Change in the interferential current therapy — induced sensory threshold on the bodies of elderly people

It is widely known that interferential current therapy (ICT) decreases the noxious effects of stimulation-induced pain without skin resistance. However, no studies have investigated the change in sensory threshold and time-dependent stimulus by applying ICT on regions of the body. The objective of the present study is to examine the difference in sensory threshold when electrical stimulation is applied to the low back, shoulder, and knee joint regions in elderly people. The results showed that the sensory threshold was significantly decreased in the shoulder compared with the low back and knee joint regions. The sensory threshold tended to increase in the older age group. The change in sensory threshold was significantly time-dependent, increasing after stimulation for 5, 10, and 15 min compared with 0 min in all ages. Furthermore, in response to the application of ICT, the sensory threshold revealed a time-dependent response; the sensory threshold tended to increase with age, particularly in the lower back and knee joint regions. Therefore, these results at least partially suggest that the change in sensory threshold is associated with age. Awareness of this change in sensory threshold is necessary in the development of specialized physical therapy for the healthy rehabilitation of senile patients.     

Analysis of high-frequency transcutaneous electrical nerve stimulation-induced sensory threshold from the elderly people for healthy life

It is generally known that transcutaneous electrical nerve stimulation (TENS) decreases the threshold of pain and release of catecholamine by mechanical and chemical stimulation. However, there have been no studies to find the change in the sensory threshold and time-dependent stimulus by TENS on the body regions. The present study was to examine the difference of sensory threshold by electrical stimulation at low back and scapulodorsal and knee joint regions in the elderly people. The sensory threshold was significantly increased in the lower back compared with the shoulder and knee joint regions. The sensory threshold tended to increase in the older age group, increasing particularly in subjects in their 80s. The change of the sensory threshold was significantly associated with a time-dependent manner, increasing after stimulation from 5, 10, and 15 min compared with 0 min for all ages. Furthermore, the sensory threshold in response to the application of TENS revealed a time-dependent response, with the sensory threshold tending to increase with age, in particular, in the lower back region. Therefore, these results at least partially suggest that the change of sensory threshold is associated with age, and that needed of the development of senile specialized physical therapy for healthy life.     

肩关节镜下双排缝合桥技术治疗老年肩袖损伤46例

目的 探讨肩关节镜下双排缝合桥修复手术对老年肩袖损伤病人疼痛、手臂与肩部功能障碍（DASH）评分及再撕裂发生率的影响。方法 回顾性分析2018年8月至2020年2月阜阳市第二人民医院收治的89例老年肩袖损伤病人的临床资料,依照手术方法的不同划分成对照组（肩关节镜下单排铆钉固定）、治疗组（肩关节镜下双排缝合桥修复手术）,分别为43例、46例。于术前、术后1年采用视觉模拟评分法（VAS）评定患肩疼痛度,采用手臂与肩部功能障碍（DASH）评分量表评定肩关节功能,测量患肩关节前屈、外展活动度,并统计两组1年内再撕裂发生率。通过logistic回归分析确定病人术后再撕裂发生的影响因素。结果 术后1年两组不同撕裂程度病人VAS、DASH评分及患肩关节前屈、外展活动度与同组术前相比均明显改善（均P<0.05）,术后两组轻度撕裂病人上述指标改善情况比较差异无统计学意义（均P>0.05）,而治疗组中、重度撕裂病人上述指标改善情况均明显较对照组优（均P<0.05）;治疗组再撕裂发生率4.35%明显较对照组的23.26%低（P<0.05）;年龄、手术方式是病人术后再撕裂发生的影响因素...     

