided into 6 groups : KO Chang Qiang group、KO Non-Point group、KO cntrol group、WT Chang Qiang group、WT Non-Point group、WT control group, each are 10. Continuous intervention on them lasted 6 days, and the brains were removed on the 7^th day, and detected the expression of BDNF and the SYN protein by immunohistochemical methods in mouse hippocampus region. BDNF are observed under a microscope.

Results: The expression of BDNF positive cells is mainly in the part of nucleus and membrane. The expression of BDNF of FMR1 knockout mice in hippocampus were lower than Wild-type mice, there are significant difference (P<0.05) in statistical comparison. The expression of BDNF FMR1 knockout mice in Chang Qiang group was significantly higher than Non-acupoint group and the control group, and there are statistically significant difference (P<0.05).The expression of SYN positive cells is mainly in the cytoplasm and intercellular space. The expression of SYN of FMR1 knockout mice in hippocampus were lower than Wild-type mice.

Conclusion: The expression of BDNF and SYN in brain were regulated positively by FMRP in normal circumstances. The acupuncturing the point of Chang Qiang may improve the hippocampus BDNF and SYN of FMR1 knock out mice.

P-85 SCALP ELECTROACUPUNCTURE IN STROKE REHABILITATION RESEARCH : FMRI METHODOLOGICAL ISSUES AND SOLUTIONS

Kathleen Lumiere, Bastyr University; Bensheng Qiu, University of Washington; Leanna Standish, Bastyr University

This presentation focuses on the challenges of evaluating the effects of scalp electroacupuncture for stroke rehabilitation using fMRI. Scalp electroacupuncture is a common form of treatment in TCM (Traditional Chinese Medicine) stroke rehabilitation, with demonstrated efficacy in clinical trials. To date, fMRI studies of stroke and electroacupuncture have focused on distal points, as opposed to scalp acupuncture points, in regard to hemodynamic brain function. A major challenge presenting scalp acupuncture research is material. Magnetic substances such as ferrous metals produce distort magnetic signaling and can produce heat, a significant safety issue. Non-ferrous metals such as gold and copper have been approved for use in fMRI, however, gold and copper are soft metals and extremely difficult to manipulate. An austentistic (non-ferrous) needle has been developed in China for MR research purposes with the collaboration of Dr. Qiu at the University of Washington's Biomedical Imaging Center. Austentistic needles can be safely used in this study. Insulated solid copper wire would be used to conduct the electrical impulse to the needles. Copper has been demonstrated to be safe with fMRI technology. The issue of clips would be eliminated by wrapping the copper wire around the needle handle, then securing it with electrical tape. The electroacupuncture machine itself would be outside the MR room, in the control area, beyond the range of the magnetic bore. Other challenges with such research would be addressed by the proposed study design. An fMRI study of short- and long-term effects of scalp electroacupuncture is significant because it more closely mimics effective TCM stroke rehabilitation clinical practice than many research protocols to date. fMRI allows investigation of mechanisms of action of for scalp electroacupuncture including neurological response to a specific electrical frequency, and the effects on localized perfusion and blood flow in the damaged motor cortex.

P-86 SEROTONERGIC CHANGES AFTER CUPUNCTURE STIMULATION IN THE PREFRONTAL CORTEX OF MATERNALLY-SEPARATED RAT PUPS

Seung-Tae Kim, School of Korean Medicine, Pusan National University; Sunoh Kwon, Acupuncture & Meridian Science Research Center, Kyung Hee University; Dae-Hyun Hahm, Acupuncture & Meridian Science Research Center, Kyung Hee University; Hi-Joon Park, Acupuncture & Meridian Science Research Center, Kyung Hee University; Hyejung Lee, Acupuncture & Meridian Science Research Center, Kyung Hee University

The present study investigated a possible role of acupuncture in alleviating depression-like behavioral changes and regulating serotonin signaling in the prefrontal cortex (PFC) of maternally-separated rat pups. On postnatal day 15, rat pups were maternally-separated and received acupuncture stimulation at acupoint HT7 or ST36 once a day for 7 days. On postnatal day 21, the tail suspension test was performed and the PFC was harvested. Tissue levels of serotonin (5-HT) and 5-hydroxyindole-3-acetic acid (5-HIAA) were then measured by high performance liquid chromatography analysis and the expressions of serotonin transporter (5-HTT) and brain-derived neurotrophic factor (BDNF) were assessed by Western blotting. The levels of 5-HT and 5-HIAA were not significantly changed, but 5-HIAA/5-HT ratio was significantly increased by maternal separation. The immobility time of maternally-separated rat pups was increased, and increased 5-HTT expression and decreased BDNF level were observed in the PFC. But acupuncture stimulation at HT7 alleviated the behavioral change and regulated the changes of 5-HIAA/5-HT ratio, 5-HTT and BDNF. In conclusion, acupuncture stimulation at HT7 can relieve the maternal separation-induced changes, and we propose that the regulations of 5-HIAA/5-HT ratio and 5-HTT expression by acupuncture stimulation play an important role in the acupuncture-induced benefits in this animal model of depression.

P-87 SIMPLIFIED MODEL FOR MEASURING HEAT STIMULATION OF MOXIBUSTION AND HEAT STIMULATION OF COMMERCIAL INDIRECT MOXA

O Sang Kwon; Seong Jin Cho; Kwang Ho Choi; Sun Hee Yeon; Sae Bhom Lee; Sang Hoon Lee; Sun Mi Choi; Yeon Hee Ryu

Objective: Moxibustion treatment uses heat stimulation and chemical stimulation. Heat stimulation is mainly heternined by heat temperature and heating duration. In due here stimulation can remoke thermal injury and insufficient heat stimulation does not effectable.

