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A characteristic of rotifers is their mastax purchase amoxicillin 500 mg on line, which is a jaw-like device that grinds food as it enters the stomach discount 250 mg amoxicillin. Indicator: Euchlanis is commonly found in activated sludge when effluent quality is good buy amoxicillin 500 mg with amex. It requires a continual supply of dissolved oxygen, evidence that aerobic conditions have been sustained. Waterborne Diseases ©6/1/2018 52 (866) 557-1746 Protozoan Diseases Protozoan pathogens are larger than bacteria and viruses but still microscopic. Some parasites enter the environment in a dormant form, with a protective cell wall, called a “cyst. Effective filtration treatment is therefore critical to removing these organisms from water sources. It has also been referred to as “backpacker’s disease” and “beaver fever” because of the many cases reported among hikers and others who consume untreated surface water. Symptoms include chronic diarrhea, abdominal cramps, bloating, frequent loose and pale greasy stools, fatigue and weight loss. Waterborne outbreaks in the United States occur most often in communities receiving their drinking water from streams or rivers without adequate disinfection or a filtration system. The organism, Giardia lamblia, has been responsible for more community-wide outbreaks of disease in the U. Cryptosporidiosis Cryptosporidiosis is an example of a protozoan disease that is common worldwide, but was only recently recognized as causing human disease. Cryptosporidium organisms have been identified in human fecal specimens from more than 50 countries on six continents. The mode of transmission is fecal-oral, either by person-to-person or animal-to-person. All of these diseases, with the exception of hepatitis A, have one symptom in common: diarrhea. They also have the same mode of transmission, fecal-oral, whether through person-to-person or animal-to-person contact, and the same routes of transmission, being either foodborne or waterborne. Although most pathogens cause mild, self-limiting disease, on occasion, they can cause serious, even life threatening illness. By understanding the nature of waterborne diseases, the importance of properly constructed, operated and maintained public water systems becomes obvious. While water treatment cannot achieve sterile water (no microorganisms), the goal of treatment must clearly be to produce drinking water that is as pathogen-free as possible at all times. For those who operate water systems with inadequate source protection or treatment facilities, the potential risk of a waterborne disease outbreak is real. For those operating systems that currently provide adequate source protection and treatment, operating and maintaining the system at a high level on a continuing basis is critical to prevent disease. Waterborne Diseases ©6/1/2018 53 (866) 557-1746 Summary of Common Waterborne Diseases Name Causative organism Source of organism Disease Viral gastroenteritis Rotavirus mostly in young children; Human feces; Diarrhea or vomiting. Norwalk-like viruses Human feces; also, shellfish; lives in polluted waters; Diarrhea and vomiting. Human feces; Symptoms vary with type caused; gastroenteritis Typhoid Salmonella typhi (bacterium) Human feces, urine Inflamed intestine, enlarged spleen, high temperature— sometimes fatal. Cholera Vibrio cholerae (bacterium) Human feces; also, shellfish; lives in many coastal waters; Vomiting, severe diarrhea, rapid dehydration, mineral loss —high mortality. Hepatitis A virus Human feces; shellfish grown in polluted waters; Yellowed skin, enlarged liver, fever, vomiting, weight loss, abdominal pain — low mortality, lasts up to four months. Amebiasis Entamoeba histolytica Human feces; Mild diarrhea, dysentery, (protozoan) extra intestinal infection. Giardiasis Giardia lamblia (protozoan) Animal or human feces; Diarrhea, cramps, nausea, and general weakness — lasts one week to months. Cryptosporidiosis Cryptosporidium parvum (protozoan) Animal or human feces Diarrhea, stomach pain — lasts days to weeks. The Best Method to kill most of these Bugs Disinfection is usually synonymous with chlorination. That is because chlorine addition is by far the most common form of disinfection used today. Disinfection is the process of killing microorganisms in water that might cause