SYMPATHETIC MODULATION OF SENSORY NERVE ACTIVITY WITH AGE: HUMAN AND RODENT SKIN MODELS

1. Sensory nerves serve an afferent role and mediate neurogenic components of inflammation and tissue repair via an axon reflex release of sensory peptides at sites of injury. Dysfunction of these nerves with age could contribute to delayed tissue healing. 2. Complementary animal and human skin models were used in the present studies to investigate changes in the modulation of sensory nerve function by sympathetic efferents during ageing. Laser Doppler flowmetry was used to monitor neurogenic skin vascular responses. 3. The animal model used skin of the hind footpad of anaesthetized rats combined with electrical stimulation of the sciatic nerve, while the human model comprised capsaicin electrophoresis to the volar surface of the forearm. Sympathetic modulation was effected by systemic phentolamine pretreatment in animals and local application in the human model. 4. The results obtained from the human model confirmed the reported decline in sensory nerve function and showed no change in sympathetic modulation with age. The results from the animal model confirm and expand results obtained from the human model. 5. The use of low (5 Hz) and high (15 Hz) frequency electrical stimulation (20 V, 2 ms for 1 min) revealed a preferential response of aged sensory nerves to low-frequency electrical stimulation parameters with differential sympathetic modulation that is dependent on the frequency o. stimulation.     

Nociceptive threshold and analgesic response to morphine in aged and young adult rats as determined by thermal radiation and intracerebral electrical stimulation

The present experiment compared the nociceptive threshold and analgesic response to morphine in young (4-5 months) and aged (24 months) rats using peripheral thermal stimulation and intracerebral electrical stimulation. Responses to thermal stimuli were assessed using both the classical tail-flick procedure in which latency of response is the dependent variable and a new method in which threshold in calories of heat is the dependent variable. In the intracerebral nociceptive threshold procedure, electrical stimuli were delivered via an electrode implanted in the mesencephalic reticular formation (MRF), a pain pathway, and the animals were trained to terminate the stimulation by turning a cylindrical manipulandum embedded in one wall of the experimental chamber. For the classical tail-flick method, the aged rats required a greater intensity of stimulation to produce a basal response latency that was between 2.5 and 3.5 s. Using the new psychophysical method for determining the tail-flick threshold, the aged rats' basal thresholds were significantly higher than that of the young rats. However, the basal thresholds obtained by direct stimulation of the MRF failed to show a significant age effect, suggesting that the registration of pain is not different between young and aged rats. These age-related differences in baseline tail-flick response may be due to changes in the spinal reflex associated with aging. Although, there was no difference in the analgesic effects of morphine between young and aged rats using the latency of the tail-flick response, evidence for decreased analgesic response was seen using the tail-flick threshold measure and the intracerebral stimulation threshold method.     

玻璃酸钠治疗早、中期膝关节骨性关节炎的疗效分析

目的探讨玻璃酸钠(SH)关节腔内注射对膝关节骨性关节炎的疗效。方法将84例患者随机分为玻璃酸钠注射组(SH)和物理治疗组(对照组),对两组患者治疗前后进行膝关节功能综合评分,并对68例随访患者分别于治疗后3个月、6个月、1年时评定疗效。结果治疗时间太短膝关节功能综合评分两组无统计学差异;随访结果疗效优良率SH组明显优于对照组。结论关节腔内注射玻璃酸钠治疗早、中期膝关节骨关节炎远期疗效持久、稳定。     

穴位注射联合中药综合疗法治疗膝骨性关节炎临床疗效观察

目的观察穴位注射联合中药综合疗法治疗膝骨性关节炎的临床疗效。方法将100例膝骨性关节炎患者随机分为治疗组和对照组各50例。治疗组采用穴位注射联合中药综合治疗,对照组口服氨基葡萄糖片、维生素C和美洛昔康片。2组均以1个月为1个疗程。治疗后比较2组临床疗效及症状总积分变化情况。结果治疗组治疗后X线分级Ⅰ级、Ⅱ级患者优良率高于对照组,差异有统计意义(P<0.05),2组总有效率比较差异无统计学意义(P>0.05)。治疗后2组症状总积分均较治疗前明显下降,治疗组X线分级Ⅰ级、Ⅱ级患者治疗后症状总积分低于对照组,差异均有统计学意义(P<0.05或P<0.01)。结论穴位注射联合中药综合疗法治疗膝骨性关节炎能有效改善临床症状。     

Effects of low frequency electrical stimulation on the change of male sex hormones in normal men