Methods: We build a simple model for measuring heat stimulation (MMHS) of moxibustion by using specific heat, density of 3% agarose gel and human skin. Six brands of commercial indirect moxa has used to measure character of heat stimulation

Result: With the MMHS, we could calculate human skin temperature, quantity of effective heat stimulation and safety from thermal injury.

Conclusion: We made a simple heat measuring model for moxibustion and measured character of heat stimulation of six commercial indirect moxa, and has a measuring as a first heat measuring model for moxibustion. It is expected that this model could easily measure quantity of heat stimulation without using animal model. Model made by this study does not considering blood perfusion and it should be included for accurate result.

P-88 SIX-MOVEMENT TAI CHI REHABILITATION FORM FOR COMMUNITY-BASED PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Kun Shi, Xiangya Medical College, Central South University, P.R.China; Jin Yan, Third Xiangya Hospital, Central South University, P.R.China

Objectives: Evaluate the effectiveness of a 12-week program involving the modified 6-movement Tai Chi form for community-based stable COPD patients by measuring exercise capacity, pulmonary function, dyspnoea and quality of life.

Methods: A quasi-experimental design was used. 20 patients were recruited from July 2011 to October 2011. Participants were assigned to one of 2 groups: The Tai Chi group (Experimental group; n=10), which received modified Tai Chi training 3 times each week, 50 minutes per session, for a total of 12 weeks from October 2011 to January 2012; and the control group (Control group; n=10), which received usual care for the same period of time.

Results: There were 10 patients in each group. There were no statistically significant differences between two groups regarding sex, age, smoking status, education level, family income, daily activity, occupation, or medical expense payment, nor were there any statistically significant differences between the baseline data of exercise capacity, pulmonary function, dyspnea, or quality of life between the two groups. After the 12-week intervention, the Tai Chi group's 6MWT, FEV1, FVC, VC and CAT scores were significantly improved compared to baseline. In the control group, the 6MWT, CAT score and BODE were significantly worsened after 12 weeks when compared to baseline. Comparing the changes from baseline to 12-week evaluation in each group showed significant differences between the two groups in 6MWT, FEV1, FVC and CAT score, but the differences in FEV1/FVC, VC, MVV, mMRC and BODE were not significant.

Conclusions: The 6-movement Tai Chi Rehabilitation form can improve exercise capacity, pulmonary function and quality of life among COPD patients. The 6-movement Tai Chi Rehabilitation form exercise is an effective rehabilitation exercise for COPD patients. The authors would like to replicate the study in a larger study to confirm the findings.

P-89 TEACHING ACUPUNCTURE: THE BRAZILIAN MEDICAL RESIDENCY PROGRAMME

Jéssica Maria Costi, Hospital Geral de São José, São José, Santa Catarina, Brazil; João Bosco G. Silva, Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil; Li Shih Min, Universidade Federal de Santa Catarina, Florianópolis, Brazil; Ari O. O. Moré, Universidade Federal de Santa Catarina, Florianópolis, Brazil; André Luis Hokama, Rio Preto Medical School, São José do Rio Preto, São Paulo, Brazil

Acupuncture has had a successful story in Brazil. With its use in the public health system supported by legislation since 1988, its recognition as a medical specialty in 1995 enabled the introduction of an annual board examination and the creation of an official Medical Residency Programme. Since then, medical acupuncture has developed considerably, mostly through its massive spread into the Brazilian public health system. Brazil is the only country outside China that has created a Medical Residency Programme on Acupuncture. The 2-year programme consists of 5760 training hours, beginning with major clinical areas (internal medicine, neurology, orthopaedics and gynaecology) during 24 weeks in the first year. The residents study and practice acupuncture using the traditional Chinese Medicine approach and also the biomedical model. Specialists educated by this programme are therefore expected to have an optimum knowledge of both Western and Eastern medicine. Since it was first created, nine public health institutions have adopted the residency programme on acupuncture so, rather than being an alternative therapy, acupuncture has become an easily accessible and well-accepted conventional medical resource in Brazil.

P-90 TEMPERATURE CHARACTERISTICS OF MOXIBUSTION WITH WARMING NEEDLES MADE OF DIFFERENT MATERIALS

Ke Cheng, Shanghai University of Traditional Chinese Medicine, Acupuncture-moxibustion and Tuina College; Shanghai Research Center for Acupuncture and Meridians; Jianzi Wei, Shanghai University of Traditional Chinese Medicine, Acupuncture-moxibustion and Tuina College; Xueyong Shen, Shanghai University of Traditional Chinese Medicine, Acupuncture-moxibustion and Tuina College; Shanghai Research Center for Acupuncture and Meridians

Purpose: To observe the temperature characteristics of moxibustion with warming needle of different materials at acupoint and the response of the subjects.

Methods: 10 healthy volunteers were recruited. Three kinds of needle including stainless steel needle, gold needle and silver needle with two different weights of moxa (1.2 g and 1.5 g) were used. The temperature at the acupoint where needle penetrate the skin was recorded with a digital thermometer. During the experiment, the heat pain threshold and the heat pain tolerance were recorded according to the response of subjects. The sense of comfort, sense of hotness, side effects and the acceptance of the moxibustion were surveyed after the experiment.

Results: moxibustion with silver needle (moxa of 1.5 g) produced the warmest and the longest stimulation. Next to silver needle (moxa of 1.5 g) is in turn moxibustion with silver needle (moxa of 1.2 g), gold needle (moxa of 1.5 g) and stainless steel needle (moxa of 1.5 g). Subjects could tolerate moxibustion with stainless steel needle and gold needle, while 30% of subjects felt too hot to tolerate two kinds moxibustion with silver needle. There was no side effect after moxibustion with stainless steel needle and gold needle. 40% and 90% subjects got mild burn after two kinds of moxibustion with silver needle (moxa of 1.2 g and 1.5 g) respectively. Moxibustion with stainless steel needle, gold needle and silver needle (moxa of 1.2 g) were accepted by all subjects, while moxibustion with silver needle (moxa of 1.5 g) were accepted by 70% of the subjects. All subjects accepted the side effect of mild burn at surface if in treatment.

