偏头痛经皮神经低频电刺激疗法及临床应用研究

<正>目前非药物治疗偏头痛主要采用神经调制。神经调制可分为有创非药物治疗和无创非药物治疗两大类,有创治疗主要包括脑深部电刺激、运动皮质刺激、脊髓电刺激以及外周神经刺激等治疗方法。无创治疗主要包括经皮神经电刺激和经颅磁刺激等多种方法~([1])。经皮神经电刺激(TENS)属于非药物电磁疗法~([2]),因其在治疗偏头痛无创、简单同时伴有极小不良反应而受到越来越多的关注。TENS是通过皮肤将特定的低频脉冲电流输入人体以治疗疼痛的电疗方法,可分为传统型、电针型和强刺激型三种~([3])。TENS目前主要采用经皮神经低频电刺激疗法,通过适当强度频率的电流连续刺激神经、肌肉和细胞,激发身体自然产生吗啡,阻断和舒缓疼痛信息,     

2/100Hz经皮穴位电刺激治疗青少年网瘾ET结果的初步探讨

目的:使用脑电超慢涨落分析技术(ET),初步探讨2/100Hz经皮穴位电刺激治疗网络成瘾的脑机制。方法:26名被试随机分成对照组和治疗组。对照组12人,接受模拟经皮穴位电刺激;治疗组14人,接受经皮穴位电刺激。比较两组被试12个脑区内γ氨基丁酸(GABA)、谷氨酸(Glu)、乙酰胆碱(Ach)、去甲肾上腺素(NE)的含量。结果:与对照组相比,2/100Hz经皮穴位电刺激治疗1d后,可显著升高治疗组被试F3、C3、F7、T6脑区GABA含量(P<0.05,P<0.01,P<0.001,P<0.05);显著降低F7、T6脑区Glu含量(P<0.01,P<0.05);显著升高T6脑区NE的含量(P<0.05)。治疗5d后,与对照组相比,治疗组被试Glu含量在F7脑区显著降低(P<0.05)。结论:2/100Hz经皮穴位电刺激通过降低脑内Glu含量来发挥对青少年网络成瘾的治疗作用。     

吗啡对糖尿病神经病理痛大鼠机械及冷刺激痛敏症状的影响

目的探讨吗啡对糖尿病神经病理痛大鼠机械及冷刺激痛敏症状的影响。方法35只SD雄性大鼠(180～220 g)腹腔注射链脲佐菌素(STZ)制备成糖尿病神经病理痛模型,出现痛敏症状后,随机分为5组,采用von Frey测试针和冷板(5度)法,测量鞘内给予吗啡后不同时间机械缩腿阈值和冷刺激后的抬足次数(次/5min)变化。结果吗啡以剂量依赖方式提高糖尿病神经痛大鼠机械缩腿阈值、降低冷刺激后的抬足次数,给予吗啡后30 min,0.5、1.0、5.0μg剂量吗啡组的机械缩腿阈值明显增高,而冷刺激抬足次数分别为显著下降,分别与用药前和对照组相比,差异有统计学意义(P<0.05)。结论吗啡能显著提高糖尿病神经痛大鼠的机械缩腿阈值,有效减少冷刺激的抬足次数,对神经源性痛具有明显的镇痛作用。     

经皮电刺激治疗脱毒后期稽延性戒断症状的疗效观察

目的:对经皮电刺激治疗脱毒后期稽延性戒断症状的效果进行观察。方法:采用LH202H韩氏穴位神经刺激仪(HANS),对76例海洛因依赖者,196人次相应经络穴位电刺激。结果:缓解最明显的症状依次是肌肉关节疼痛95.83%,烦躁不安94.59%和四肢麻痹不适93.33%。临床治疗总有效率83.78%。治疗前后症状比较P<0.01,差异有显著性。结论:根椐临床症状选择适宜的穴位、频率、波形和时间,经皮电刺激治疗对稽延性戒断症状的改善有明显效果。     

经皮穴位电刺激“足三里”对海训士兵血红蛋白的影响

目的观察经皮穴位电刺激“足三里”疗法对海训士兵血红蛋白的影响。方法将40名士兵随机分成治疗组和对照组,治疗组在海训前进行经皮穴位电刺激足三里穴,对照组无任何处理,分别观察士兵海训前后血红蛋白、红细胞、心率的变化。结果对照组士兵海训后血红蛋白浓度、红细胞数量明显降低（P〈0.01）,心率明显加快（P〈0.01）;治疗组士兵海训后血红蛋白浓度、红细胞数量无明显降低（P〉0.05）,并高于对照组（P〈0.01）,心率虽明显加快（P〈0.01）,但幅度低于对照组（P〈0.01）。结论海训前行经皮穴位电刺激疗法能提高机体血红蛋白浓度和红细胞含量,从而延缓士兵海训疲劳的发生。     