It is widely known that electrotherapy decreases the pain by mechanical and chemical stimulation. However, there have been no studies to find the change in the sex hormones by acupoint electrical stimulation for healthy rehabilitation. This study examines the effects that electrical stimulation of volunteers’ meridian points has on their levels of total testosterone, dehydroepiandrosterone sulfate (DHEA-S), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and other erectile dysfunction-related substances. A serum analysis showed that electrical stimulation using a 1 Hz current significantly increased the subjects’ concentrations of total testosterone and DHEA-S; however, there were no significant differences in the concentrations of FSH, LH, and prolactin in subjects treated with electrical stimulation. These results suggest that the increased responsiveness to electrical stimulation, particularly a current of 1 Hz continue type, may be partially related to an improvement in sexual functions.     

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。     

浅谈血友病性骨关节病的X线表现

目的：结合本院收集的多个病例,分析血友病性骨关节病的X线表现,提高对该病的认识。方法结合本院多年来收集的20例血友病性骨关节病的临床与X线表现,并分析文献所见。结果20例病例中均为多发,其中单侧膝关节合并单侧肩关节12例,双侧膝关节8例,双侧膝关节并单侧肩关节13例;均可见股骨髁间窝明显增宽加深,关节间隙明显变窄15例,轻度变窄5例。7例见肱骨外科颈处见分叶状囊样透亮区。结论血友病的关节受累常出现于容易受伤和承受重力的四肢大关节,膝关节最为常见,股骨髁间凹的变宽、变深,髌骨呈方形,被认为是血友病较特征的表现。     

Intra-articular Botulinum Toxin Type A: A new approach to treat arthritis joint pain

There is a growing need for novel treatments of refractory arthritis joint pain as the aging population is expanding with many patients who are unable to undergo joint replacement surgery. We are studying the efficacy and safety of intra-articular injection of Botulinum Toxin Type A (IA-BoNT/A) into joints with arthritis pain. In several small open label studies, initial effects for IA-BoNT/A were encouraging because two thirds of the patients had more than 50% reduction in joint pain severity that was associated with a significant improvement in function. Importantly no serious adverse effects of IA-BoN/A were noted. Based on these initial results, we have completed two pilot randomized controlled trials in painful shoulder joints and painful knee joints. In the shoulder study, IA-BoNT/A produced a significant decrease in shoulder pain severity at one month (6.8-4.4 on VAS, p = .002) that was also significantly better than the non-significant change after IA-Saline placebo (1.6 unit difference favoring IA-BoNT/A, p = .014). In the knee study IA-BoNT/A produced a significant 48% decrease in McGill Total Pain Score at one month (p = .01 1) that was still significant at 3 mo after injection (p = .002). There was a strong placebo response in one third of those but the decrease in pain severity was not significant. We are currently conducting a RCT of IA-BoNT/A for painful prosthetic knee joints. Based on these initial studies of IA-BoNT/A we have gone ‘back to the bench’ to standardize a menu of pain behaviors for mice with acute inflammatory arthritis pain and chronic inflammatory arthritis pain. IA-BoNT/A significantly reduced arthritis joint tenderness (evoked pain score) in acute and chronic inflammatory arthritis and normalized impaired spontaneous wheel running in mice with chronic inflammatory arthritis but not in those with acute inflammatory arthritis. With these models of arthritis and pain behavior methods we will be able to screen potential intra-articular analgesics, define dose response curves and injection schedule, and study the relationships of articular pain and loss of function.     

Effects of peripherally and centrally acting analgesics on somato-sensory evoked potentials.

1. The effects of aspirin 1000 mg, paracetamol 1000 mg, codeine 60 mg on somatosensory evoked potentials (SEPs) were measured in a four-way cross-over study. 2. SEPs were elicited by electrical stimulation of the skin overlying the digital nerve at intensities close to pain threshold. 3. Amplitudes and latencies of both early and late SEPs were recorded, as well as first sensory threshold and subjective pain threshold. 4. None of the study medications affected the amplitude or latency of the late SEP components (100-250 ms post-stimulus). The amplitude of early components (15-30 ms post-stimulus) was also unaffected, but aspirin shortened the latency 30 min after ingestion. 5. Sensory detection and pain threshold to electrical skin stimulation were also unaffected by any of the study medications despite subjective central effects with codeine.     