Conclusion: Moxibustion with silver needle (moxa of low dose) could produce enough warm stimulation and would not cause apparent side effects and discomfort. In clinic, it's still necessary to inform the patients about the possible side effects before treatment.

P-91 THE ACUPUNCTURE THERAPY OF CHILDHOOD AUTISM (REVIEW)

Yi-wen Li, Neuroscience Research Institute, Peking University; Rong Zhang, Neuroscience Research Institute, Peking University

With the development of autism therapy, acupuncture is becoming popular among patients as an alternative therapy. There are 31 papers about acupuncture therapy of autism so far. The review summarized the most relational papers, introduced the traditional medicine basis and history of acupuncture therapy of autism and compare methods and effectiveness of this therapy. It is suggested that acupuncture is a relatively effective therapy for autistic children, which has positive role in improving autistic syndromes especially in language development, self-life day care, social communications and without any side-effect. Although there are lots of questions to be answered in this rather new therapy, we hold the positive opinion that acupuncture therapy might be a green therapy for autistic children in future.

P-92 THE ANTI-DEPRESSIVE MECHANISM OF ELECTROACUPUNCTURE (EA) ON THE RAS-MEK-ERK SIGNAL PATHWAY

Xinjing Yang, Beijing University of Chinese Medicine; Jia Liang, Beijing University of Chinese Medicine; Linlin Sun, Beijing University of Chinese Medicine; Zhuo Guo, Beijing University of Chinese Medicine; Sihan Wang, Beijing University of Chinese Medicine; Huifang Ma, Beijing University of Chinese Medicine; Fengxian Meng, Dongfang Hospital, the second clinical medical college of Beijing University of Chinese Medicine; Xiaotian He, Division of Traditional Chinese Medicine, Sanlitun Community Health Service Center; Chao Liu, University of Macau, Institute of Chinese Medicine Science; YI SAK LEE, Beijing University of Chinese Medicine; YOUNGJUNG IHM, Beijing University of Chinese Medicine; Wuye Bao, Beijing University of Chinese Medicine; Tuya

Purpose: Electroacupuncture (EA) has been reported to be effective for treating depression. The purpose of the present study was to explore the mechanisms of EA's actions on the Ras-MEK-ERK signaling pathway, which is known to be associated with depressive disorders.

Methods: A rat model of depression induced by chronic stress was established by alternating the following methods, water-break (24h), night light (12h), swimming (4°C, 5 min), shaking (30 min), and bounding (3h), every day for four weeks. Rats were randomly divided into five groups (n=10 each): normal, normal+EA, model, model+EA, and model+paroxetine. EA was given at acupoints Baihui (Du 20), Yintang (Extra) and Neiguan (PC6) for ten minutes (2/100 Hz alternating, 0.2 mA) every other day for four weeks. The rats were decapitated and brain tissues were collected following the four-week treatment. Because ERK1/2 phosphorylation is a key indicator of activation of the signaling pathway, the hippocampus and prefrontal cortex were isolated for p-ERK1/2 content assay using western blot.

Results: Compared to the normal group, p-ERK1 significantly decreased in the model group (P<0.01) in the hippocampus and prefrontal cortex. Compared to the model and paroxetine groups, the EA group showed significantly increased p-ERK1 (P<0.05). Similarly, p-ERK2 levels were lower in the model group compared to normal rats (p<0.01). P-ERK2 increased in the EA and paroxetine groups compared to the model group (P<0.01) and in the EA group compared to the paroxetine group (P<0.01).

Conclusions: Acupuncture had no effect on ERK phosphorylation in normal animals. However, in depression, acupuncture appears to have raised levels of phosphorylated ERK1/2 protein kinase. These data suggest that acupuncture might act on depression by stimulating the Ras-MAPK-ERK pathway and expanding protein expression of BDNF to protect the neurons.

P-93 THE COMBINING ACUPUNCTURE AND PAROXETINE TO TREAT DEPRESSION

Sihan Wang, Beijing University of Chinese Medicine; Xuehong Ma, Beijing University of Chinese Medicine; Yuanzheng Wang, Beijing University of Chinese Medicine; Zhuo Guo, Beijing University of Chinese Medicine; Xinjing Yang, Beijing University of Chinese Medicine; Linlin Sun, Beijing University of Chinese Medicine; Ya Tu, Beijing University of Chinese Medicine

Purpose: To compare the efficacy of acupuncture plus paroxetine with paroxetine alone in treating depression.

Methods: A large sample, multi-centred, randomized controlled clinical trial was performed. In four clinical centres, patients with depression (n=477) were randomly divided into three groups: EA and paroxetine (n=161), MA and paroxetine (n=162), paroxetine (n=154). EA and MA were given for 30 minutes every other day for six weeks; 10 mg/day of paroxetine was given for the first two days, 20 mg/day from the third day onward. Outcome was assessed with HAMD at baseline and week 1, 2, 4, and 6. Side effects were assessed with SERS at baseline and week 2, 4, and 6. The WHOQOL-BREF scale on quality of life was given at baseline and week 6. Four weeks after the end of treatment, participants were reassessed with HAMD.

Results: There was no difference among the three groups at baseline (p>0.05). In the two acupuncture plus paroxetine groups, HAMD scores improved significantly greater than those in the paroxetine group (p<0.05); no significant difference was found between the two acupuncture groups (p>0.05). In HAMD scores, significant differences from baseline appeared in the two acupuncture groups after the 1st week of treatment (p<0.01); while after the 2nd week in the paroxetine group (p<0.01). It indicates that acupuncture may have a faster treatment effect. SERS scores in the acupuncture groups were significantly lower than those in paroxetine group at weeks 2, 4, and 6 (p<0.05). WHOQOL-BREF scores for total subjective feelings regarding quality of life and health were significantly higher in the two acupuncture groups than those in paroxetine group (p<0.05).

