Drug- and temperature-induced changes in peripheral circulation measured by laser-Doppler flowmetry and digital-pulse plethysmography

We measured the effects of a new transdermal nitroglycerin patch (25 mg, 10 cm2) applied for 24 h, norphenephrine (6 mg), prazosin (1 mg) as well as local heat and cold provocation on blood pressure, heart rate, skin blood flow (measured by laser-Doppler flowmetry, L-D) and peripheral arterial resistance (assessed by digital pulse plethysmography, D-P) in 15 healthy volunteers (aged 21-31 years). Heat provocation induced a three-fold increase in skin blood flow in the hand (p less than 0.001) and cold provocation a decrease in flow (p less than 0.05) of about 20%. Forehead skin blood flow did not change. Peripheral arterial resistance showed less consistent changes during the provocation tests. Prazosin increased the forehead skin blood flow (p less than 0.01) and decreased peripheral arterial resistance, while norphenephrine showed an opposite effect. Transdermal nitroglycerin induced an increase of 25% in forehead skin blood flow (p less than 0.05) which persisted for 24 h and a decrease in peripheral arterial resistance (p less than 0.02), but this effect was evident up to 8 h only. We conclude that (1) local heat and cold provocation mainly affected skin blood flow, (2) vasodilative and vasoconstrictive drugs showed marked changes in peripheral arterial resistance, but at different points in time from subject to subject, and (3) transdermal nitroglycerin patches induced haemodynamic changes persisting for up to 8-24 h.     

Electroconvulsive therapy in patients with depression and fibromyalgia

The effect of electroconvulsive therapy (ECT) on depression and other symptoms of fibromyalgia was studied in a prospective 3‐month trial in 13 patients with fibromyalgia and concomitant depression. All the patients met the DSM‐IV diagnostic criteria for Major Depressive Disorder and fulfilled the American College of Rheumatology diagnostic criteria for fibromyalgia. The Montgomery and Åsberg Depression Rating Scale (MADRS) and the clinical global impression scale (CGI) were used to assess the severity of depression and the clinical change of the patients. The fibromyalgia impact questionnaire (FIQ) was used to evaluate the severity of the fibromyalgia symptoms. The intensity of pain was evaluated using a 6‐point scale (0=no pain, 5=very severe pain), and tender point palpation. All assessments were performed at baseline and at follow‐up visits, which took place one week, one month and three months after ECT. There was a significant improvement in depression after ECT according to MADRS. Using CGI, six patients were much or very much improved, while four patients were minimally improved and three patients had no change. There was significant improvement in four out of ten FIQ item scores, “feel good”, “fatigue”, “anxiety” and “depression”. No significant change was found in the FIQ item scores “physical function”, “pain”, “stiffness” and “morning tiredness” or number of tender points and self‐reported pain. We conclude that ECT is a safe and effective treatment for depression in fibromyalgia patients, but has no effect on the pain or other physical symptoms of these patients.     

Noninvasive blood flow measurement over acupuncture points (Gb21): a pilot study

OBJECTIVE: Noninvasive evaluation of the cutaneous (cBF) and subcutaneous (sBF) blood flow over the acupuncture point (AP) Gb21 to assess a characteristically increased microcirculation at AP. BACKGROUND: AP show several anatomic, histologic and physiologic peculiarities that indicate a specifically elevated microcirculation. Nevertheless cBF and sBF over AP have not yet been established by noninvasive measurements. The laser Doppler spectroscope O2C allows a direct and real-time detection of the local cBF (depth: 1 mm) and sBF (depth: 8 mm) in vivo. METHODS: In 28 subjects (41.1+/-9.8 years) the glass fiber probes of the O2C were placed over Gb21 and an adjacent asymptomatic reference point (RP) at the Trapezius Muscle. The relative blood flow was measured over a period of 3 minutes in each case. Microcirculation comparisons over AP and RP were made using multivariate analysis of variance. RESULTS: The results showed significantly higher sBF compared to cBF over Gb21 (F = 89.95, p< 0.01) and RP (F = 88.47, p< 0.01). A significantly higher microcirculation was evaluated for all subjects over Gb21 compared to RP (cBF: F = 7.35, p< 0.05; sBF: F = 8.56, p< 0.01). CONCLUSION: The employment of the O2C permitted for the first time noninvasive evidence of a significantly increased cBF and sBF over AP (Gb21). This evaluation of an initial microcirculatory state of AP should be determined for several AP and larger sampling sizes. The results could be the basis for following controlled acupuncture trials. Regarding a close correlation of AP with myofascial trigger points (TP), further studies in patients with myoskeletal pain could quantify noninvasively a decreased perfusion in the area of TP that might indicate a pathologic condition. The findings of this study encourage the implementation of the laser Doppler spectroscope O2C as a reliable diagnostic tool for various pain syndromes in prevention, therapy, and rehabilitation.     