disease (pathogens). Disinfection, however, should not be confused with sterilization, which is the destruction of all microorganisms. Cryptosporidium parvum and Giardia lamblia will require proper water treatment techniques. An illustrated guide to the species used as biological indicators in freshwater biology. Pollution related structural and functional changes in aquatic communities with emphasis on freshwater algae and protozoa. Soil protozoa: fundamental problems, ecological significance, adaptations in ciliates and testaceans, bioindicators, and guide to the literature. Respiratory energy losses related to cell weight and temperature in ciliated protozoa. Temperature responses and tolerances in ciliates from Antarctica, temperate and tropical habitats. The annual cycle of heterotrophic planktonic ciliates in the waters surrounding the Isles of Shoals, Gulf of Maine: an assessment of their trophic role. Field evaluation of predictions of environmental effects from multispecies microcosm toxicity test. Waterborne Diseases ©6/1/2018 55 (866) 557-1746 Waterborne Diseases ©6/1/2018 56 (866) 557-1746 Chapter 1 Review Example Question, fill-in-the blank with one correct answer. The German scientist __________________, a student of Jacob Henle, and the British surgeon Joseph Lister developed techniques for growing cultures of single organisms that allowed the assignment of specific bacteria to specific diseases. The first experimental transmission of a viral infection was accomplished in about 1880 by the German scientist __________________, when he demonstrated that extracts from infected tobacco leaves could transfer tobacco mosaic disease to a new plant, causing spots on the leaves. Because __________________ was unable to isolate a bacterium or fungus from the tobacco leaf extracts, he considered the idea that tobacco mosaic disease might be caused by a soluble agent, but he concluded incorrectly that a new type of bacteria was likely to be the cause. The Russian scientist __________________ extended Mayer’s observation and reported in 1892 that the tobacco mosaic agent was small enough to pass through a porcelain filter known to block the passage of bacteria. In 1917 the French-Canadian scientist __________________ discovered that viruses of bacteria, which he named bacteriophage, could make holes in a culture of bacteria. In 1935 the American biochemist __________________ crystallized tobacco mosaic virus to demonstrate that viruses had regular shapes, and in 1939 tobacco mosaic virus was first visualized using the electron microscope. Frosch (both trained by __________________) described foot-and-mouth disease virus as the first filterable agent of animals. In 1900, the American bacteriologist __________________ and colleagues recognized yellow fever virus as the first human filterable agent. For several decades viruses were referred to as filterable agents, and gradually the term virus (Latin for “__________________” or “poison”) was employed strictly for this new class of infectious agents. Through the 1940s and 1950s many critical discoveries were made about viruses through the study of __________________ because of the ease with which the bacteria they infect could be grown in the laboratory. Louis Pasteur along with __________________ developed the germ theory of disease which states that "a specific disease is caused by a specific type of microorganism. In 1876, __________________ established an experimental procedure to prove the germ theory of disease. Bacteria are prokaryotes (Kingdom Monera), which means that they have a large nucleus. Most bacteria lack or have very few internal membranes, which means that they don’t have some kinds of organelles (like mitochondria or chloroplasts). Most bacteria are benign (benign = good, friendly, kind) or beneficial, and only a few are “bad guys” or pathogens. All bacteria relatives can do photosynthesis—because they have chloroplasts, because chlorophyll and other needed chemicals are built into their cell membranes. These organisms are called Cyanobacteria (cyano = blue, dark blue) or bluegreen algae, although they’re not really algae (real algae are in Kingdom Protista). Like us, some kinds of bacteria need and do best in O , while others are poisoned/killed by it. All other life forms are Eukaryotes (you-carry-oats), creatures whose cells have nuclei.