Conclusions: Acupuncture plus paroxetine was more effective for patients with depression than paroxetine. The two groups given the combined therapy experienced earlier treatment effects, fewer side effects, and better quality of life.

P-94 THE DYNAMICS OF DEVELOPING OF A GROUP ACUPUNCTURE MODEL IN A HOSPITAL BASED JOINT REPLACEMENT CENTER

Cynthia Miller, Penny George Institute for Health and Healing, Abbott Northwestern Hospital; Pamela Weiss-Farnan, Penny George Institute, Abbott Northwestern Hospital

Purpose: To discuss the operational dynamics of providing group acupuncture treatment for joint replacement patients in an acute care setting.

Methods: In a large Midwestern hospital, group physical therapy is provided to joint replacement patients. Orthopedic surgeons added acupuncture to the standard post-operative care provided through the specialized nursing unit, the Joint Replacement Center (JRC). Acupuncture is introduced in the pre-hospital class for surgery preparation and provided immediately after physical therapy on post-operative days one two and three. Multiple factors affect the success of this program.

Results: Between 1/1/2010 and 12/31/2011, 1321 patients were provided acupuncture. This accounts for 67.5% of the patients who had surgery during this period of time. This is a higher proportion of adults who have had acupuncture compared to the general public (which is approximately 9 %).

Discussion: The addition of acupuncture to the JRC model of delivery is a distinguishing characteristic of the services provided by this Midwestern hospital that competes with other hospitals to provide joint replacement surgery, making it unique among the community options. Coordination of multiple hospital departments and services as well as enlisting support and commitment is required to provide this service effectively. Data are being collected about the effectiveness of acupuncture on pain and nausea control as well as patient satisfaction with their care. Patient satisfaction scores are becoming increasingly important in the health care industry with the ongoing changes in reimbursement methods.

Conclusions: Group acupuncture can improve the patient experience and can be developed with coordination of multiple stakeholders including physicians, nursing, physical therapy, support staff and administration. It provides the patient with an initial positive experience of acupuncture and motivates ongoing interest in continuing in the care of an acupuncturist.

P-95 THE EFFECT OF ACUPUNCTURE ON WORKING MEMORY AND ANXIETY

Jason Bussell, Guangzhou University of Chinese Medicine

Context: Memory is an area that everyone would like to improve. Anxiety has been shown to impair memory and acupuncture has been shown to reduce anxiety.

Objective: To investigate whether acupuncture can improve memory and reduce anxiety in healthy subjects and, if so, whether those effects are correlated.

Design, Setting and Subjects: A two-group, randomized, single-blind study (Jan to Dec of 2011) involving 90 healthy undergraduate students recruited from local universities and treated at private acupuncture clinics in the Chicagoland area. Interventions: All subjects completed the State-Trait Anxiety Inventory (STAI) form Y-1 (State Anxiety, SA) and Y-2 (Trait Anxiety, TA). Then all subjects were laid on a treatment table for 20 minutes. Subjects randomized to the Acupuncture group had needles inserted into Sishencong, Shenting (Du24), Yintang, Neiguan (PC6), Shenmen (Ht7), and Taixi (Kd3). Subjects randomized to the Control group had the same points touched and swabbed with alcohol but not needled. After the 20 minutes, all subjects completed the STAI form Y-1 again. All subjects then completed the Automated Operation Span Task (AOSPAN)- a computerized test of working memory.

Main outcome measures: Performance on the AOSPAN and STAI scores.

Results: Acupuncture group scored 9.5% higher than Control (65.39 vs. 59.9, raising percentage correct to 87.2% vs. 79.6%, p=0.0134) on the AOSPAN Total Correct Score, and committed 36% fewer math error (2.68 vs. 4.22, p=0.0153). Subjects who received acupuncture also reported lower SA after intervention than control (26.14 vs. 29.63, p=0.0146). Regression analysis showed no correlation between AOSPAN score SA.

Conclusion: Acupuncture improves performance on a test of working memory and reduces anxiety, but those effects are not correlated.

Clinical Trial Registry: Clinicaltrial.gov ID=NCT01492738.

P-96 THE EFFECT OF LOW FREQUENCY ELECTRICAL STIMULATION AT BL62·KI6 ON P300 ACTIVITY IN MIDDLE AGED MEN AND WOMEN

Kwang-Ho Choi, Korea Institute of Oriental Medicine; Min Yoo, Korea Institute of Oriental Medicine; Seong Jin Cho, Korea Institute of Oriental Medicine; O Sang Kwon, Korea Institute of Oriental Medicine; Sanghun Lee, Korea Institute of Oriental Medicine; Sun Hee Yeon, Korea Institute of Oriental Medicine; Sun-Mi Choi, Korea Institute of Oriental Medicine; Yeonhee Ryu, Korea Institute of Oriental Medicine

Objectives: The aim of this study is to investigate the effects of constant low frequency electrical stimulation applied to BL62·KI6 on brain activity by analyzing P300 and slow alpha wave.

Methods: The study was done as a double-blind test to 55 subjects of 26 males and 29 females in their 50's and it lasted for a month with 12 sessions. In each session, on average of 24μA, 2Hz low frequency electrical stimulation was applied to BL62·KI6 and background quantitative electroencephalography (QEEG) and Event related potentials (ERPs) were measured before the first session and after the last session of the electrical stimulation.

Results: The result of chi-square test indicated that double-blind test was done correctly. Compared to the sham group, the real group showed the tendency of decreasing P300 latency and increasing P300 amplitude after all 12 sessions of the low frequency electrical stimulation in all subjects. In women the amplitude significantly increased at Fz, Fcz, Cz, Cpz and Pz and Slow alpha mean frequency significantly increased at Fz, Fcz and Pz.

