磁渗药膏治疗跟痛症40例

磁渗药膏治疗跟痛症４０例上海市静安区中心医院（２０００４０）包祖良，许军跟痛症是指跟骨厢面着力点疼痛的病种，多系跟底部软组织（跖腱膜、跟骨下脂肪垫等）损害性疼痛，临床上并不少见。笔者自１９９４年３～４月间，应用磁渗药膏治疗４０例跟痛症，取得了满意疗效...     

盆底磁刺激联合点阵CO2激光治疗阴道松弛症疗效分析

目的：分析盆底磁刺激联合点阵CO₂激光治疗阴道松弛症(Vaginal laxity,VL)的疗效。方法：选取2020年12月-2021年8月于笔者科室就诊的VL患者118例，按随机数字表法分为磁刺激组(36例)、激光组(42例)和联合组(40例)。磁刺激组给予盆底磁刺激治疗，激光组给予阴道内点阵CO₂激光治疗，联合组给予盆底磁刺激治疗+阴道内点阵CO₂激光治疗。观察三组患者治疗前及治疗后3个月的阴道健康指数调查表(Vaginal health index score,VHIS)、女性性功能量表(Female sexual function index,FSFI)评分、阴道松弛度及盆底Ⅰ、Ⅱ类肌纤维肌力的变化情况。结果：治疗后3个月，激光组、联合组的VHIS、FSFI评分及阴道松弛程度改善情况均优于同组治疗前,并优于治疗后的磁刺激组(P<0.05)；磁刺激组、联合组的盆底Ⅰ、Ⅱ类肌纤维肌力改善情况均优于治疗前,并优于治疗后的激光组(P<0.05)。结论：与单一治疗相比，盆底磁刺激联合点阵CO₂     

磁刺激和碱性成纤维细胞生长因子对脊髓损伤早期的保护作用

目的探讨脊髓损伤后，应用磁刺激和外源性碱性成纤维细胞生长因子(bFGF)对损伤脊髓组织早期的保护作用。方法实验利用Allen WD(weight drop)技术，以致伤力(砝码质量10g，下落高度2．5cm)制成wistar大鼠T8脊髓损伤模型，治疗组分别于术后即刻、1h、2h、4h、24h分别予0．5HZ、70％输出强度的磁刺激，同时经蛛网膜下腔导管注入20ul bFGF，对照组不做处理。术后2h、6h、24h取治疗组、对照组动物损伤区脊髓组织作以下检测：用干湿法测水含量；用原子吸收光谱法测钙、镁离子含量；伤后5d取损伤脊髓组织，电镜观察脊髓结构。结果损伤区脊髓组织水含量增多，钙离子水平升高，镁离子水平下降，白质内髓鞘结构紊乱，囊性变严重；而应用磁刺激和bFGF可改善上述变化。结论脊髓损伤后应用磁刺激和bFGF可减轻脊髓损伤后的离子失衡，从而对继发性脊髓损伤具有保护作用。     

磁刺激腰骶部神经根的兴奋点及其在腰骶神经根病中的应用

采用磁刺激腰骶部的神经根运动诱发电位（MEPs）和磁刺激窝F波相结合的方法测定运动神经根传导时间（MRCT）。随机抽查50名正常受试者，在胫前肌（TA）和比目鱼肌（SOL）记录出可靠的运动神经传导时间（MNCT）和MRCT，并根据MRCT推算磁刺激腰骶部神经根的兴奋点位置，结合5例尸解测出的L5和S1神经根的长度，确定该兴奋点在椎间孔的近端。同样方法记录和观察40例手术证实单侧L5或S1神经根受压患者MNCT和MRCT的改变。结果显示：病人组与正常组相比MNCT无显著性差异，而MRCT有显著性差异，异常率为85％。作者认为，无痛无创的磁刺激MEPs对腰骶神经根病有很大的诊断价值。     

重复经颅磁刺激治疗脑卒中后中枢性疼痛的临床疗效研究

目的观察重复性经颅磁刺激（rTMS）对于脑卒中后中枢性疼痛的治疗作用。方法将47例脑卒中患者随机分为假刺激对照组、低频rTMS治疗组（1Hz）和高频rTMS治疗组（20Hz）。治疗前后3组均进行基础疼痛视觉模拟评分（VAS）,Mc—Gill疼痛问卷量表（MPQ）评分。结果治疗20天后,假刺激对照组无改善,低频rTMS治疗组部分患者有改善,总体较治疗前差异无显著性,高频rTMS治疗组改善明显,与治疗前比较差异有显著性（P〈0．05）。结论高频rTMS对脑卒中后中枢性疼痛有明显的缓解作用。     