The Counsyl Family Prep Screen - Disease Reference Book Page 82 of 287 What is the prognosis for a person with Factor V Leiden Thrombophilia? People with two mutations for factor V Leiden thrombophilia are at an 18 to 80 times greater risk than the general population for life-threatening blood clots buy 500 mg amoxicillin overnight delivery. That said amoxicillin 500mg line, the majority of people with the condition do not experience life- threatening blood clots and will live normal lifespans amoxicillin 500 mg without a prescription. Studies have shown that people with only one mutation for factor V Leiden thrombophilia have a normal lifespan. Detection Population Rate* <10% African American 97% Ashkenazi Jewish <10% Eastern Asia <10% Finland <10% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American <10% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia <10% Southern Europe * Detection rates shown are for genotyping. Bleeding can be a particular problem after tooth extraction, dental surgery, tonsil surgery, or urinary tract surgery. More than half of women with the disease have abnormally heavy and prolonged menstrual periods. The Counsyl Family Prep Screen - Disease Reference Book Page 84 of 287 Bleeding problems can occur, however, when levels are as high as 70% of the normal level. The severity of the bleeding varies widely from person to person, even among members of the same family. Studies have suggested that 20 to 50% of carriers of the disease show "excessive bleeding," although the defnition of this phrase varies. The disease is also common among families in northwest England, where 1 in 10,000 people has the disease. In the case of bleeding in the mouth, nose, intestines, or uterus, there are several medications which may be helpful, though they are not efective for major internal bleeding and can cause clotting throughout the body. In people who do not realize they have the disease, life-threatening bleeding is possible following surgery or injury. The Counsyl Family Prep Screen - Disease Reference Book Page 86 of 287 Familial Dysautonomia Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American >99% Ashkenazi Jewish <10% Eastern Asia <10% Finland <10% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American <10% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia <10% Southern Europe * Detection rates shown are for genotyping. Familial dysautonomia is an inherited condition that causes nerve cells to deteriorate. It afects the autonomic nervous system, which controls involuntary actions such as breathing, tear production, blood pressure, and body temperature. It also afects the sensory nervous system, which controls senses such as the abilities to perceive taste, pressure, pain, and temperature. Early symptoms in infants include feeding problems, poor growth, lack of tears, poor muscle tone, frequent lung infections, and marked fuctuations in body temperature. Until about age 6, children with the condition may also hold their breath for long periods of time, which may cause fainting or make their lips or skin appear blue. Starting around age 5 or 6, children with the condition may develop symptoms including bed-wetting, vomiting, reduced sensitivity to temperatures and pain, decreased ability to taste, poor balance, abnormal curvature of the spine, easily fractured bones, and kidney and heart problems. They commonly experience a sharp drop in blood pressure when they stand up, which can cause blurred The Counsyl Family Prep Screen - Disease Reference Book Page 87 of 287 vision, dizziness, or fainting. By adulthood, people with familial dysautonomia may have balance problems that prevent them from walking unaided. Other common complications include sleep apnea, lung damage due to repeated infections, poor vision as optic nerves atrophy, and kidney disease. Familial dysautonomia is found almost exclusively in people of Ashkenazi Jewish descent, where it afects approximately 1 in 3,700 people. Infants with the condition may need to be fed thickened formula to ensure adequate nutrition and prevent them from inhaling their food. Recurrent pneumonia caused by inhaling food or vomit requires daily chest physiotherapy. Older children who experience low blood pressure may require elastic stockings and leg exercises to improve muscle tone and prevent blood from pooling in leg veins. Corneal injuries caused by low tear production may be treated with regular eye drops, soft contact lenses, or in rare cases, surgery. The average lifespan of a person with familial dysautonomia is signifcantly shortened. The Counsyl Family Prep Screen - Disease Reference Book Page 88 of 287 Familial Mediterranean Fever Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 75% Ashkenazi Jewish <10% Eastern Asia <10% Finland <10% French Canadian or Cajun <10% Hispanic 96% Middle East <10% Native American <10% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia <10% Southern Europe * Detection rates shown are for genotyping. This symptom is most common among people of Turkish and North African Jewish heritage, afecting 60% and 75% respectively. Afected people may also develop an infammation of the membrane that surrounds the brain and spinal cord, though this is not usually serious or damaging. These may include a mild, unpleasant sensation in parts of the body that will soon be afected or may consist of other physical and emotional symptoms. One in every 200 to 1,000 people in these groups is afected by the disease and carrier rates in some populations have been estimated as high as 1 in 5. Colchicine also prevents the dangerous buildup of proteins in the kidneys which could otherwise lead to kidney failure. Episodic attacks of fever and infammation can be treated with non-steroidal anti-infammatory drugs. Those who do develop serious kidney failure may be helped by kidney transplantation. The disease has the potential to be life- threatening only if the person is untreated (or does not respond to treatment) and develops kidney failure. The Counsyl Family Prep Screen - Disease Reference Book Page 90 of 287 Fanconi Anemia Type C Available Methodologies: targeted genotyping and sequencing. Detection