Okayama University research: Self-administered aroma foot massage may reduce symptoms of anxiety

Researchers at Okayama University conduct the first community-based study on the effects of self-administered aromatherapy foot massage on stress and anxiety symptoms. The results suggest aromatherapy massages might provide an inexpensive, simple way of managing anxiety.

The continuing popularity of complementary therapies, such as aromatherapy and massage, has prompted scientists to investigate the effects of such therapies on the body in more detail. Complementary therapies are said to reduce the symptoms associated with stress and anxiety, and therefore may reduce the chances of severe illness, such as hypertension and heart disease. The precise effects on the body following such therapies is unclear, however.

Previous studies have focused on the effects of massage and aromatherapy treatments on blood pressure and mental state in hospitalized patients in Japan, but none have been conducted on individuals living in the community. Now, Eri Eguchi and co-workers at Okayama University, together with researchers across Japan, have conducted the first study into the effect of aromatherapy-based foot massage on blood pressure, anxiety and health-related quality of life in people living in the community.

57 participants took part in the study; 52 women and 5 men. Baseline blood pressure and heart rate values were taken at the start and end of the four-week trial period, as well as at a follow-up session 8 weeks later. Participants also completed questionnaires on anxiety status and health-related quality of life at each stage of the trial. The participants were divided into two groups, and one group were taught to perform a 45-minute aromatherapy-based foot massage on themselves three times a week for four weeks.

The results suggest that aroma foot massage decreased the participants’ average blood pressure readings, and state of anxiety, and tended to increased mental health-related quality of life score. However the effect of massages was not significant with changes in other factors such as physical health-related quality of life scores and heart rate.

In their paper published in March 2016 in PLOS One, Eguchi’s team are cautiously optimistic about the potential for self-administered massage to reduce anxiety in the population: “[although] it was difficult to differentiate the effects of the aromatherapy from the effects of the massage therapy... [the combination] may be an effective way to increase mental health and improve blood pressure.”

Background

Aromatherapy and massage

Aromatherapy has long been used to relieve stress and anxiety in populations across the globe. Different aroma essential oils are said to have different properties, and are used to induce relaxation and promote well-being. Trials have indicated that certain essential oils, when inhaled, can reduce blood pressure levels and alleviate depression by stimulating the olfactory system.

Massage (in its many forms) also has a long history in therapeutic medicine, and the practice of manipulating key pressure points in the body to induce relaxation has been shown to improve mental and physical health. However, detailed scientific studies of the effects of aromatherapy foot massage – an increasingly popular treatment in Japan – on blood pressure and perceived quality of life are limited.  

Significance and further work

While the trial carried out by Eguchi and her team is limited in some respects, their results provide an initial starting point from which to extend studies into the benefits of aroma foot massage for the general population. Their findings that massage, or the aromatherapy, or a combination of both, reduce blood pressure readings (at least in the short term) warrants further investigation.

Eguchi and her team acknowledge that their decision to advertise for participants may have encouraged more health-conscious and pro-active people to apply. They also received far more applications from women than men, although their age-range (from 27 to 72) was diverse. Further work is needed to determine the effect of aroma foot massage on specific age and sex categories, for example, before such interventions are encouraged in the wider population.   

Okayama University research: Medical supportive device for hemodialysis catheter puncture‏

Medical doctors at Okayama University Medical School and Shigei Medical Research Hospital in Okayama City, in collaboration with K.Techno Inc. develop a medical supportive device for hemodialysis catheter puncture.

Hemodialysis is used to purify the blood of people with kidney failure with a growing need for dialysis using a catheter in countries with aging populations, such as Japan. The precise catheter placement for secure and efficient dialysis, requires specialized knowledge and skills of the doctor. 
The implication of improper catheter placement include:  the appropriate and correct hemodialysis cannot be carried out; the possibility of medical accidents;, increase the exposure of patients to radiation through the use of X-ray equipment during replacement; and wastefulness in healthcare costs due to unnecessary disposal of expensive dialysis catheters.

Now, Dr Toshiaki Ohara at the Okayama University Medical School and clinical staff at the Shigei Medical Research Hospital in Okayama City, in collaboration with K.Techno Inc., have developed a “medical supportive device for hemodialysis catheter puncture” (hereafter ‘device’). 
Clinical tests conducted at Shigei Medical Research Hospital showed no safety problems with excellent placement results of hemodialysis catheters. 
The Okayama team will publish their results in an international journal and are preparing to commercialize this invention as well as looking for other non- hemodialysis catheter related applications of this technology. 

Details of the process for using the ‘device’ 
Before inserting the catheter the patient lies horizontally on an X-ray table followed by disinfection and sheets to define the operation area. Next, the ‘device’ is laid over the patient and a pen used to mark the path for the catheter. Then, a catheter of the appropriate length is selected and the internal jugular vein is punctured.
Then, in a state in which the wire and the dilator have been inserted, the device is used to make a line along the wire again. Then, actually superimpose the catheter to check that there is no deviation.