磁刺激运动诱发电位在腰骶神经根病应用研究

作者采用磁刺激腰骶部运动诱发电位（ＭＥＰ）和磁刺激窝Ｆ波相结合的方法测定运动神经根传导时间（ＭＲＣＴ）．随机抽查５０名正常受试者在胫骨前肌（ＴＡ）和比目鱼肌（ＳＯＬ）记录出可靠的运动神经传导时间（ＭＮＣＴ）和ＭＲＣＴ；同样方法记录和观察４０例手术证实单例Ｌ５或Ｓ１神经根受压患者ＭＮＣＴ和ＭＲＣＴ的改变，同时进行节段性皮神经刺激皮层体感诱发电位（ＳＥＰ）对比．结果显示：病人组ＭＮＣＴ与正常组相比无显著性差异，而ＭＲＣＴ则有显著性差异．异常率为８５％，其明显高于ＳＥＰ的异常率４５％．因此，无痛无创的磁刺激ＭＥＰ对腰骶神经根病有很大的使用价值，而且磁刺激优于电刺激．     

经颅磁刺激和局部电刺激促进周围神经再生的组织学研究

目的　研究和比较经颅磁刺激和局部电刺激促进周围神经再生的组织学变化。方法　建立 2 0只大鼠坐骨神经损伤模型后 ,分别用经颅磁刺激动物头颅正上方 2cm处 (相当于运动皮层 ,为经颅磁刺激组 ) ,和直流点送电刺激坐骨神经缝合口近端 (局部电刺激组 )。刺激 2 0min·d-1× 2 0d ;每组 10只大鼠。术后 2 0d取材 ,观察 2组新生神经的形态学变化和有髓神经纤维数目。结果　电刺激组可见许多新生有髓神经纤维 ,但同时可见到有神经纤维髓鞘的退变现象。磁刺激组则有大量新生有髓神经纤维 ,髓鞘较薄但结构完整 ,板层清晰。经颅磁刺激组再生神经纤维的数目明显多于电刺激组 (P <0 0 5 )。结论　经颅磁刺激促进受损周围神经再生和恢复传导功能的作用优于局部电刺激。     

深部脑刺激操作中蛛网膜下腔应用阿片类药物控制慢性腰背痛

在进行为时较长的深部脑刺激操作时，慢性腰背痛患者可能无法忍受手术所要求的仰卧位。许多神经生理学家在进行深部脑刺激操作过程中，严格限制应用阿片类药物和镇静药物，理由是担心在放置刺激导联时这些药物会抑制用于大脑定位的细胞放电频率。本文所述2个病例，经蛛网膜下腔给予阿片类药物，可使慢性背痛患者长时间缓解疼痛，而并未影响在大脑定位中具有关键作用的细胞放电。     

磁扭力刺激人肺微血管内皮细胞模型的建立

目的 观察人肺微血管内皮细胞在磁扭力刺激后肌动蛋白骨架的变化.方法 人工合成整合素胞外保守肽段序列精氨酸-甘氨酸-天冬氨酸(Arg-Gly-Asp,RGD)包被磁珠与人肺微血管内皮细胞孵育2 h后,放入磁扭力刺激仪,通过磁珠的运动牵拉细胞2 h,荧光探针鬼笔环肽(FITC-phalloidine)染色肌动蛋白纤维.结果 磁珠与细胞共孵育2 h后,两者紧密结合;磁扭力刺激后应力纤维形成.结论 磁扭力刺激人肺微血管内皮细胞模型是实施细胞牵拉的理想模型.     

硬膜外脊髓电刺激镇痛

采用自制电极，在动物实验的基础上，以硬膜外阻滞穿刺方法将电极置入患者的硬膜外腔，观察了硬膜外脊髓电刺激的镇痛效果，并筛选了电刺激镇痛的各参数范围。结果表明，低电压、低频率硬膜外电刺激可有效地减轻疼痛，近期镇痛效果良好；电刺激参数为强度１～１０Ｖ,频率３～３０Ｈｚ。     

Effects of chronic alcohol intake and secretory stimulation on sodium taurocholate-induced pancreatic necrosis in the rat

The effects of long-term alcohol intake and pancreatic secretory stimulation on pancreatic necrosis were studied in rats with acute pancreatitis induced by an intraductal injection of sodium taurocholate. Neither alcohol nor pancreozymin alone influenced the extent of pancreatic tissue damage in this experimental model. However, when animals were exposed to both alcohol and pancreozymin, the tissue lesions induced by the bile salt were wider than those in the presence of either alcohol or secretory stimulation alone. The results indicate that secretory stimulation with pancreozymin superimposed on chronic alcohol intake sensitizes the pancreas to the injury caused by intraductal bile salt administration.     

Postoperative Left Prefrontal Repetitive Transcranial Magnetic Stimulation Reduces Patient-controlled Analgesia Use

Background: Several recent studies suggest that repetitive transcranial magnetic stimulation can temporarily reduce pain perception in neuropathic pain patients and in healthy adults using laboratory pain models. No studies have investigated the effects of prefrontal cortex stimulation using transcranial magnetic stimulation on postoperative pain.