Population Rate* <10% African American 99% Ashkenazi Jewish <10% Eastern Asia 54% Finland 54% French Canadian or Cajun <10% Hispanic <10% Middle East <10% Native American 54% Northwestern Europe <10% Oceania <10% South Asia <10% Southeast Asia 54% Southern Europe * Detection rates shown are for genotyping. This defective protein results in an impaired ability of bone marrow to produce all types of blood cells. Without a sufcient number of red blood cells, the body does not receive enough oxygen, which can lead to abnormal bones and organs as well as developmental delay. A shortage of white blood cells makes the body more susceptible to infection and cancer. A reduction in blood platelets make it difcult for the blood to clot when an injury arises. In many cases, the frst symptoms of Fanconi anemia type C appear in infancy as frequent nosebleeds, a tendency to bruise, and physical abnormalities such as spotted skin or malformations of the thumbs, forearms, eyes, kidneys, gastrointestinal system, ears, or heart. Children with the disease may also show signs of hearing loss or developmental delay. However 25 to 40% of people with the condition do not have physical abnormalities. They may be frst diagnosed in childhood with abnormally low levels of red blood cells, white blood cells, or platelets. Although their bone marrow may appear normal at frst, it deteriorates progressively. Occasionally, the initial signs of leukemia appear in childhood as the frst symptom of the disease. Other cancers may also appear at an unusually early age, particularly tumors of the head and neck, esophagus, cervix, vulva, or liver. Certain mutations are associated with more or less severe courses of Fanconi anemia type C. For example, one particular mutation is associated with less severe symptoms in people of Japanese ancestry. Fanconi anemia is most common in people of Ashkenazi Jewish descent, where 1 in 90 are carriers and 1 in 32,000 have the disease. About half of all people with the condition can improve their blood cell counts with medication. Over a period of years, however, people often develop resistance to the medication. Treatment with medication may also decrease the efectiveness of a later bone marrow transplant. Bone marrow transplantation can cure the leukemia associated with Fanconi anemia type C. However people with the condition are extremely sensitive to the chemotherapy and the radiation treatment necessary to prepare for transplantation, so they may not be good candidates for this surgery. A bone marrow transplant does not prevent solid tumors elsewhere in the body, which must be treated with chemotherapy and radiation.

If her partner stranger increases his or her chances of getting a protests that wearing a condom feels too much like sexually transmitted disease safe amoxicillin 500mg. Disregard of a part- diseases are endemic safe 250mg amoxicillin, and the only way to protect ner’s health and well-being is clearly not a loving discount 500 mg amoxicillin with visa, oneself is to have no sexual contact (to practice caring approach to sexual activity. If the teen is unwilling to do so, he or Both partners are wise to keep in mind that only she must initiate a candid talk with a potential sex one unprotected instance of sex can result in a sex- partner. Certainly, a passionate Being involved sexually with an individual who scenario is the wrong time because this is not fer- is cavalier about harming a partner’s health is a bad tile ground for any kind of conversation, much choice. A man with a selfish approach to sex is ask- less the safe-sex kind, which may be embarrass- 207 208 talking with a sex partner ing. This begs the question many people ask: “cooler” time, when it appears likely that sexual since so many people will not be truthful, why activity is on the horizon. You can easily anticipate sex partner has something to hide or is not inter- responses you will hear from your partner. Forget the idea that sex needs to be has never before been gutsy should make this glitzy and glamorous. If you are a teen, look for nal that this potential partner looks at you as sources that have better information than most short-term gratification, not a serious possibility people your age actually have. The upshot of a situ- knowledge from a peer does not yield what you ation in which someone is not being cherished or need to know. In fact, a person may be misin- respected as a person can be a rapid dampening of formed and inadvertently pass on incorrect passionate feelings. For example, a person who is aware of having of the person dispensing tips; if he or she is not a herpes may be less moved by a desire to be honest medical professional such as a physician or nurse than by an urge to have sex. Be direct and make sure you get your discovers that she has a herpes infection a week questions answered. If a young man experiences these symp- about it will not be so difficult in preadolescence. Trial participants were uninfected injection drug users attending 17 drug treatment clinics in testicular torsion The spermatic cords and blood Bangkok. In contrast, informed as to which participants received the newer technique—ThinPrep Pap test—results placebo and which vaccine. Thrush resembles creamy white curd- people would take risks, regardless of admoni- like patches on the tongue and inside the mouth, tions to the contrary. These white patches can In the United States, two of three participants in be rubbed off. Therefore, determining which sexual will help steer decisions about future development partner was the disease carrier often is hard. Deformities of ThinPrep Pap smear The ThinPrep is believed to the teeth can result from congenital syphilis in its be an improvement on the standard Pap smear, late stage if this disease is untreated. These charac- which is used to screen for abnormal changes that teristic deformities of the teeth are called Hutchin- point to cervical cancer. In view of the fact that tage of the old Pap smear is that other elements col- many sexually active people do not use condoms lected (blood, mucus, inflammation) are included consistently or correctly, many drug companies toxoplasmosis 211 