Pressure pain thresholds of tender point sites in patients with fibromyalgia and in healthy controls.

Pressure pain threshold (PPT) is defined as the minimum force applied which induces pain. This measure has proven to be commonly useful in evaluating tenderness symptom. Our aim was to study the intra-examiner reproducibility of PPT measurement, define cutoffs in normal groups, and compare these results with patients with fibromyalgia (FM). Fifty healthy females, 50 healthy males, and 20 patients with FM participated in the study. PPTs were assessed for 18 specific tender point sites by a dolorimeter. The intra-individual coefficient of variation determined by a test-retest PPT measurement procedure with 3-days interval reached, respectively, 17% and 13% in healthy females and males, versus 24% in patients with FM. PPTs were significantly lower in healthy females than in healthy males (p<0.01). Statistical analysis failed to show any differences between the dominant and nondominant side for both normal groups. PPTs were lower over all examined areas in patients with FM than those obtained in healthy females (p<0.000). Lower cutoff levels were calculated from normal values for all specific tender point sites. On average, 14 tender point sites in patients with FM were under the established lower cutoffs. In conclusion, pressure pain sensitivity was influenced by the anatomical localization of tender point and gender differences. Lowest PPTs were localized in trapezius, occiput, anterior cervical, and second rib. The reduction of total tender point score in patients with FM averaged 60% comparatively with normal values. PPT reproducibility and discrimination between the two groups were optimal for the gluteal and knee sites.     

口腔定位疗法联合特定穴位针刺对脑卒中后吞咽障碍的影响

目的:研究口腔定位疗法联合特定穴位针刺对脑卒中后吞咽障碍的影响。方法:按照病例纳入标准,选择脑卒中后吞咽障碍患者78例,随机分成对照组和治疗组,每组各39例。两组患者同时接受常规疗法,2周为1个疗程,连续治疗2个疗程。治疗组在第一疗程加用廉泉、风池、金津、玉液针刺,第二疗程进一步加用口腔定位疗法。于第一疗程、第二疗程后分别采用标准吞咽功能评价量表对两组患者吞咽功能进行评定,并对其临床疗效进行比较。结果:2个疗程后,两组患者的标准吞咽功能评价量表评分均低于治疗前(P<0.001),且治疗组患者的标准吞咽功能评价量表评分低于对照组(P<0.001)。治疗组第一、第二疗程的标准吞咽功能评价量表评分改善值及标准吞咽功能评价量表评分总改善值均高于对照组(P<0.01)。此外,对照组患者2个疗程的标准吞咽功能评价量表评分改善值差异无显著性(P>0.05),而治疗组患者第二疗程的标准吞咽功能评价量表评分改善值高于第一疗程(P<0.05)。结论:常规疗法联合特定穴位针刺能显著改善脑卒中后吞咽障碍,且疗效高于单纯常规疗法。此外,融入口腔定位疗法后的疗效明显优于单纯融入特定穴位针刺。     

针刺、压耳治疗脑卒中后顽固呃逆22例

BACKGROUND:The patients with acute cerebral infarction often suffer from stubborn hiccup and are difficult to cure.     

针刺背俞穴联合呼吸训练对脑卒中气切术后患者肺部感染的影响

目的:观察针刺背俞穴联合呼吸训练对脑卒中气切术后患者肺部感染的影响。方法:将60例卒中后气切合并肺部感染患者随机分为对照组和观察组,每组各30例。对照组接受基础治疗及呼吸训练,观察组在此基础上加用针刺背俞穴治疗。观察记录2组治疗前后的用力肺活量(FVC)、每分钟最大通气量(MVV)、呼气峰流速(PEF)、最大吸气压力(MIP)、最大呼气压(MEP)、C反应蛋白(CRP)、白细胞(WBC)计数和临床肺部感染评分(CPIS)。结果:治疗2周后,2组患者FVC、MVV、PEF均较治疗前有所提高(均P0.05),且观察组均高于对照组(均P0.05)。治疗后,2组患者MIP、MEP均高于治疗前(均P0.05),且观察组均高于对照组(均P0.05)。治疗后,2组CRP、WBC计数、CPIS评分均较治疗前下降(均P0.05),且观察组均低于对照组(均P0.05)。结论:针刺背俞穴联合呼吸训练可改善脑卒中气切术后患者的肺功能,增强呼吸肌肌力,进一步改善肺部感染情况。     