Conclusion: Electrical stimulation applied to BL62·KI6 induces the activation of P300 amplitude in more male subjects than in female subjects. Further study is necessary to investigate the effects of electrical stimulation in different ages and sexes and to discover the underlying mechanisms responsible for the enhancement of P300 amplitude.

P-97 THE EFFECTIVENESS OF EARLY INTERVENTION FOR TREATMENT COMMUNITY RESIDENTS WITH DEPRESSION

Zhuo Guo, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Xueqin Yang, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Sihan Wang, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Xinjing Yang, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Linlin Sun, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Danmei Zhang, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Chen Hu, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina; Ya Tu, Beijing University of Chinese Medicine School of Acupuncture-Moxibustion and Tuina

Purpose: Apply early intervention to depressed residents of convenient treatment; compare acupuncture, psychology (Cognitive Behavioral Therapy, CBT), and combined methods for efficacy in improving depressive state and quality of life; analyze the features and advantages of acupuncture and psychological treatments for depression.

Methods: Community residents (n=650) were studied between Nov. 2009 and Nov. 2010. Residents were assessed using a general statement, CES-D (Center for Epidemiologic Studies Depression Scale), and HAMD (Hamilton Depression Rating Scale). Residents (n=60) with CES-D scores ≥16, HAMD scores >7 and <17 were selected for early intervention. Residents were randomly divided into control(n=15), electro-acupuncture(n=14),psychological treatment(n=15), and combined therapy(n=16) groups to receive treatment over an 8-week period to evaluate the efficacy of these methods in improving the depressive state.

Results: After 8 weeks, there were significant differences in HAMD score reduction rates and HAMD scores among groups post-intervention and between baseline and post-intervention. According to HAMD score reduction rates: the control group 41.18%, psychological group 66.67%, electro-acupuncture group 75%, and combined group 94.12%. According to HAMD scores among groups: the control group showed no significant(t=2.031,p>0.05); psychological group showed significant differences(t=7.808,P<0.01);electro-acupuncture group showed significant differences (t=8.720,P<0.01); combined group showed significant differences(t=11.123,P<0.01), and after the treatment, the last three groups' HAMD score markedly reduced.

Conclusion: Early intervention with acupuncture, psychological therapy, and combined methods can improve depression. The combined intervention is better than either acupuncture or psychological methods alone.

P-98 THE EFFECTS OF MOXIBUSTION ON THE MYOCARDIAL ISCHEMIA MODEL RABBITS IN ENERGY METABOLISM

Jianzi Wei, Shanghai University of TCM; Xiaobo Gao, Shanghai University of TCM; kelvin Wong, Shanghai University of TCM; Xian Song, Shanghai University of TCM; Xueyong Shen, Shanghai University of TCM

Objective: Observe the influences of moxibustion on the content of myocardial ATP, ADP, AMP of rabbits with myocardial ischemia, and explore the mechanism of moxibustion in treating myocardial ischemia from the aspect of modulation effect of energy metabolism of myocardial cells.

Methods: 30 cases of New Zealand rabbits were randomly divided into 3 groups: normal group, control group, and moxibustion group. Coronary artery LCX ligation was used to establish the myocardial ischemia model. Every rabbit was controled by a self-made holder whether it received invention or not. For normal group, no modeling no invention. For thecontrol group, no invention. For the moxibustion group, the rabbits were treated by moxa on acupoint PC6(Neiguan) for 20 minutes. The first treatment was performed three days after modeling, and repeated every other day in 12 days. There were 7 treatments totally. All the rabbits were killed after the last treatment finished. The hearts were taken and preserved in −80°C. HPLC method was used to quantify the levels of ADP, ATP, AMP in myocardial cells.

Results: Comparing with the normal group, the ATP, AMP and TAN of the control group are significantly lower(the P value was0.001, 0.008 and 0.007) while the ADP shows no significance(P>0.05).Compare to the control group, the ATP and TAN in myocardial cells of the moxibustion group are significantly higher (the P value was 0.004, 0.04).

Conclusion: The energy metabolism of the myocardial ischemia.rabbit was weaker than normal rabbit. Moxibustion on PC6 can enhance energy metabolism of myocardial cells.

P-99 THE EFFECTS OF TWELVE WEEKS OF TAI CHI PRACTICE ON ANXIETY IN STRESSED BUT HEALTHY PEOPLE COMPARED TO AN EXERCISE ONLY AND WAIT LIST COMPARISON GROUP – A PILOT STUDY

Shuai Zheng, University of Technology, Sydney; Peter Meier, University of Technology, Sydney; Chris Zaslawski, University of Technology, Sydney

Aim: The study aimed to evaluate the effects of Tai Chi (TC) on stress in healthy individuals when compared with an exercise and wait list group.

Methods: This pilot study is a three arm parallel randomised controlled trial. Twenty one participants were randomised to a TC, exercise or wait list group. TC and exercise groups were required to complete five hours per week of either TC or exercise for 12 weeks. The wait list group maintained their current lifestyle. The primary outcome measure was the State Trait Anxiety Inventory which assesses both state anxiety (Y-1) and trait anxiety (Y-2). The secondary outcome measure was the Perceived Stress Scale 14 (PSS14). Data was collected at baseline, midway (week 6) and at the completion of the trial (week 12).

Results: An ANOVA was computed however there were no significant changes observed from baseline across groups at either week 6 or 12. This may have been due to the small sample size. However using a paired t-test the within group results showed that for Y-1 there were significant difference within the TC group at week 6 (p=0.028) and at week 12 (p<0.000) compared to baseline, the exercise group only showed a significant change at 12 weeks (p=0.02). For Y-2 data there were significant differences in the TC group at weeks 6 (p=0.032) and 12 (p=0.003) and similarly with the exercise group at both weeks 6 (p=0.014) and 12 (p=0.025). This trend was also reflected within the PSS14 scores for TC at weeks 6 (p=0.009) and 12 (p=0.009) and the exercise group at weeks 6 (p=0.016) and 12 (p=0.005).