have worked to make available a new class of Prevention guidelines for those who are preg- products that can serve as viable options. Some of nant or have a severely weakened immune system these are now being tested. Many health care professionals believe that a you test positive, your doctor will prescribe vaginal microbicide that women can use is needed medication if that is necessary to prevent the worldwide and should be a research priority. If you test nega- tive, then it is wise to take precautions to pre- toxoplasmosis Found throughout the world, a vent infection. If she tests beings by means of undercooked meat, other con- positive, she most likely does not need to worry taminated foods, contaminated soil, or handling of about passing the infection to her infant because cat litter. In most cases, a person with toxoplasmo- the positive test result means she has already sis has mild to severely enlarged lymph nodes as been exposed. Sometimes the disease causes Toxoplasma during pregnancy or shortly before, flulike symptoms: muscle aches, pain, and fever. After that more than 60 million Americans have the Tox- going inside, wash your hands with soap and oplasma species parasite, few of these people have warm water. Carefully wash kitchen utensils and Often a person is infected by inadvertently swal- cutting boards that raw meat has touched. Another route is putting hands to mouth after touching raw or partly cooked meat (pork, lamb, • Avoid handling stray cats. In rare instances, • Do not change a litter box if a healthy or non- toxoplasmosis is contracted as a result of a transfu- pregnant person can do this for you. Wash your to mothers who are first exposed to Toxoplasma hands carefully after cleaning the box. Unfortunately, you will not know low-green), vaginal or vulvar redness, painful or whether your cat is passing this parasite, and your frequent urination, lower abdominal pain, and dis- cat can be reinfected. The problems appear Treatment for toxoplasmosis may or may not be within five to 28 days of exposure. Typically, if a person is healthy and is woman is going to have symptoms, she has them not pregnant, there is no need for treatment within six months of being infected. Sometimes because toxoplasmosis is a self-correcting condi- the symptoms are worse after menstruation. Medication is used for pregnant women and Men, on the other hand, rarely have symptoms. Testing This problem led to improved screening of blood and To test for trichomoniasis, a health care provider blood products, and today the likelihood of contract- does a physical examination and a lab test. Trichomonas vaginalis The flagellated protozoan For diagnosis of trichomoniasis, a doctor collects that causes trichomoniasis. This is either sent to a lab or examined under a microscope in the doctor’s office to check trichomoniasis Commonly called “trich,” a sexu- for the presence of Trichomonas species. In men, the ally transmitted disease that produces an estimated parasite is often hard to detect. Mainly an infec- Both sex partners need to be treated even when tion of the urogenital tract, it usually occurs in cer- there are no symptoms (men can transmit the tain sites—the urethra in men and vagina in disease to sex partners). It is pronounced “trick-oh-moe-nye-uh- niasis is treated with antibiotics—usually a single sis. The individual taking this drug should not drink Cause alcoholic beverages (which may cause nausea Trichomoniasis is caused by the single-celled proto- and vomiting). It is spread infected men may disappear without treatment, through penis-to-vagina intercourse or vulva-to- but this is deceptive because a man with tri- vulva contact with an infected partner. A female chomoniasis can still infect female partners until can contract this disease from an infected man or he has been treated and cured. Therefore, it is woman, but men usually contract it from infected important for both partners to be treated at the women only. Women are more likely to have same time to eliminate the parasite, and a couple symptoms than are men, but both the woman and should not have sex until treatment has ended and her sexual partners must be treated. If a person is treated but remains infected, the Symptoms doctor usually prescribes the same drug at a higher It is not unusual for a person with trichomoniasis dose and for a longer period—or more than one to have no symptoms. To prevent reinfection dur- symptoms, these may include burning, itching, ing treatment, one should avoid sexual inter- frothy and smelly vaginal discharge (gray or yel- course entirely. Also, someone who has had trichomoniasis A pregnant woman with trichomoniasis may should be aware that she or he can still be infected experience premature rupture of the mem- again. Treatment is necessary for any infant, child, September 12, 2000), examined the molecular epi- or teen who has trichomoniasis. Researchers noted possible that trichomoniasis may be transmitted by that the Trinidad V3 consensus sequence “differs by infected sheets and towels, so it is a good idea not a single amino acid from the prototype B V3 con- to share these items with someone who is infected. Sexually active individuals need to know that condoms do not provide complete protection tubal ligation An operation, also referred to as against all sexually transmitted disease; that is having the “tubes tied,” that is performed on a because sores, lesions, and infective organisms may woman’s fallopian tubes to make her unable to occur in places that a condom does not cover, and conceive. After a tubal ligation, she should not be thus the partner can be exposed to the infection. This means of contraception Another caveat for prevention is to limit the is considered permanent, but in very rare cases number of sex partners and avoid alternating part- there are failures and a woman does get pregnant. The best course of action is sexual abstinence or sexual activity limited to one uninfected partner. A person who believes infection may have tubal pregnancy Also known as an ectopic preg- occurred should avoid sexual contact and see a nancy, a pregnancy implanted accidentally in the doctor for treatment.