靳三针疗法结合康复训练治疗脑卒中后肩手综合征的疗效研究

目的:观察靳三针疗法结合康复训练对脑卒中后肩手综合征(SHS)患者治疗效果。方法:60例脑卒中后肩手综合征患者随机分为治疗组30例,对照组30例,治疗组给予靳三针疗法结合康复训练,对照组给予单纯康复训练,疗程28d。治疗前后采用上肢简化Fugl-Meyer评分(FMA)、视觉模拟量表(VAS)、功能综合评定量表(FCA)对患者的运动功能、疼痛及综合功能进行评定。结果:治疗后,两组患者的上肢运动功能、疼痛程度、综合功能与治疗前相比均有显著改善(P<0.01),且治疗组的改善程度明显优于对照组(P<0.01)。结论:靳三针疗法结合康复训练对脑卒中后肩手综合征患者有良好的疗效。     

Biochemical changes in relation to a maximal exercise test in patients with fibromyalgia

Summary. Patients with fibromyalgia often complain of fatigue and pain during exercise and of worsening of pain days after exercise. The aim of the study described here was to determine if abnormal changes in potassium or lactate could be observed during an exercise test in fibromyalgia. Whether an abnormal incline in plasma creatine kinase or myoglobin could be observed days after the test was studied also. Fifteen female fibromyalgia patients and 15 age- and sex-matched controls performed a stepwise incremental maximal bicycle-ergometer test. Blood samples were collected from a catheter in a cubital vein. The changes in heart rate, potassium levels, and haematocrit during the exercise test were similar in the two groups. The maximal obtained lactate concentration was 4-2 mmol 1^-1 (3–5-5-6) in the patients as compared to 4–9 mmol l^-1 (3–9-5-9) in the controls (NS). The estimated anaerobic threshold of 2 mmol 1^-1 was reached at a heart rate of 124 min^-1 in the patients with fibromyalgia as compared to 140 min^-1 in the controls (P= 0–02). In relation to workload, the patients scored higher on a Borg scale for perceived exertion during exercise, but if the Borg score was related to lactate no significant difference was found. The patients reported 86% and 79% of maximal pain in the thighs on the visual analogue scale 1 and 2 days after the test, but the creatine kinase and myoglobin concentrations were not increased.,     

20例颅脑术后尿潴留病人行腧穴热敏化艾灸治疗的效果观察

[目的]观察腧穴热敏化艾灸治疗颅脑术后病人尿潴留的效果.[方法]将40例颅脑术后尿潴留病人随机分为对照组和实验组,对照组病人采用心理疏导、诱导排尿法等常规护理方法,实验组在对照组的基础上加以腧穴热敏化艾灸治疗.观察两组病人尿潴留治疗的效果.[结果]实验组、对照组有效率分别为90%、75%,差异有统计学意义(P＜0.05).[结论]常规护理的基础上配合腧穴热敏化艾灸治疗能有效缓解尿潴留.     

针刺联合镜像疗法对脑卒中后偏瘫患者上肢运动功能的疗效观察

目的：观察针刺联合镜像疗法（MT）对脑卒中后偏瘫患者上肢运动功能的疗效。方法：选取脑卒中患者80例,按照随机数字表法将患者分为4组,对照组（A组）、针刺组（B组）、镜像组（C组）、联合组（D组）,每组20人。4组患者均进行常规综合康复训练,在此基础上,B组增加针刺治疗,C组增加MT,D组增加针刺治疗和MT。治疗前及治疗4周后评估4组Fugl-Meyer运动功能量表的上肢部分（FMA-UE）评分,改良Barthel指数（MBI）评分,Wolf上肢运动功能（WMFT）评分。结果：治疗后,4组FMA-UE评分、MBI评分、WMFT评分较治疗前均有所升高（P＜0.01）,上述3项评分：D组明显高于A、B、C组（P＜0.05）,B组高于A组（P＜0.05）,C组高于A组（P＜0.05）,B、C组间比较差异无统计学意义。结论：针刺联合镜像疗法能有效改善脑卒中偏瘫患者上肢运动功能,比单一使用针刺或镜像疗法更有利于偏瘫患者上肢运动功能的恢复。     