Shuttlebox self-stimulation in the rat: An anatomical analysis and the effect of morphine with two current levels

A shuttlebox paradigm was used to train rats to turn electrical stimulation ON and OFF by crossing back and forth in a stabilimeter cage. Two experiments are presented. In the first experiment a threshold current level was used in testing four electrode sites: the lateral hypothalamic area (LHA), lateral septal nucleus (LSN), periaqueductal grey (PAG), and the mesencephalic reticular formation (MRF). In the second experiment, a suprathreshold current level was used to explore two electrode sites: the PAG and the MRF. Stimulation with electrodes in the MRF produced an aversive behavioral response; animals shuttled mainly to turn electrical stimulation OFF. At the other electrode sites, both rewarding and aversive properties were apparent: animals shuttled to turn the stimulation ON as well as OFF. Systemic morphine (10 mg/kg) injections nonselectively increased both average ON and OFF times for the three rewarding sites (minimum p<0.05) at the threshold current level. Systemic morphine injections (10 mg/kg) in animals stimulated at a suprathreshold current level in the PAG selectively increased time spent with stimulation ON (p<0.05) as opposed to time spent with stimulation OFF. No significant behavioral change due to morphine was seen in the aversive MRF at either current level. Animal behavior also was found to vary as a function of site of stimulation (p<0.05). The use of suprathreshold currents appears necessary to produce selective reward facilitation effects of morphine such as those found in the PAG or LHA.     

超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的效果

目的 探讨超声引导下腰丛-坐骨神经阻滞在老年膝关节镜手术中的应用实效性.方法 选择80例老年择期行膝关节镜手术患者,按随机数字表法平均分为观察组和对照组各40例,观察组患者使用超声引导下腰丛-坐骨神经阻滞,对照组患者使用硬膜外麻醉,比较两组患者麻醉效果、感觉神经及运动神经阻滞情况、血流动力学变化及不良反应发生率.结果 观察组麻醉优良率为95.0％,对照组麻醉优良率为90.0％,两组比较,差异无统计学意义(χ2=0.62,P>0.05);两组感觉神经与运动神经麻醉起效时间比较,差异无统计学意义(t=1.874、1.189,P>0.05);两组感觉神经阻滞、运动神经阻滞、镇痛效果的持续时间比较,均差异有统计学意义(t=8.729、8.948、5.275,P<0.05);观察组患者血流动力学指标收缩压(SBP)、舒张压(DBP)及心率(HR)在麻醉各时期差异无统计学意义(P>0.05),对照组患者SBP及DBP在T2及T3时刻均较T0和T1时刻明显降低,差异有统计学意义(P<0.05),而且T2及T3下,两组SBP及DBP比较,对照组低于观察组,均差异有统计学意义(P<0.05);观察组不良反应发生率为7.5％,对照组不良反应发生率为40.0％,差异有统计学意义(χ2=11.67,P=0.001).结论 随着可视化技术在麻醉中推广应用,使得神经阻滞技术定位准确,麻醉完善,负影响小,对临床有一定指导意义.     

钙对小鼠疼痛阈的影响

小鼠静脉注射氯化钙可抑制醋酸所致扭体反应,也提高小鼠对热刺激的痛阈值,证明钙有镇痛作用。但并不提高小鼠对电刺激的痛阈。异搏定则对上述三种致痛作用均无对抗。     

关刺配合手法治疗对老年膝骨性关节炎疼痛程度和运动功能的影响

目的 观察经筋关刺法配合郑氏手法治疗老年膝骨性关节炎疼痛程度和运动功能的影响.方法 将68例老年膝骨性关节炎患者随机分为实验组(经筋关刺及郑氏手法组)与对照组(普通电针组).以临床疗效、Lysholm评分、膝HSS评分为观察指标,比较两组治疗方法对膝关节疼痛程度和运动功能的影响.结果 疗效评估:实验组有效率94.1%,优于对照组.Ly-sholm评分项目:闭锁感、肿胀度、楼梯攀爬得分均得到较大程度的改善,且实验组优于对照组(P<0.05).膝HSS评分项目:疼痛、功能、活动度得到较大程度的改善,且实验组优于对照组(P<0.05).结论 经筋关刺法配合郑氏手法发挥了良好的协同效应,恢复膝关节周围力学的平衡,能更有效的改善老年患者的膝关节疼痛程度及运动功能,适合老年患者,对老年膝骨性关节炎有显著疗效.     