In manual acupuncture discount 500mg amoxicillin overnight delivery, it has been suggested that the acupoints should be strongly stimulated by hand manipulation (Shi 1998) buy cheap amoxicillin 500 mg line. Some clinical reports showed that heart failure could be improved by acupuncture treatment generic 250mg amoxicillin with mastercard. Li and Man (2004) randomly divided 60 patients with symptomless heart failure into two groups (30 patients per group) and treated them with western medicine and acupuncture, respectively. The efficacy was evaluated by determining the left ventricle ejection fraction, shortening fraction, and plasma brain natriuretic peptide before and after the treatment. Thus, they concluded that acupuncture treatment could improve cardiac function, like western medicine. Apparently, it may be a better option for some patients, as acupuncture is convenient and cost-effective with producing little side effects. Some researchers observed the therapeutic effect of acupuncture on viral myocarditis and rheumatic heart disease (Zhu 1998; Deng et al. The total effective rate was more than 88% in 150 patients with viral myocarditis. However, the efficacy needs to be further verified, because the patients received the treatment along with the Chinese herbal medicine (Li et al. Nevertheless, all the above mentioned data strongly suggest that acupuncture could induce a therapeutic effect on various cardiovascular diseases, including arrhythmia, coronary artery disease, and cardiac failure. Thus, the subsequent question is to determine whether there is a scientific basis for acupuncture treatment, and the following contents of this chapter will explore the potential mechanisms. Among the complex mechanisms, neural 268 10 Effects of Acupuncture on Arrhythmia and Other Cardiac Diseases regulation plays a critical and unique role in the regulation of cardiovascular function and the correction of cardiovascular abnormality. The stimulation of the median nerve significantly improved the electrocardiogram of acute myocardial ischemia. In contrast, the stimulation of the cubital nerve induced little effect on the myocardial ischemia, and the muscle stimulation had no effect at all. In addition to neural regulation, other mechanisms such as endocrine and humoral factors also play a role in the acupuncture-induced regulation of cardiovascular system. Accumulating evidence suggests that the mechanisms underlying acupuncture correction of arrhythmia 269 Acupuncture Therapy of Neurological Diseases: A Neurobiological View mainly involve nervous system and endocrine-humoral system, leading to cellular, intracellular, and ionic regulation of the cardiovascular system. For example, an electrical stimulation of the medial portion of the hypothalamus was observed to increase the cardiac sympathetic discharges and arrhythmia (especially, premature ventricular contraction) in naive animals (Xia et al. Arrhythmia almost completely disappeared after the removal of ganglion stellares on both the sides (Xia et al. At the bedside, cerebrovascular disorders often cause cardiovascular dysfunction or even mor- phological changes in the cardiac muscles, which is the so-called cerebrocardiac syndrome. These patients exhibit neurological symptoms and arrhythmia, as well as abnormal electrocardiogram (Fu and Zhao 1997). Lin et al (1980) considered that it was the activity of the body surface-internal organ reflex through acupuncture regulation of the autonomic nervous system. Thus, they concluded that the integrity reflex path in the body surface-internal organs and the telotism of the cardiac nerves were critical for the acupuncture therapy for experimental arrhythmia. It is mainly innervated by the median nerve that belongs to the spinal cord segments at Cervicum 7 (C-7) ~ Thorax 2 (T-2). This observation provided additional evidence that the intact nerve pathway in one side can transfer acupuncture signals in this particular side and induce cardiac reaction. Based on our previous work and literature search, we believe that the dysfunction of the nervous system significantly contributes to the generation of arrhythmia, and acupuncture therapy for arrhythmia is dependent on the regulation of this system. The acupuncture signals are processed in the central nervous system, and subsequently regulate the activity of the cardiovascular centers and autonomic nervous system, thereby adjusting the heart function and inhibiting arrhythmia (Xia 1983; Xia et al. In most of the cases, afferent signals and outgoing signals of acupuncture are regulated and integrated by the superior position of the brain. As a result, many neurotransmitters in the brain undergo significant changes in their activity in response to acupuncture. Central