Discussion: The findings from this pilot study permitted a power analysis to be computed and a larger study using a sufficiently powered sample size is currently being undertaken based on these pilot findings.

P-100 THE ROLE OF ACUPUNCTURE IN EMERGENCY DEPARTMENT SETTINGS: A SYSTEMATIC REVIEW

Kun Hyung Kim, Department of Acupuncture & Moxibustion, Korean Medicine Hospital, Pusan National University; Byung Ryul Lee, Division of Clinical Medicine, School of Korean Medicine, Pusan National University; Ji Ho Ryu, Department of Emergency Medicine, School of Medicine, Pusan National University; Tae-Young Choi, Korea Institute of Oriental Medicine; Gi Young Yang, Division of Clinical Medicine, School of Korean Medicine, Pusan National University

Objectives: Patients with non-emergent and non-life threatening conditions often present to the emergency department (ED), which hinders the efficient utilization of healthcare resources. Acupuncture has frequently been used for such common conditions, although not in the ED context. This study aimed to evaluate the current evidence for acupuncture treatment in the ED and to inform future randomized controlled trials (RCTs) for acupuncture in ED settings.

Methods: Four English databases (MEDLINE, EMBASE, CENTRAL and AMED) were systematically searched to identify studies that tested the effects of acupuncture in ED settings using the search terms of “acupuncture” and “emergency”. Data extraction and the risk of bias assessments were performed by two independent reviewers.

Results: Of the 102 screened studies, two RCTs and two uncontrolled observational studies were deemed eligible. Sample sizes ranged from 42 to 100. The conditions treated included various musculoskeletal and non-musculoskeletal symptoms and showed substantial clinical heterogeneity. Acupuncture was delivered in conjunction with standard medical care with the goal of immediate pain alleviation; in one RCT, acupuncture resulted in a positive outcome, but it did not in the other. The risk of bias was generally high or unclear. Uncontrolled studies reported beneficial effects for acupuncture, although these studies were prone to bias. Two studies reported mild and transient adverse events associated with acupuncture.

Conclusions: The current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED. The effectiveness and safety as well as the feasibility of acupuncture should be tested in future RCTs.

P-101 THE ROLE OF HIPPOCAMPAL ERα ON PERIMENOPAUSAL AFFECTIVE DISORDERS IN OVARIECTOMIZED RATS: EFFECT OF ELECTROACUPUNCTURE

Xun Wang, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Yongheng Huang, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Shiwen Yuan, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Ting Xu, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Gencheng Wu, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Boying Chen, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan Universi; Yi Feng, Department of Integrative Medicine and Neurobiology, State Key Laboratory of Medical Neurobiology, Shanghai medical college; Institute of acupuncture research (WHO collaborating center for traditional medicine), Institutes of brain science, Fudan University

To study the mechanisms of electroacupuncture (EA) treatment on perimenopausal affective disorders at the behavioral and cellular levels and to make comparisons regarding the effects of EA and estrogen treatments, adult female Sprague-Dawley (SD) rats were divided into intact (INT), ovariectomy (OVX), chronic unpredictable stress (CUS) and ovariectomy+chronic unpredictable stress (OVX+CUS) groups. The OVX and CUS groups were created to model perimenopausal affective disorder conditions in the animals. EA and E2 treatments were applied to each group once the conditions had been established. The behavioral tests used to assess the conditions of the affective disorders included the elevated plus maze (EPM), the open field (OF), and the forced swimming (FS) tests. Brain sections that were processed for immunofluorescence of ER-α in the hippocampus were examined to evaluate neuronal changes in the hippocampus. After EA and E2 treatment, the estrous cycles of the ovariectomized rats were restored. Across the different groups, the effects of the EA and E2 treatments were comparable for both the behavioral results and the ER levels. EA treatment restored the estrous cycle of the OVX rats and ameliorated the affective disorder indices of the model rats in the behavioral tests. Importantly, within each group, compared to the control group, the thickness of the CA1 region of the hippocampus after EA or E2 treatments was significantly larger, with enlarged numbers and volumes of ERα-positive neurons. Therefore, the EA treatment had a positive effect on the affective disorders caused by estrogen deficiency or stress, and hippocampal ERα neurons may contribute to its mechanism of action.

P-102 THE SCIENCE OF GUA SHA

Dr. Arya Nielsen, Beth Israel Medical Center, Department of Integrative Medicine, New York, NY; Dr. Suk-Tak Chan, Department of Radiology, Massachusetts General Hospital, Harvard Medical School; Dr. Kenneth K. Kwong, Department of Radiology, Massachusetts General Hospital, Harvard Medical School

Purpose: To evaluate research on Gua sha therapeutic mechanism.

Background: Gua sha has been used for centuries in Asia, in Asian immigrant communities and by acupuncturists and practitioners of traditional East Asian medicine worldwide. Sometimes called coining, spooning or scraping, Gua sha is defined as instrument-assisted unidirectional press-stroking of a lubricated area of the body surface that intentionally creates ‘transitory therapeutic petechiae’ representing extravasation of blood in the subcutis. Gua sha is valuable in the treatment of pain and for functional problems with impaired movement, the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many acute or chronic disorders.

Methods: Analysis of research literature to elucidate Gua sha's therapeutic mechanism.