加巴喷丁联合经皮神经电刺激治疗带状疱疹后遗神经痛临床观察

目的 观察加巴喷丁联合经皮神经电刺激治疗带状疱疹后遗神经痛的疗效.方法 40例带状疱疹后遗神经痛患者,随机分成两组,A组(n=20)给予口服加巴喷丁治疗;B组(n=20)服用与A组相同剂量加巴喷丁,同时在其患处给予每日1次经皮神经电刺激治疗,分别观察两组患者治疗前以及治疗后3d,5d,7d,14d,28d的疼痛程度变化,以视觉模拟评分(VAS)评定治疗效果.结果 治疗后两组患者VAS评分均明显下降(P＜0.05),且B组VAS评分明显低于A组(P＜0.05).结论 加巴喷丁联合经皮神经电刺激是治疗带状疱疹后遗神经痛的一种有效方法.     

颏孔区解剖结构研究进展

近年来随着颏部美容手术、正颌外科和牙种植术的广泛开展,为了避免术中损伤下牙槽神经血管束、颏神经血管束,造成术中出血、骨板侧穿及术后下唇颏部麻木、感觉丧失等并发症的发生,颏孔周围的解剖结构逐渐引起了人们的重视,其相应的测量研究也越来越多。本文就颏孔区解剖结构的研究进展作简要综述。     

电致孔和离子导入对胰岛素经皮渗透的促进作用

目的研究电致孔(EP)和离子导入(ION)对胰岛素经皮渗透的影响。方法以水平双室扩散池的方法,研究电致孔与离子导入联合应用对胰岛素经皮渗透的促进作用,并与单独使用离子导入或电致孔进行比较。结果 电致孔与离子导入联用比单独离子导入显著增加胰岛素的经皮渗透性(P<0.05),且高电压比低电压电致孔离子导入显著增加胰岛素的渗透速率(P<0.01)。胰岛素离子导入前,500 V电压,给90次脉冲(指数衰减脉冲,每次脉冲持续时间20～24 ms,3次·min^-1),导致了透皮流速(Flux)的快速稳定增加。结论电致孔和离子导入联用能明显促进大分子胰岛素的经皮渗透性。     

依帕司他联合生物电刺激治疗糖尿病周围神经病变疗效观察

目的观察依帕司他联合生物电刺激治疗糖尿病周围神经病变的疗效。方法选择 2017年 1月至 2018年 12月在赤峰学院附属医院诊治的糖尿病周围神经病变病人 90例作为研究对象，根据随机数字表法，将其分为依帕司他组，生物电刺激组(TENS组)和联合治疗组，每组各 30例。三组均进行 4周治疗，依帕司他组以 50毫克 /次， 3次/天剂量口服依帕司他，生物电刺激组以 8分钟 /次， 2次/天频率进行经皮电神经刺激，联合组采取两者结合治疗，用法用量与上述相同，随访 1周。观察并比较各组疗效，检测并比较各组治疗前后血清超氧化物歧化酶(SOD)、丙二醛、 8?羟基脱氧鸟苷酸(8?OHdG)水平、震动感觉阈值和神经电生理情况。结果依帕司他组有效率 73.3%，TENS组有效率 70.0%，联合治疗组有效率 96.7%，三组间差异有统计学意义(χ2＝7.917，P＝0.019)。治疗前三组血清 SOD、丙二醛、 8?OHdG水平、腓总神经、正中神经传导速度和 VPT数值差异无统计学意义(P＞0.05)治疗后三组 SOD水平、腓总神经及正中神经传导速度明显增加，丙二醛、8?OHdG水平及 VPT数值明显降低(均 P＜0.05)，且以联，合治疗组改善程度最为明显(P＜0.016 7)。结论依帕司他联合生物电刺激治疗糖尿病周围神经病变可明显改善症状和神经传导速度，提高机体抗氧化能力，具有较高临床应用价值。     