neurotransmitters are the important substances to regulate the cardio- vascular activity. The signals of acupuncture may activate a series of actions in the central nervous system, including the activity of the central neurotransmitters (Xia and Cao 1985). This activation may attenuate the sympathetic nervous activity and enhance the parasympathetic nervous activity (Holaday 1983; Xia et al. These early observations have been confirmed by other 271 Acupuncture Therapy of Neurological Diseases: A Neurobiological View independent investigators. Subsequently, the heart rate and blood pressure of the rats were recorded 18 24 h after morphine withdrawal. All these studies demonstrate that the opioid peptide system in the brain is very important for acupuncture therapy for experimental arrhythmia. This may be especially true for rapid arrhythmia resulting from an increase in the sympathetic activity (Fig. If this phenomenon can be verified, the mechanisms underlying acupuncture therapy for arrhythmia may be more interesting, i. In addition to the opioid peptide, a variety of other neurotransmitters have been observed to be involved in acupuncture suppression of arrhythmia. These substances could inhibit the neuronal activity in the rostral ventrolateral medulla and the adrenergic nerve output, with the amelioration of arrhythmia and myocardial ischemia. In the study on acupuncture therapy for bradycardia, Zou et al (2000) observed that the acupuncture-induced attenuation of bradycardia was blocked by the intravenous (i. Fu et al (2004) found that acupuncture could decrease plasma norepinephrine and dihydroxyphenyl ethylamine to normal level in patients with cerebrocardiac syndrome, sustain neuroendocrine and body- fluid equilibrium, and thus protect the cardiac muscle from injury. Clinical observations show that patients are sensitive to transient hypopotassemia or hypomagnesemia, which often causes disruption of the bioelectrical activity and physiological integrity of the cardiac muscle cells, especially during myocardial ischemia (Nordrehaug 1985; Zheng and Zhao 1991). Thus, patients who suffer from acute myocardial infarction, complicated with hypopotassemia or hypomagnesemia, have more chances to suffer from arrhythmia, such as premature ventricular contraction, ventricular tachycardia, and ventricular fibrillation (Solomon 1984). However, could acupuncture regulate arrhythmia via the regulation of potassium and/or magnesium level? On the other hand, the second-phase platform and the third-phase slope rate recovered and 274 10 Effects of Acupuncture on Arrhythmia and Other Cardiac Diseases almost reached the normal level. In addition, they speculated that acupuncture could increase the coronary blood flow, reduce the resisting power, and enhance the responsiveness of fast channels, thus improving the stability of the cardiac cell membrane. Myocardial ischemia can cause arrhythmia as a result of remodeling of Cx43 gap-junction protein of the ventricular muscle, changes in the electrical conductivity between the myocardial cells, and damages to the electro synchronism of the heart. Therefore, ischemic arrhythmia may be at 2+ least partially attributed to the disruption of the electric conductance in Ca -Cx43 gap junction. Some investigators considered that acupuncture might improve the 2+ electric conductance in Ca -Cx43 gap junction, and subsequently enhance the cardiac function and attenuate arrhythmia (Qin et al. Both participate in the physiological and pathophysiological process of the cells, including cellular growth, differentiation, and reaction to hormones. However, in some tissues, their physiological effects are found to be contrasting. Once the balance is broken, a series of physiological and biochemical processes may occur. When the level was higher than the normal level, acupuncture was observed to decrease it, and vice versa. In the studies on the mechanisms, Gao et al (2006) investigated the pathways of signal transduction. Such attenuation was significantly inhibited by the intraperitoneal injection of propranolol, a specific ȕ-adrenoreceptor antagonist. Ca is one of the important ions that participate in multiple functions of the body, including cardiac activity. Therefore, some studies tried to determine whether 2+ acupuncture could alter Ca concentration when attenuating arrhythmia. Interes- 2+ tingly, some investigators noticed changes in the Ca concentration at the acupoints. Zhang et al (1995) established two models of experimental arrhythmia in rabbits, by injecting aconitine and electrically stimulating the hypothalamus. They 276 10 Effects of Acupuncture on Arrhythmia and Other Cardiac Diseases induced arrhythmia in rabbits by i.

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