Results: Gua sha radically increases surface micro perfusion and has been shown to upregulate gene expression of heme oxygenase-1 (HO-1) at multiple internal organ sites immediately after treatment and over a period of days following Gua sha treatment[1]. Biliverdin, bilirubin and carbon monoxide (CO), the products of hemoglobin breakdown and heme degradation, catalyzed by HO-1, exhibit potent anti-oxidative and anti-inflammatory properties. HO-1 has been shown to provide protection in many disease models among them asthma, organ transplantation rejection, inflammatory bowel disease, experimental autoimmune encephalomyelitis, and many others by modulating immune reactions. Evidence-based studies both in China and the US, find Gua sha is hepatoprotective in active hepatitis B and C, reducing liver inflammation and improving liver profile.

Conclusion: Gua sha results in modulation of HO-1 that likely accounts for Gua sha's long-term anti-inflammatory and immunoprotective role. Analysis of current research clarifies a role for Gua sha in treating organ pathology. [1] Kwong KK, Kloetzer L, Wong KK et al. Bioluminescence imaging of heme oxygenase-1 upregulation in the Gua Sha procedure. J Vis Exp. 2009;30 (August 28):1385

P-103 THERMAL PROPERTIES OF SUPPLEMENTATION/DRAINAGE MANIPULATION OF MOXIBUSTION

Seung-Ho Yi, Kyung Hee University

The purpose of this study was to understand supplementation /drainage (S/D) manipulation of moxibustion, which is one of major treatment methods in TCM. S/D manipulation could make imbalanced human state balanced, which is the main purpose of moxibustion and acupuncture. Despite its importance, few papers have been reported for S/D manipulation except acupoint selection and not much has been known for the basic physical properties of the manipulation. Several methods have been known for S/D manipulation of acupuncture. However, there is practically only one method for moxibustion. According to ‘Ling Shu’, supplementation manipulation can be achieved by letting a moxa burn out itself to achieve and drainage manipulation can be achieved by supplying external air flow after lighting a moxa. To differentiate the thermal properties of moxibustion for S/D manipulation, we measured temperature of a burning minimoxa (1×10 mm, dia. X length) while we applied varied the magnitude of air flow (0.3–1.0 m/s) for drainage manipulation to compare with supplementation manipulation (0 air flow). To reflect clinical situation, we also varied the incident angle of the flow (0–60°). According to our measurement, a peak temperature for the moxibustion is not meaningfully relevant to the magnitude of air flow. But the temperature increase rate is proportional to the magnitude. The decrease rate after the peak temperature is similar each other. The incident angle of air flow does not affect the overall trend of S/D manipulation of moxibustion. The results of this measurement show that S/D manipulation of moxibustion might be to manipulate the ramp rate of heat stimulus rather than the amount of heat stimulus as thermodynamically point of view. Based on the results, the concept of the S/D manipulation of moxibustion could be tested for clinical application as well as basic understanding of TCM.

P-104 USING ACUPUNCTURE TO ENCOURAGE COMMUNITY WELLNESS IN UGANDA

Kathia Kirschner, New England School of Acupuncture; Richard Mandel, New England School of Acupuncture; Lisa Conboy, New England School of Acupuncture

This project considers the treatment benefits and challenges to using a manualized acupuncture protocol in the context of Ugandan health care system. Treatments and data collection were performed by members of the Pan African Acupuncture Project (PAAP) (http://www.panafricanacupuncture.org/). PAAP was created in 2001 and is a volunteer-based not-for-profit training organization. It encourages community empowerment and wellness by training local health-care providers how to use simple, effective acupuncture protocols to treat the symptoms of HIV/AIDS, malaria, tuberculosis, and other chronic conditions. PAAP organizes and administers this manualized, symptom-based treatment program through three week-long trainings. The training manual explains the theory of acupuncture and the techniques associated with it in clear and simple terms. The bulk of the manual is the presentation of specific acupuncture protocols associated with the signs and symptoms manifested by malaria, as well as and other illnesses, commonly seen in Uganda. Both acupuncture and herbs have been used throughout history to combat malaria in China. Several clinical studies will be reviewed that indicate that acupuncture is an undervalued tool in the global fight against malaria. With further research and acceptance by public health workers, acupuncture could join herbal medicine as a pivotal aid against this disease, as well as being an effective treatment for other health complaints. Methods: Pre-post acupuncture treatment data was collected on 117 patients at Isingiro, Uganda over the course of 4 days (17/4/12 – 20/4/12). A personalized scale in which the subjects offered a main and secondary symptom with corresponding severity was used. Student's t-tests were conducted on the 24 subjects with complete data, which indicate that the acupuncture treatments significantly reduced main symptom severity from a mean of 4.2 on a 7 point scale to 2.3. Also reviewed are types of symptoms reported, and rich demographics to describe this novel data collection.

P-105 USING STATIC BALANCE AS A MAIN INDEX TO EVALUATE THE EFFECTIVENESS OF CONVALESCENCE ISCHEMIC APOPLEXY IN ACUPUNCTURE PATIENTS

Chunyan Chen, Shanghai Qigong Institute

50%–70% of people who have sufferedfrom stroke have serious disability, and among those, ischemic stroke accountfor about 80% percent. To observe the clinical effect of acupuncture in treating ischemic apoplexy. This will be done by comparing clinical measures as well as variations in training equipment and the static balance test between acupuncture patients and control patients. Sixty patients diagnosed with convalescence ischemic apoplexy were randomly divided into 2 groups. The medicine group was given common medicine, while the acupuncture group was given common medicine and acupuncture. After 20 days, the curative effect, ANFD, Barthel index, and blood lipid concentrations were compared. In addition, the variations in the static balance test and training equipment of the 30 patients treated by acupuncture and the 28 patients treated with common medicine were compared. The ANFD of both groups improved significantly (p<0.001), however the acupuncture group had a larger improvement than the medicine group (p<0.05). The Barthel index of the acupuncture group had a significant change (p<0.001) and the acupuncture group's was better than the medicine group's (p<0.05). After treatment, the blood lipid concentration of the acupuncture group had no statistically significant difference (p>0.05). The static balance test and training equipment of the acupuncture group showed indices that were significantly different post-treatment (p<0.05). The medicine group had a significant effect in their left and right extremity burden ratio deflexions, the center of gravity standard deviation, and the goals attainment rate (p<0.05). Acupuncture has a significant effect in patients suffering from convalescence ischemic apoplexy. This is indicated by the significant difference between the acupuncture and medicine groups improvement on ANFD, the Barthel index and the Fugl-meyer integral. Such treatment could improve life quality in stroke patients. Specifically, acupuncture therapy could improve the equilibrium function of the convalescence ischemic apoplexy patients.