2/100Hz经皮穴位电刺激对27例青少年网络成瘾症的治疗作用

目的:评价2/100Hz经皮穴位电刺激对青少年网络成瘾症的影响。方法:治疗组18人,施以2/100Hz经皮穴位电刺激(HANS);对照组9人,给予模拟经皮穴位电刺激(假HANS)。分别治疗3d后,比较两组治疗前后的平均上网时间、累计上网率以及网瘾症综合评分。结果:(1)治疗组每天上网时间由768.22min±s77.15min降至324.44min±s29.26min;对照组前后分别是652.22min±s90.61min和634.44min±s81.97min。表明治疗组与对照组之间差异具有显著性(P<0.05)。(2)治疗组网瘾症综合评分的中位值由6减至3,与对照组的6相比差异也具有显著性(P<0.05)。(3)两组的网上中位生存期分别是33h和32.5h,两组的网上生存率没有统计学差异。结论:2/100Hz经皮穴位电刺激能够有效地减少青少年网络成瘾者的上网时间,也能能够明显地抑制网瘾综合征,目前尚不能明显地减少累计上网率。     

Local transcutaneous electrical stimulation (TENS) effects in experimental inflammatory edema and pain

Few studies in the literature associated transcutaneous electrical stimulation (TENS) use with an antiinflammatory activity. The purpose of this study was to investigate the effects of low (10 Hz)- and high (130 Hz)-frequency TENS on hyperalgesia and edema that occur after injection of carrageenan in rat paw. After induction of inflammation, either low- or high-frequency TENS was applied in the rat paw for 20 min, and the effect of TENS treatment on escape or paw withdrawal and edema was measured. Both low- and high-frequency TENS inhibited by 100% the hyperalgesia but not the edema response. However, low-frequency TENS presented longer lasting effect as compared with high-frequency TENS. Naltrexone-treated animals showed a complete reversion of the analgesic effect induced by low- but not high-frequency TENS. Thus, our data demonstrated absence of an antiinflammatory effect associated to TENS use and confirmed the participation of endogenous opioids on low TENS-induced analgesia.     

Camptothecin accumulation and variations in camptotheca

Camptotheca (Nyssaceae) is a major source of anticancer camptothecin (CPT). It is imperative to understand CPT accumulation and variations in Camptotheca in order to develop CPT production strategies for endangered germplasm. Our study results showed that CPT is primarily accumulated in glandular trichomes of leaves and stems, and CPT content varies among species and varieties but even more significantly within the plant (with different tissues, tissue ages, and seasons). Because of higher CPT yield and desirable biological and ecological features, 'Hicksii' and 'Katie' should be considered the major management germplasm as CPT sources in the future. Young leaves and mature fruits have higher CPT contents than other tissues in the plants. Young photosynthetic leaves and stems contain higher CPT contents than old ones, but 'sink' tissues such as wood, roots, and fruits show different patterns. CPT content also shows a great seasonal change, but is less influenced by tree age. Intact clipping of young leaves and stems should be managed for harvest for CPT production. Preservation and treatment methods influence the CPT extraction. CPT is better preserved in fresh or freeze-dried material than in air or oven-dried material. CPT can be more efficiently extracted after homogenizer treatment of plant materials because more trichome walls can be broken to allow solvent extraction.     

Electron paramagnetic resonance (EPR) study of spin-labeled camptothecin derivatives: a different look of the ternary complex

Camptothecin (CPT) derivatives are clinically effective poisons of DNA topoisomerase I (Top1) able to form a ternary complex with the Top1-DNA complex. The aim of this investigation was to examine the dynamic aspects of the ternary complex formation by means of site-directed spin labeling electron paramagnetic resonance (SDSL-EPR). Two semisynthetic CPT derivatives bearing the paramagnetic moiety were synthesized, and their biological activity was tested. A 22-mer DNA oligonucleotide sequence with high affinity cleavage site for Top1 was also synthesized. EPR experiments were carried out on modified CPT in the presence of DNA, of Top1, or of both. In the last case, a slow motion component in the EPR signal appeared, indicating the formation of the ternary complex. Deconvolution of the EPR spectrum allowed to obtain the relative drug amounts in the complex. It was also possible to demonstrate that the residence time of CPT "trapped" in the ternary complex is longer than hundreds of microseconds.     

原发性三叉神经痛应用针刺神经孔及神经节治疗的效果分析

目的 探讨应用针刺神经孔及神经节治疗原发性三叉神经痛的效果.方法 收集2015年9月至2016年9月入院的80例原发性三叉神经痛患者随机分为两组,对照组患者予以常规针刺治疗,实验组患者则予以针刺神经孔及神经节治疗,比较两组患者治疗前后疼痛程度与积分、总体治疗效果与不良反应率.结果 实验组患者治疗后VAS、疼痛范围、疼痛程度、分支数量、触发状况、持续时间、发作频次与疼痛总积分组间比较均显著低于对照组(P＜0.01),治疗期间不良反应率显著低于对照组(P＜0.01),愈显率明显高于对照组(P＜0.05).结论 应用针刺神经孔及神经节治疗原发性三叉神经痛的效果显著,具有借鉴意义.     