冠心病患者抗血小板治疗短期内血小板多项参数的变化趋势

目的:观察不同类型冠心病患者血小板活化、血小板聚集率,比较各组间差异及同组患者治疗前后血小板各项指标的变化.方法收集我院心内科2011年3月至2012年2月期间108例冠心病患者:分为稳定型心绞痛、不稳定型心绞痛、急性心肌梗死3组.入院时均查血小板活化指标PAC-1、CD62p和血小板聚集率(分别由AA或ADP诱导的),比较各组间上述指标的差异.按病情给予抗血小板治疗、PCI治疗及其他常规治疗,治疗10d后重复检查上述指标,比较治疗前后上述各项指标变化及治疗后各组患者与正常对照组间的差异程度.结果:入院时冠心病各组的PAC-1、CD62p阳性率、血小板聚集率水平均较对照组高(P＜0.05),而AMI组最为显著.治疗10d后各组CHD患者上述指标均较入院时明显降低(P＜0.01).治疗后,除SAP组患者CD62p对比对照组无明显差异,其余各组CD62p及各组PAC-1仍高于对照组(P＜0.05).结论:PAC-1、CD62p、血小板聚集率可作为早期发现冠心病、观察病情变化、实现个体化治疗的重要方法.     

Peripheral effects of needle stimulation (acupuncture) on skin and muscle blood flow in fibromyalgia.

Acupuncture has become a widely used treatment modality in various musculoskeletal pain conditions. Acupuncture is also shown to enhance blood flow and recovery in surgical flaps. The mechanisms behind the effect on blood flow were suggested to rely on vasoactive substances, such as calcitonin gene-related peptide, released from nociceptors by the needle stimulation. In a previous study on healthy subjects, one needle stimulation into the anterior tibial muscle was shown to increase both skin and muscle blood flow. The aim of this study was to examine the effect of needle stimulation on local blood flow in the anterior tibial muscle and overlying skin in patients suffering from a widespread chronic pain condition. Fifteen patients with fibromyalgia (FM) participated in the study. Two modes of needling, deep muscle stimulation and subcutaneous needle insertion were performed at the upper anterior aspect of the tibia, i.e., in an area without focal pathology or ongoing pain in these patients. Blood flow changes were assessed non-invasively by photoplethysmography (PPG). The results of the present study were partly similar to those earlier found at a corresponding site in healthy female subjects, i.e., deep muscle stimulation resulted in larger increase in skin blood flow (mean (SE)): 62.4% (13.0) and muscle blood flow: 93.1% (18.6), compared to baseline, than did subcutaneous insertion (mean (SE) skin blood flow increase: 26.4% (6.2); muscle blood flow increase: 46.1% (10.2)). However, in FM patients subcutaneous needle insertion was followed by a significant increase in both skin and muscle blood flow, in contrast to findings in healthy subjects where no significant blood flow increase was found following the subcutaneous needling. The different results of subcutaneous needling between the groups (skin blood flow: p=0.008; muscle blood flow: p=0.027) may be related to a greater sensitivity to pain and other somatosensory input in FM.     

Different patterns of blood flow response in the trapezius muscle following needle stimulation (acupuncture) between healthy subjects and patients with fibromyalgia and work-related trapezius myalgia.

Needle stimulation (acupuncture) has recently been shown to increase blood flow in the tibialis anterior muscle and overlying skin in healthy subjects (HS) and patients with fibromyalgia (FM). The aim of the present study was to examine the effect of needle stimulation on local blood flow in the trapezius muscle and overlying skin in HS and two groups of patients suffering from chronic pain in the trapezius muscle, i.e., FM and work-related trapezius myalgia (TM) patients. Two modes of needling, deep muscle stimulation (Deep) and subcutaneous needle insertion (SC), were performed at the upper part of the shoulder and blood flow was monitored for 60 min post-stimulation. Blood flow changes were measured non-invasively by using a new application of photoplethysmography. Increased blood flow in the trapezius muscle and overlying skin was found in all three groups following both Deep and SC. In HS, Deep was superior to SC in increasing skin and muscle blood flow, whereas in FM, SC was as effective as, or even more effective, than Deep. In the severely affected TM patients, no differences were found between the stimuli, and generally, a lesser blood flow response to the stimuli was found. At Deep, the muscle blood flow increase was significantly larger in HS, compared to the two patient groups. Positive correlations were found between muscle blood flow at Deep and pressure pain threshold in the trapezius muscle, neck movement and pain experienced at the stimulation, and negative correlations were found with spontaneous pain-related variables, symptom duration and age, pointing to less favorable results with worsening of symptoms, and to the importance of nociceptor activation in blood flow increase. It was hypothesized that the different patterns of muscle blood flow response to the needling may mirror a state of increased sympathetic activity and a generalized hypersensitivity in the patients. The intensity of stimulation should be taken into consideration when applying local needle stimulation (acupuncture) in order to increase the trapezius muscle blood flow in chronic pain conditions.     