P-106 USING THE EIGHT EXTRAORDINARY VESSELS FOR TREATMENT OF PSYCHOEMOTIONAL CONDITIONS: A MIXED METHOD CASE SERIES APPROACH

Yvonne Farrell, LA Herbs and Acupuncture; Dawn Upchurch, UCLA

Purpose: Although acupuncture research has emphasized treatment of physical conditions, there is a long tradition in Chinese medicine identifying the eight extraordinary vessels as gateways to treat psychoemotional problems. The goal of this clinical study was to describe treatment protocols and assess patient subjective outcomes over time.

Methods: A mixed methods design was used. Quantitative clinical data and qualitative data were both obtained on a case series of 3 patients. Patients were assessed and treated by a provider (YF) with training and expertise in eight extraordinary vessel applications. Patients were prospectively followed for up to 12 weeks.

Results: Patients presented with a diversity of psychoemotional concerns (e.g., anxiety, depression, obsessive thinking, sleep disorders). Following 8EV theory Ren Mai treatments, self-reports indicate substantial specific improvements in intensity and frequency of anxious episodes and non-specific improvements in the ability of patients to self-soothe. Based on self-reports, Du Mai treatments resulted in a decrease in severity of depression and increased self-motivation. The Chong Mai also improved depressive states and patients reported increases in self-esteem and reduction in feelings of shame.

Conclusions: Clinically, an 8EV approach offers an opportunity to access and successfully treat psychoemotional concerns. These vessels are linked to the concept of pre-natal qi in Chinese medicine and are therefore associated with genetic predisposition and personality. There support the Mind-body connection allows patients to have increased body awareness and increased control over their thoughts and emotional states. This study demonstrated the utility of mixed method design in this emerging area of research.

P-107 WARMING UP WITH TAI CHI INCREASES MUSCLE STRENGTH AND ENDURANCE

Shin Lin, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Integrative Medicine, University of California, Irvine; Asal Samadi, Depts. of Developmental & Cell Biology and Biomedical Engineering, Susan Samueli Center for Integrative Medicine, University of California, Irvine

With integration of whole body movement with deep breathing cycles and mental concentration, Tai Chi has a good potential as an effective warm up exercise for various types of athletic activities. The purpose of this pilot study is to determine whether the basic exercise of "Silk Reeling" from Chen style Tai Chi can improve muscle function in weightlifting tests. In the initial part of the study involving a group of 5 healthy male and female college students, “1-Rep Max” for bicep curls on a Bowflex machine was determined as described (http://www.timinvermont.com/fitness/orm.htm). For each subject, the measurement was made on one day without warm up and repeated on a different day after 15 minutes of 2-handed silk reeling (4 cycles/minute, half the time with hands-arms sweeping clockwise and the other half counterclockwise) coordinated with deep breathing and mental concentration. We found that all 5 subjects were able to lift an average of 10% more weight when warming up with silk reeling compared to no warm up. Next, we measured 10 new subjects (similar personal characteristics)in the number of repetitions of bicep curls at 50% of “1-Rep Max” using a set of barbells. As control, the subjects performed the test on 4 different days using conventional warm up of 20 empty-handed curls and the results were averaged. On 4 alternative days, the subjects did the same test but used silk reeling as a quick warm up (10 times clockwise and 10 times counterclockwise). We found that the subjects increased their number of repetitions by an average of 33% (range: 11- 78%) when warming up with silk reeling compared to empty-handed curls. The results of this study show that Tai Chi silk reeling is a highly effective warm up exercise that can measurably increase muscle strength and endurance in weightlifting tests.

P-108 WHO USES A STUDENT ACUPUNCTURE CLINIC: DEMOGRAPHIC AND MYMOP SYMPTOM RESULTS

Kai Yin Hsu, New England School of Acupuncture; Lisa Conboy, New England School of Acupuncture

While Acupuncture is becoming become more widely accepted by the American public as well as federal policy makers, relatively little data has been obtained to date of acupuncture users' demographic characteristics and reasons for using acupuncture teaching clinics in the U.S. It is important to understand patients' sociodemographics as well as their symptoms in order to better serve acupuncture consumers and provide information to health care providers and investigators.

Design: This retrospective chart review reports on the 676 patients using one of the student clinics at the New England School of Acupuncture (NESA) in Massachusetts, USA in 2011. Annually, NESA interns administer over 27,000 treatments for a variety of conditions across all of its clinics. The NESA teaching clinics are learning environments where student interns treat patients under the direct supervision of experienced and licensed acupuncturists.

Methods: A retrospective chart review was used to look at all patients who visited the NESA main clinic site in 2011. This report focuses on patient demographics and “Measure Your Medical Outcome Profile” (MYMOP) results.

Results: Patients were mostly female (72%) and White (82%) with 62% having at least a college education. Common activities that subjects sought help for are improvements in their ability to exercise, and work. Twenty-nine percent desired that their acupuncture treatment would them reduce their prescribed and over the counter medication use. Pain, fatigue, and anxiety were the most common symptoms for which treatment was sought. The sample self-reported a high level of general ‘wellbeing” on the MYMOP, with 64% reporting at most a 4 out of 6, on a wellbeing scale of 0 (as good as it could be) to 6 (as bad as it could be).

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