SYSTEMIC ADENOSINE INCREASE DURING COLD PRESSOR TEST IS DEPENDENT ON SYMPATHETIC ACTIVATION

1. Following local vasoconstriction-inducing stimuli, such as the cold pressor test (CPT), significant changes occur in haemodynamics, with a rise in arterial blood pressure and heart rate (HR) due to the activation of the sympathetic nervous system. Among the compensatory mechanisms to local ischaemia, the endogenous nucleoside adenosine (ADO) has been suggested to play a relevant role by contributing to sympathetic stimulation. The possibility was investigated that CPT-induced increases in plasma ADO levels were not only an expression of the increased production of ADO in the ischaemic area, but also a consequence of systemic sympathoexcitatory mechanisms, thus showing a bidirectional involvement of the mechanisms of ADO formation. 2. The CPT was performed in 15 volunteers and mean arterial blood pressure (MABP) and HR were evaluated, together with plasma levels of noradrenaline (NA) and ADO in the tested and contralateral arm. The 15 subjects were then divided into three groups of five that were treated with either 5 mg transdermal clonidine weekly, 100 mg atenolol daily or 600 mg aminophylline twice daily. After 1 week treatment, the same test was repeated in the respective groups. 3. The CPT induced a rise in MABP and HR and an increase in plasma levels of NA and ADO. Increases in ADO were more pronounced in the tested arm. Clonidine blunted the haemodynamic response and NA release, while increases in ADO increase were reduced to a greater extent in the contralateral arm rather than the tested arm. Atenolol only affected MABP and HR without any effect on NA and ADO levels. Theophylline did not show any effect on CPT-induced changes. 4. In conclusion, local vasoconstriction and ischaemia induced in one arm following CPT are associated with haemodynamic changes dependent on the activation of the sympathetic system. The observed increase in plasma levels of ADO seems to be, in part, a direct expression of local responses to ischaemia (pre-dominant in the tested arm), but also appears as the consequence of systemic sympathoexcitatory mechanisms. Such increases in ADO are not dependent on a beta 1-adrenoceptor-mediated mechanism. Finally, theophylline, at a therapeutic dose, has no effect on the response to CPT.     

Spinal muscarinic receptors are activated during low or high frequency TENS-induced antihyperalgesia in rats

Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological modality used clinically to relieve pain. Central involvement of serotonin and endogenous opioids are implicated in TENS-induced analgesia. Activation of spinal cholinergic receptors is antinociceptive and these receptors interact with opioid and serotonin receptors. In the current study, the possible involvement of spinal cholinergic receptors in TENS analgesia was investigated in rats. Hyperalgesia was induced by inflaming one knee joint with 3% kaolin–carrageenan and assessed by measuring paw withdrawal latency (PWL) to heat before and 4 h after injection. The non-selective nicotinic antagonist mecamylamine (50 μg), non-selective muscarinic antagonist atropine (30 μg) or one of the muscarinic subtype antagonists: pirenzepine (M₁, 10 μg), methoctramine (M₂, 10 μg), 4-DAMP (M₃, 10 μg), or saline was administered intrathecally just prior to TENS treatment. Low or high frequency TENS was then applied to the inflamed knee and PWL was determined again. Atropine, pirenzepine and 4-DAMP significantly attenuated the antihyperalgesic effects of low and high frequency TENS while mecamylamine and methoctramine had no effects, compared to saline control. The results show that TENS-induced antihyperalgesia is mediated partially by activation of spinal muscarinic receptors but not spinal nicotinic receptors. Further, the results also indicate that spinal M₁ and M₃ muscarinic receptor subtypes mediate the muscarinic component of TENS antihyperalgesia.     

