不同强弱刺激对痛痹患者肢体血流图的影响

目的:探讨不同强度针刺刺激量对痛痹患者肢体血流图的影响。方法:选择以寒邪为主的下肢痛痹病人41例,在患肢悬钟针刺得气后行捻转手法,通过同一病人强、弱刺激后观察患侧肢体血流图,计算波幅值以做比较。结果:强刺激针后使波幅下降,弱刺激针后使波幅上升。结论:不同刺激量可以引起患肢血管舒缩机能截然不同的规律性反应。     

筋会穴用于痺证的临床与实验研究

目的　观察筋会穴阳陵泉治疗痺证的疗效及实验依据。方法　用单取筋会穴阳陵泉或针或灸或针灸兼施的方法治疗痺证,并与传统多穴组及药物治疗组比较,另作相关实验观察。结果　其有效率达90.5%,与传统多穴治疗组比较,虽然P>0.05,无显著差异,但临床总体疗效较其为高;与药物治疗组比较,P<0.01,有显著意义。实验观察显示针刺筋会穴阳陵泉能提高机体痛阈及耐痛阈。结论　表明筋会穴用于痺证的治疗,其疗效是肯定的。     

Osteoclastogenesis induced by CHIKV-infected fibroblast-like synoviocytes: A possible interplay between synoviocytes and monocytes/macrophages in CHIKV-induced arthralgia/arthritis

Fibroblast-like synoviocytes are known to migrate from joint to joint and are proposed to be one of the key players in the inflammatory cascade amplification in rheumatoid arthritis patients. In the recent CHIKV epidemic, patients developed arthritis-like syndrome and the synoviocyte is one of the suspected players in CHIKV-induced polyarthritis. Thus, to learn more on this syndrome, the responses of fibroblast-like synoviocytes to chikungunya virus (CHIKV) infection, and the interaction between CHIKV-infected synoviocytes and phagocytes, were investigated. Primary human fibroblast-like synoviocyte (HFLS) cultures were infected with clinical isolates of CHIKV at an MOI of 0.001 pfu/cell. Data indicated that HFLS are permissive to CHIKV replication, generating peak titers of 10⁵–10⁶ pfu/ml. Interestingly, CHIKV-infected HFLS cultures secreted mainly the mediators that are responsible for phagocytes recruitment and differentiation (RANKL, IL-6, IL-8 and MCP-1) but not arthritogenic mediators (TNF-α, IL-1β, MMP-1, MMP-2 or MMP-13). The interaction between CHIKV-infected synoviocytes and phagocytes was studied using UV-irradiated, CHIKV-infected HFLS supernatant. Data revealed that supernatants from CHIKV-infected HFLS cultures not only induced migration of primary human monocytes, but also drove monocytes/macrophages into osteoclast-like cells. These differentiated osteoclast-like cells produced high levels of TNF-α and IL-6, principal mediators of arthritis. This data suggests a potential interplay between infected HFLS and recruiting phagocytes which may responsible for the arthralgia/arthritis in CHIKV-infected patients.     

Alternate sessions of transcranial direct current stimulation (tDCS) reduce chronic pain in women affected by chikungunya. A randomized clinical trial

ContextThousands of people worldwide have been infected by the chikungunya virus (CHIKV), and the persistence of joint pain symptoms has been considered the main problem. Neuromodulation techniques such as transcranial direct current stimulation (tDCS) act on brain areas involved in the processing of chronic pain. It was previously demonstrated that tDCS for five consecutive days significantly reduced pain in the chronic phase of chikungunya (CHIK).ObjectiveTo analyze the effect of alternate tDCS sessions on pain and functional capacity in individuals affected by CHIK.MethodsIn a randomized clinical trial, 58 women in the chronic phase of CHIK were divided into two groups: active-tDCS (M1-S0, 2 mA, 20 min) and sham-tDCS. The Visual Analogue Scale (VAS) and the Brief Pain Inventory (BPI) were used to assess pain, while the Health Assessment Questionnaire (HAQ) assessed functional capacity. These scales were used before and after six sessions of tDCS in nonconsecutive days on the primary motor cortex, and at follow-up consultation 7 and 15 days after the last session. A repeated measures mixed-model ANOVA was used for comparison between groups (significant p-values < 0.05).ResultsA significant pain reduction (Z [3, 171] = 14.303; p < 0.0001) was observed in the tDCS group compared to the sham group; no significant difference in functional capacity was observed (Z [1.57] = 2.797; p = 0.1).ConclusionOur results suggest that six nonconsecutive sessions of active tDCS on M1 reduce pain in chronic CHIKV arthralgia.     