关节镜下半月板成形术对老年膝关节半月板损伤患者术后膝关节功能的影响

目的:探究关节镜下半月板成形术对老年膝关节半月板损伤患者术后膝关节功能的影响。方法:选取某院2016年3月~2018年3月老年膝关节半月板损伤患者74例,采用随机数字表法分为对照组(n=37)与观察组(n=37)。对照组行关节镜下半月板切除术,观察组行关节镜下半月板成形术,对比两组疗效及术前、术后6个月国际膝关节文献委员会膝关节评估表(IKDC)、Lysholm评分。结果:观察组优良率97.30%较对照组78.38%高(P<0.05);术后6个月两组IKDC、Lysholm评分高于术前,且观察组高于对照组(P<0.05)。结论:老年膝关节半月板损伤患者采用关节镜下半月板成形术治疗,可改善膝关节功能,疗效显著。     

Peripheral and spinal components of the sensitization of spinal neurons during an acute experimental arthritis

In cats the injections of kaolin and carrageenan into the knee joint lead to an acute arthritis which develops within 1-3 hours. In parallel articular afferents (low, high threshold and unresponsive ones) are becoming (more) sensitive to movements in the working range of the joint and many show (enhanced) ongoing discharges. Consequently spinal nociceptive-specific and wide dynamic range neurons with afferent input from the inflamed knee develop (increased) responsiveness to gentle stimulation of the joint. But in addition most of these neurons display enhanced reactions to non-inflamed parts of their receptive fields, too, and some neurons show enlargement of their total receptive fields. These latter findings indicate that the sensitization of spinal neurons is not simply reflecting the increased afferent input from the inflamed knee but that intrinsic spinal mechanisms may participate in the sensitization process.     

沙利度胺致月经不调简

1 例28 岁女性患者,主诉左膝关节肿痛3 年,腰背痛及左髋关节疼痛2 年.左膝关节肿痛起病,腰背痛伴有晨僵及夜间痛,双足跟疼痛,无虹膜炎及强直性脊柱炎（AS）家族史.化验HLA-B27 阳性,ESR 36 mm·h-1,CRP 3.48 mg·dL-1,骶髂关节CT示双侧骶髂关节虫蚀样改变,诊断为强直性脊柱炎,给予洛索洛芬钠及柳氮磺吡啶治疗后,患者左髋关节疼痛好转,但腰背痛症状改善不明显,加用沙利度胺（50 mg,qn）,2 周后给药剂量调至100 mg,qn.服用4 个月后,腰背痛症状明显减轻,晨僵及夜间痛消失,但逐渐出现月经量减少至停经,停用沙利度胺2 个月后症状好转.     

Etofenamate levels in human serum and synovial fluid following iontophoresis.

The absorption of etofenamate (CAS 30544-47-9, Rheumon gel) by iontophoresis in 11 patients with low back pain and in 13 patients with synovitis of the knee was evaluated. During the 5-day treatment period, the test gel in a quantity corresponding to 100 mg etofenamate was applied to affected body regions every day by 20-min iontophoresis sessions. Two hours after the fifth application, the concentration of etofenamate in serum and synovial fluid (in patients who had knee joint iontophoresis) were measured by HPLC. Iontophoresis of etofenamate into the lumbar region as well as to the knee joint resulted in consistent serum levels: 219 +/- 136.3 micrograms/l and 191 +/- 84.6 micrograms/l, respectively. In patients with synovitis of the knee, the synovial level of etofenamate (368 +/- 109.2 micrograms/l) was almost twice as high than the serum concentration. The authors conclude that with topical application of etofenamate by iontophoresis the drug appears not only in the serum but also--with higher levels--in the synovial fluid.