喜树碱/聚天冬氨酸衍生物-接枝-聚乙二醇共聚物胶束的制备及性质研究

目的制备喜树碱/聚天冬氨酸衍生物-接枝-聚乙二醇的聚合物胶束,并对其化学结构进行表征。方法采用透析法制备喜树碱/聚合物胶束,采用动态激光散射法、透射电镜和核磁共振法测定胶束的粒径、形态及药物分布,采用高效液相色谱法测定喜树碱含量。结果喜树碱/聚合物胶束近似球形,粒径小于50nm,分布较窄,喜树碱被包裹在胶束内,在pH7.4的缓冲液中孵育12h,溶液组喜树碱70%被破坏,而被胶束组喜树碱仅有20%被破坏;在小鼠血浆中孵育12h,溶液组喜树碱90%多被破坏,而胶束组喜树碱约23%被破坏,喜树碱/聚合物胶束在pH7.4的介质中释药接近Higuchi模型。结论聚天冬氨酸衍生物-接枝-聚乙二醇聚合物胶束对喜树碱具有保护作用。     

甘油注射治疗原发性三叉神经痛临床分析

目的探索甘油封闭治疗原发性三叉神经痛的作用。方法对40例原发性三叉神经痛患者采用眶下孔、腭大孔、上牙槽后神经、下颌孔、颏孔注射纯甘油,观察罹患神经支配区注射前后面部感觉功能的改变,角膜反射、视力、下颌运动以及有无疱疹、麻痹、无茵性脑膜炎等并发症。结果随访6—24个月,疼痛完全缓解占80．00％,12月复诊复发率为22．58％,24月复诊复发率为16．66％,未发现严重并发症。结论甘油封闭治疗原发性三叉神经痛安全可靠,并发症少。     

Effect of methylglyoxal bis(guanylhydrazone) on hepatic, heart and skeletal muscle mitochondrial carnitine palmitoyltransferase and beta-oxidation of fatty acids

Methylglyoxal bis(guanylhydrazone) (MGBG) is an antileukemic agent and a structural polyamine analogue which inhibits S-adenosyl methionine decarboxylase. However, MGBG also produces profound mitochondrial structural damage and inhibition of fatty acid oxidation. Carnitine palmitoyltransferase-A (CPT-A) is located on the outer surface of the inner mitochondrial membrane and is the putative rate-controlling enzyme for mitochondrial long-chain fatty acid oxidation. The present experiments were designed to determine if MGBG inhibits CPT-A. Liver, heart and skeletal muscle mitochondria were isolated from rats following 24 hr of starvation. Measuring the reaction in the direction of palmitoylcarnitine plus CoA formation from palmitoyl-CoA plus carnitine ("forward reaction"), MGBG was competitive with l-carnitine. The MGBG CPT-A Ki values were (mM): liver, 5.0 +/- 0.6 (N = 15); heart 3.2 +/- 1.2 (N = 3); and skeletal muscle, 2.8 +/- 1.0 (N = 3). Lysis of hepatic mitochondria with Triton X-100 yielded a Ki of 4.0 +/- 2.0, which was not significantly different from intact mitochondria or inverted vesicles (4.9 mM). Purified hepatic CPT had a Ki of 4.2 mM. MGBG did not inhibit purified CPT in the "reverse reaction" (palmitoyl-CoA plus carnitine formation from palmitoylcarnitine plus CoA). Spermine and spermidine, which are structurally similar to MGBG, did not inhibit either CPT activity or acid-soluble product formation from 1-[14C]palmitoyl-CoA. MGBG inhibited mitochondrial state 3 oxidation rates of palmitoyl-CoA and palmitoylcarnitine, as well as of glutamate. However, the fatty acid substrates were considerably more sensitive than glutamate to MGBG inhibition. MGBG also increased hepatic mitochondrial aggregation which was reversed by l-carnitine. Fluorescence polarization, using 1,6-diphenyl-1,3,5-hexatriene (DPH) as a probe, indicated that MGBG increased membrane rigidity in a dose-dependent manner. This effect was not altered by l-carnitine. MGBG also inhibited purified pigeon breast carnitine acetyltransferase (CAT; Ki = 1.6 mM). While MGBG appeared to be competitive with l-carnitine for both CPT and CAT, MGBG also exhibits a number of effects which may be mediated through membrane interaction and which are not reversed by carnitine.     

Antinociceptive action of captopril and transcutaneous electric nerve stimulation in Mus musculus mice

1. In the present study, the antinociceptive action of captopril was investigated, as well as its association with transcutaneous electric nerve stimulation (TENS), in mice under nociceptive stimulation. 2. The modulation of abdominal contortions (writhes) produced by acetic acid was observed in order to evaluate captopril pain stimuli blockade. 3. The administration of captopril produced a significant reduction of nociception, which was further reduced when captopril was associated with TENS. 4. Apparently this increase in the inhibition of nociception was produced by an indirect mechanism, involving opioid liberation by TENS and an enzymatic inhibition induced by captopril and this may lead to clinical applications of captopril and TENS association in pain relief.