Then the exit section is set and the catheter is guided in a direction from the outlet to the neck, and the inner cylinder of the dilator is removed. The catheter is inserted into the dilator and the process is completed when the dilator sheath is split and removed. This process enables the accurate and reproducible placement of catheters without deviation. 

Okayama University research: Lack of enzyme promotes fatty liver disease in thin patients‏

 Researchers observe protection against obesity and insulin resistance but at the cost of prominent fatty liver disease in mice lacking the PEMT enzyme and patients with low levels of PEMT.

Non-alcoholic fatty liver disease – steatohepatitis - is an increasingly common chronic form of hepatitis. As Jun Wada and colleagues at Okayama University Graduate School of Medicine, Shigei Medical Research Institute and Dainippon Sumitomo Pharma explain in a recent report, “Although obesity is undoubtedly one of the main risk factors for the development of non-alcoholic fatty liver disease, many clinical observations demonstrated the presence of lean NAFLD patients with normal body mass index (BMI).” The team’s latest work shows that absence of the enzyme phosphatidylethanolamine N-methyltransferase (PEMT), while protecting from diet-induced obesity and diabetes, leads to the prominent development of fatty liver disease and tumours in response to a high-fat high-sucrose diet.

PEMT catalyses methylation of phosphatidylethanolamine (PE) to phosphatidylcholine (PC) in liver cells using S-adenosyl methionine as a methyl donor. The ratio of PE to PC is known to be crucial to cell membrane integrity and resistance to endoplasmic reticulum stress and the infiltration of the liver with fat. 

Wada and colleagues fed mice lacking the PEMT enzyme a high-fat high-sucrose diet for up to 90 weeks. They monitored the fat accumulation and insulin resistance before dissecting them to examine their livers. The researchers noted enhanced apoptosis and cell proliferation in the liver, which they explain through transactivation of the protein p53, which is inhibited in the presence of PEMT. The researchers also note a similarity in the response of the PEMT knock-out mice to that of lean human patients suffering from non-alcoholic steatohepatitis.

The researchers then performed genome-wide sequencing-based DNA methylation analysis. Further investigation revealed that PEMT mRNA expression in liver tissues of human non-alcoholic steatohepatitis patients was significantly lower than for simple steatosis, and as they add “lower quartiles of PEMT mRNA demonstrated lower BMI and platelet counts, suggesting lower expression of PEMT is critically linked to the pathogenesis of lean non-alcoholic steatohepatitis.”

Background
Non-alcoholic fatty liver disease (NAFLD)
Extensive build-up of fat in the liver is responsible for a range of diseases including simple steatosis and non-alcoholic steatohepatitis (NASH). The increased instances of NAFLD are linked with the rise in obesity and diabetes, which are now considered to have reached epidemic proportions. However, NASH has also been reported in patients with a normal body mass index (BMI), and the prevalence of “lean NAFLD” was recently reported at 12% in Greece, 20% in India and 15% in China.

Choline deficiency and lean NAFLD
Mice fed a methionine- and choline-deficient diet (MCD) are a widely used mouse models for NASH research. An absence of obesity and insulin resistance has been observed in both MCD mice and PEMT knockout mice fed high-fat high-sucrose diets.

PC is synthesized from choline, and a balance in PE and PC levels is thought to be important for maintaining cell membrane integrity, stabilising lipid droplets and the normal distribution of fat. Disrupting this balance appears to cause accumulation of fat in the liver. 

PEMT catalyses methylation of PE, which also produces PC. The similar effects – lack of obesity and prominent steatohepatitis – is also observed in PEMT knock-out mice and human NAFLD patients with low levels of PEMT.

DNA methylation analysis
The genome-wide sequencing-based DNA methylation analysis by the researchers revealed enhanced methylation of two genes associated with cyclin D1 degradation and negative regulation. These results implicate the upregulation of cyclin D1 in the development of liver disease and tumours in PEMT knock-out mice.

 Caption

Phenotype of Pemt+/+, Pemt+/− and Pemt−/− mice under high fat-high sucrose (HFHS)
diet at 60 weeks of age. (a–c) Gross appearance of liver. Bar = 1 cm. Regenerative nodules and adenoma are indicated by arrow heads (c). (d–f) Masson-Trichrome staining of liver tissues. Bar = 100 μ m.

Reference 
Atsuko Nakatsuka, Makoto Matsuyama, Satoshi Yamaguchi, Akihiro Katayama, Jun Eguch, Kazutoshi Murakami, Sanae Teshigawara, Daisuke Ogawa, Nozomu Wada, Tetsuya Yasunaka, Fusao Ikeda, Akinobu Takaki, Eijiro Watanabe & Jun Wada. Insufficiency of phosphatidylethanolamine N-methyltransferase is risk for lean non-alcoholic steatohepatitis, Scientific Reports 6 21721 (2016). 
DOI: 10.1038/srep21721
http://www.nature.com/articles/srep21721