Methods: Twenty gastric bypass surgery patients were randomly assigned to receive 20 min of either active or sham left prefrontal repetitive transcranial magnetic stimulation immediately after surgery. Patient-controlled analgesia pump use was tracked, and patients also rated pain and mood twice per day using visual analog scales.

Results: Groups were similar at baseline in terms of body mass index, age, mood ratings, pain ratings, surgery duration, time under anesthesia, and surgical anesthesia methods. Significant effects were observed for surgery type (open vs. laparoscopic) and condition (active vs. sham transcranial magnetic stimulation) on the cumulative amount of patient-delivered morphine during the 44 h after surgery. Active prefrontal repetitive transcranial magnetic stimulation was associated with a 40% reduction in total morphine use compared with sham during the 44 h after surgery. The effect seemed to be most prominent during the first 24 h after cortical stimulation delivery. No effects were observed for repetitive transcranial magnetic stimulation on mood ratings.     

Sacral magnetic stimulation in non-inflammatory chronic pelvic pain syndrome

OBJECTIVES: To prospectively evaluate sacral magnetic high-frequency stimulation as a treatment option for patients with non-inflammatory chronic pelvic pain syndrome (CPPS, category IIIB). PATIENTS AND METHODS: Fourteen men with CPPS IIIB were treated with high-frequency sacral magnetic stimulation, with 10 treatment sessions once a week for 30 min at a frequency of 50 Hz. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and quality-of-life index were determined before and after treatment. RESULTS: All patients tolerated the stimulation well and 12 of 14 reported agreeable sensations during stimulation. There were no complications; only one patient did not complete the treatment course. The mean (range) total NIH-CPSI score did not change with treatment, at 27 (18-38) before and 27 (4-40) after treatment. Moreover, there was no sustained effect on the mean scores for pain, micturition complaints or quality of life. CONCLUSIONS: High-frequency sacral magnetic stimulation in patients with CPPS IIIB only reduces pain during stimulation, with no sustained relief of symptoms. Therefore, intermittent sacral magnetic stimulation cannot be recommended as a treatment option for CPPS IIIB.     

Postoperative left prefrontal repetitive transcranial magnetic stimulation reduces patient-controlled analgesia use

BACKGROUND: Several recent studies suggest that repetitive transcranial magnetic stimulation can temporarily reduce pain perception in neuropathic pain patients and in healthy adults using laboratory pain models. No studies have investigated the effects of prefrontal cortex stimulation using transcranial magnetic stimulation on postoperative pain. METHODS: Twenty gastric bypass surgery patients were randomly assigned to receive 20 min of either active or sham left prefrontal repetitive transcranial magnetic stimulation immediately after surgery. Patient-controlled analgesia pump use was tracked, and patients also rated pain and mood twice per day using visual analog scales. RESULTS: Groups were similar at baseline in terms of body mass index, age, mood ratings, pain ratings, surgery duration, time under anesthesia, and surgical anesthesia methods. Significant effects were observed for surgery type (open vs. laparoscopic) and condition (active vs. sham transcranial magnetic stimulation) on the cumulative amount of patient-delivered morphine during the 44 h after surgery. Active prefrontal repetitive transcranial magnetic stimulation was associated with a 40% reduction in total morphine use compared with sham during the 44 h after surgery. The effect seemed to be most prominent during the first 24 h after cortical stimulation delivery. No effects were observed for repetitive transcranial magnetic stimulation on mood ratings. CONCLUSIONS: A single session of postoperative prefrontal repetitive transcranial magnetic stimulation was associated with a reduction in patient-controlled analgesia pump use in gastric bypass surgery patients. This is important because the risks associated with postoperative morphine use are high, especially among obese patients who frequently have obstructive sleep apnea, right ventricular dysfunction, and pulmonary hypertension. These preliminary findings suggest a potential new noninvasive method for managing postoperative morphine use.     

A new concept in the measurement of neuromuscular transmission and block.

The discovery of the safety margin of neuromuscular transmission has brought forth the requirement for an improvement in the clinical examination of curarization, since the safety margin, i.e. the reserves, should also be measured. For this purpose a peripheral nerve stimulator and an electromechanical recorder unit have been produced, suitable for both the examination of manifest curarization and of the neuromuscular reserves. The measurements of muscle relaxation are performed making use of 30 Hz stimulation, while the safety margin of neuromuscular transmission is measured using stimulation at 200 Hz one.     