慢性关节疼痛患者伴发抑郁症的多因素Logistic回归分析

目的探讨慢性关节疼痛患者伴发抑郁症的原因及其相关因素,并提出预防与处理对策。方法分析630例慢性关节疼痛患者,选择性别、年龄、疼痛程度、病程、婚姻状况、疾病认知、文化程度、个性特征、医疗费用及并发抑郁症指标进行统计,采用Logistic多因素回归分析。结果 630例患者中患有抑郁症52例。疼痛程度、病程、疾病认知、文化程度、个性特征、医疗费用因素与抑郁症有相关性(P<0.05)。结论疼痛程度、病程、疾病认知、文化程度、个性特征、医疗费用是慢性关节疼痛患者产生抑郁症的危险因素。认真做好关节疼痛患者的健康教育,提高疾病认知性可以避免抑郁症的发生。     

从“肺朝百脉”论糖尿病周围神经病变

尿病周围神经病变(DPN)是糖尿病常见的慢性并发症之一。糖尿病周围神经病变在中医学中归属于痹证范畴,其为消渴后期发展而成,消渴日久,燥热内生,气血俱虚,久虚则瘀自生,故糖尿病周围神经病变的中医发病机制以瘀血阻滞为主要要点。消渴病位主要在肺脾肾三脏,而肺为首,肺主气,肺朝百脉的生理功能即推动调控全身气血运行,气行则血自畅,血畅则瘀自散,故肺朝百脉与瘀血生成密切相关。通过探究肺朝百脉与糖尿病周围神经病变中医发病机制之间的关系,以瘀血为核心从肺脏入手剖析脏腑与糖尿病周围神经病变的紧密联系,可进一步拓展中医药防治糖尿病周围神经病变的内涵与外延。     

不同方案温和灸治疗阳虚寒凝型膝骨性关节炎临床疗效观察

目的:观察采用不同方案温和灸治疗阳虚寒凝型膝骨性关节炎临床疗效差异。方法:59例阳虚寒凝型膝骨性关节炎患者采用随机数字表法随机分为对照组30例及试验组29例。对照组予以内、外膝眼穴温和灸治疗,试验组第1疗程予以内、外膝眼穴实施温和灸治疗,第2疗程予以命门、腰阳关穴实施温和灸治疗,两组均配合常规针刺,均每日治疗1次,7d为1个疗程,共治疗2个疗程。以Lysholm膝关节功能评分表进行疗效评价,比较两组治疗前后关节疼痛、晨僵、关节肿胀、步行能力评分。结果:治疗后两组患者在关节疼痛、晨僵、关节肿胀、步行能力方面均比治疗前好转(P0.05),试验组在治疗后以上各项指标比对照组改善显著(P0.05)。治疗后试验组总有效率89.66%(26/29),对照组总有效率70.00%(21/30),试验组的疗效明显高于对照组(P0.05)。结论:采用不同方案温和灸治疗膝骨性关节炎可以取得更好的疗效。     

Haemorrhagic bullous lesions in a 3-year-old girl with Henoch-Schölein purpura

Henoch–Schönlein purpura (HSP) is the most common vasculitis in children and is characterized by cutaneous purpura, arthritis, abdominal pain and nephritis. We report a case involving a 3‐year‐old girl with HSP who displayed rapidly evolving haemorrhagic bullae from primary purpuric lesions during systemic corticosteroid therapy. Conclusion: The bullae disappeared within 7 days of systemic corticosteroid therapy, although some scarring of the skin occurred. Also, bullae should not be considered as a poor prognostic factor of renal outcome in HSP.