针刺激痛点结合运动疗法治疗颞下颌关节紊乱病的临床观察

目的:观察针刺激痛点结合运动疗法对颞下颌关节紊乱病的疗效.方法:选取颞下颌关节紊乱病患者63例随机分为对照组31例和观察组32例,因治疗期间脱落3人,对照组和观察组各30例.2组均给予运动疗法包括筋膜手法、颞颌关节松动术配合宣传教育训练.观察组在对照组的基础上结合针刺激痛点的方法.在治疗前和治疗4周后,用疼痛视觉模拟评...     

针刺结合作业治疗对脑卒中单侧忽略后综合功能的影响

目的:探讨针刺结合个体化作业治疗对脑卒中单侧忽略患者综合功能的疗效。方法:对入住本院的脑卒中后偏瘫患者进行神经心理学评测,确定65例右大脑半球卒中后单侧空间忽略患者,随机分为3组:其中20例接受常规康复治疗为对照组,22例在常规康复基础上予个体化作业治疗为观察组,23例常规康复治疗同时予针刺结合作业治疗为实验组。3组患者治疗前后分别予功能独立性评定(FIM)、Fugl-Meyer运动功能评定(FMA)、简易精神状态检查(MMSE)。结果:①观察组和实验组治疗后FIM、FMA、MMSE评分组明显高于治疗前,对照组治疗前后无明显差异。②3组治疗前后FIM、FMA、MMSE评分差值的平均效应不全相同,经过两两比较,实验组FIM、FMA、MMSE评分差值均高于观察组和对照组,观察组3项评分差值均高于对照组。结论:在常规康复治疗基础上采取针刺治疗和个体化作业治疗能显著提高脑卒中后单侧空间忽略患者的康复疗效。     

隔姜施灸辅助治疗糖尿病胃轻瘫的效果观察

[目的]观察隔姜施灸辅助治疗糖尿病胃轻瘫的疗效。[方法]将60例糖尿病胃轻瘫病人随机分为两组各30例，两组均以降糖及中药治疗，治疗组加用隔姜施灸辅助治疗30d。[结果]治疗组恶心、上腹胀满、厌食、呕吐较对照组明显改善（P〈0．05），疗效优于对照组（P〈0．05）。[结论]隔姜施灸可健脾和胃、升清降浊、疏通气机，辅助治疗糖尿病胃轻瘫疗效显著。     

隔姜施灸辅助治疗糖尿病胃轻瘫的效果观察

[目的]观察隔姜施灸辅助治疗糖尿病胃轻瘫的疗效。[方法]将60例糖尿病胃轻瘫病人随机分为两组各30例,两组均以降糖及中药治疗,治疗组加用隔姜施灸辅助治疗30d。[结果]治疗组恶心、上腹胀满、厌食、呕吐较对照组明显改善(P<0.05),疗效优于对照组(P<0.05)。[结论]隔姜施灸可健脾和胃、升清降浊、疏通气机,辅助治疗糖尿病胃轻瘫疗效显著。     

针灸、生物电反馈并超声波治疗脑卒中后尿失禁106例分析

目的研究脑卒中后尿失禁患者尿动力学异常以及针灸、生物电反馈并超声波对脑卒中后尿失禁的治疗效果。方法脑卒中后尿失禁患者106例，行尿动力学检查，分析膀胱尿道功能；并将患者随机分为治疗组与对照组，对照组给予脑卒中常规治疗，治疗组在脑卒中常规治疗的基础上，给予针灸以及生物电反馈和超声波治疗。结果脑卒中后尿失禁主要尿动力学异常为逼尿肌反射亢进和尿道外括约肌无抑制性松弛。针灸、生物电反馈和超声波治疗能明显改善脑卒中后尿失禁症状。结论脑卒中后尿失禁患者尿动力学改变以逼尿肌反射亢进和尿道外括约肌无抑制性松弛为主，采用针灸、生物电反馈并超声波治疗脑卒中后尿失禁疗效满意。