Hemodynamic study of penile erection in dogs

Full erection by the optimal electrical stimulation of the cavernous nerves was induced in dogs anesthetized with pentobarbital and the hemodynamics of the corpus cavernosum investigated. In 7 dogs, the divided internal pudendal arteries were cannulated and perfused with constant and adjustable arterial inflow. Before nerve stimulation, this increase in flow raised the intracorporeal pressure (ICP). The same change in flow during nerve stimulation resulted in an elevation of ICP. Furthermore, nerve stimulation at zero flow condition elicited a significant increase in ICP. The results suggest that full penile erection requires nerve stimulation during high flow state (constant flow above 25 ml/min). The ICP cannot reach a maximum by passive increase in flow alone. The increase in ICP by nerve stimulation at zero flow condition indicates the existence of a contractile element around the corpus cavernosum or the venous compartment. This mechanism may not be essential for penile erection, but it may serve to change the flow-pressure relationship in the corpus cavernosum.     

Lumbosacral Cerebrospinal Fluid Volume Is the Primary Determinant of Sensory Block Extent and Duration during Spinal Anesthesia

Background: Injection of local anesthetic into cerebrospinal fluid (CSF) produces anesthesia of unpredictable extent and duration. Although many factors have been identified that affect the extent of spinal anesthesia, correlations are relatively poor and the extent of spread remains unpredictable. This study was designed to determine whether variability in the volume of lumbosacral CSF among individuals is a contributing factor in the variability of spinal anesthesia.

Methods: Spinal anesthesia was administered to 10 healthy volunteers with 50 mg lidocaine in 7.5% dextrose. The technique was standardized to minimize variability in factors known to affect the distribution of spinal anesthesia. The extent of sensory anesthesia was assessed by pin-prick and by transcutaneous electrical stimulation. Motor blockade was assessed in the quadriceps and gastrocnemius muscles by force dynamometry. Duration of anesthesia was assessed by pin-prick, transcutaneous electrical stimulation, and duration of motor blockade. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and sacral axial magnetic resonance images obtained at 8-mm increments. Volumes of CSF were correlated with measures of extent and duration of spinal anesthesia using the Kendall rank correlation test.

Results: Lumbosacral CSF volumes ranged from 42.7 to 81.1 ml. Volumes of CSF correlated with pin-prick assessments of peak sensory block height (P = 0.02) and duration of surgical anesthesia (as assessed by the duration of tolerance to transcutaneous electrical stimulation at the ankle (P < 0.05).     

Magnetstimulation des Beckenbodens beim älteren Menschen

Since 2001 magnetic stimulation therapy has been available in Germany for treating urinary incontinence as an alternative to traditional electrical stimulation therapy. The results of 83 patients who underwent magnetic stimulation therapy for stress incontinence, OAB, and pelvic pain syndrome were evaluated. The results differed depending on the underlying disease. Patients with stress incontinence who could not properly contract pelvic floor muscles before could do so in 74% when clinically evaluated and patients with OAB symptoms improved in 54% as assessed by objective and subjective criteria, whereas patients with pelvic pain syndrome only benefited in 23%. Comparison of the results according to age revealed no significant difference between patients >65 years and younger patients.     

Magnetic stimulation of the pelvic floor in older patients. Results of a prospective analysis

Since 2001 magnetic stimulation therapy has been available in Germany for treating urinary incontinence as an alternative to traditional electrical stimulation therapy. The results of 83 patients who underwent magnetic stimulation therapy for stress incontinence, OAB, and pelvic pain syndrome were evaluated. The results differed depending on the underlying disease. Patients with stress incontinence who could not properly contract pelvic floor muscles before could do so in 74% when clinically evaluated and patients with OAB symptoms improved in 54% as assessed by objective and subjective criteria, whereas patients with pelvic pain syndrome only benefited in 23%. Comparison of the results according to age revealed no significant difference between patients >65 years and younger patients.     

Blood Supply to the Latissimus Dorsi Muscle and Muscle Performance During Co- or Counterpulsatile Stimulation for Circulatory Assist

Abstract: For the application of the latissimus dorsi muscle (LDM) to circulatory assist, the muscle is stimulated with co- or counterpulsation during the cardiac cycle. The purpose of this study was to evaluate the blood supply to the LDM and its muscular performance during each respective stimulation. The origin of the LDM was connected to a tension gauge, a potentiometer, and 1 kg of weight in series. The LDM was stimulated at a ratio of 1:1 of heart to muscle contraction for 10 min. Copulsatile stimulation made thoracodorsal arterial flow (TDF) pre dominant during cardiac diastole. In counterpulsatile stimulation, TDF occurred predominantly during cardiac systole. Between the 2 patterns of stimulation, no significant differences were observed in the mean TDF rate during 1 cardiac cycle. The maximal force, maximal contrac tion length, and power of the LDM also did not differ significantly. These results suggest that despite the difference of the TDF profile, LDM performance may be com parable between co- and counterpulsatile stimulation for the application of the LDM to circulatory assist.