Mckenzie手法联合肌内效贴布对运动后下腰痛患者的临床观察

目的观察Mckenzie手法联合肌内效贴布对运动后下腰痛的临床疗效。方法下腰痛患者共77例,按就诊顺序,以随机数字表将患者分为治疗组39例与对照组38例。治疗组予Mckenzie手法联合肌内效贴布治疗,对照组予肌内效贴布治疗。在入选时及治疗2个疗程后分别对两组患者进行ODI腰痛失能问卷表、Roland-Morris功能障碍调查表和VAS表进行评分,同时对过敏性与安全性进行评价。结果治疗2个疗程后两组患者ODI腰痛失能问卷表、Roland-Morris功能障碍调查表得分和VAS评分前后组内比较差异有统计学意义(P<0.01);治疗组较对照组评分差异有统计学意义(P<0.05)。治疗组无过敏及不良事件发生。结论Mckenzie手法联合肌内效贴布可以明显改善运动后下腰痛患者腰部、下肢疼痛等主要症状,并在一定程度上改善腰部的功能,可作为安全有效的康复手段之一,其远期疗效及作用机制尚待进一步研究。

盐酸川芎嗪注射液参麦注射液合用治疗慢性肺心病失代偿期临床观察

通过对30例肺心病失代偿期患者在基础疗法上加用盐酸川芎嗪注射液并参麦注射液综合治疗,并与另外30例对照组比较,显效率明显优于对照组。

刘永家教授高血压病辩治经验

高血压病是当今临床上的常见病、多发病,其临床症状多以头晕,头痛,心悸等症状为主,故本病当属中医＂眩晕＂、＂头痛＂、＂中风＂等范畴。导师刘永家教授,四川省名老中医,硕士生导师,从事中医治疗心血管疾病多年，运用中医药治疗高血压病有较好的疗效。笔者有幸从师侍诊，现将导师诊治高血压病的经验总结如下。

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

Objective To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries. Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period. Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05). Conclusion In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions com-pared with fentanyl.

Fast track clinical pathway implications in esophagogastrectomy

AIM： To investigate the feasibility of fast track clinica pathway for esophageal tumor resections. METHODS： One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition. Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation. RESULTS： Among 114 patients （84 men and 30 women）, 26 patients underwent fast track surgery, including 17 patients over 65 years old and 9 under 65 （P = 0.014）; 18 patients who had preoperative complications could not bear fast track surgery （P 〈 0.001）. No significant differences in tolerance of fast track surgery were attributed to differences in gender, differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d （5-28 d）, 4% patients were readmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%. All 3 patients had no determinacy to fast track surgery approach.CONCLUSION： The majority of patients with esophageal carcinoma can tolerate fast track surgery. Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.

Clinical Application of the Du Channel

The authors have, in recent years, obtained quite good therapeutic results in their acupuncture treatment of mental diseases, heat syndromes and cerebrovascular diseases through treating mainly the Du Channel with the methods of resuscitating and regulating the mind, and clearing and activating the channels and collaterals. The illustrative cases are reported below.

Moxibustion eases chronic inflammatory visceral pain through regulating MEK, ERK and CREB in rats

AIM To investigate the effects of herb-partitioned moxibustion(HPM) on phosphorylation of mitogen-activated extracellular signal-regulated kinase(MEK)1, extracellular signal-regulated kinase(ERK)1/2 and c AMP response element binding protein(CREB) in spinal cord of rats with chronic inflammatory visceral pain(CIVP), and to explore the central mechanism of HPM in treating CIVP.METHODS Male Sprague-Dawley rats were randomized into normal, model, HPM, sham-HPM, MEK-inhibitor and dimethyl sulfoxide(DMSO) groups. The CIVP model was established using an enema mixture of trinitrobenzene sulfonic acid and ethanol. HPM was applied at bilateral Tianshu(ST25) and Qihai(CV6) acupoints in the HPM group, while in the sham-HPM group, moxa cones and herb cakes were only placed on the same points but not ignited. The MEK-inhibitor and DMSO groups received L5-L6 intrathecal injection of U0126 and 30% DMSO, respectively. Abdominal withdrawal reflex(AWR), mechanical withdrawal threshold(MWT) and thermal withdrawal latency(TWL) were applied for the assessment of pain behavior. The colonic tissue was observed under an optical microscope after hematoxylin-eosin staining. Expression of phosphor(p)MEK1, p ERK1/2 and p CREB in rat spinal cord was detected using Western blotting. The levels of MEK, ERK and CREB m RNA in rat spinal cord were detected using real-time polymerase chain reaction. RESULTS Compared with the normal group, the AWR scores were increased significantly(P < 0.01) and the MWT and TWL scores were decreased significantly(P < 0.05) in the model, sham-HPM and DMSO groups. Compared with the model group, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly in the HPM and MEK-inhibitor groups(P < 0.05). Compared with the sham-HPM and DMSO groups, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly(P < 0.05) in the HPM and MEK-inhibitor groups. Compared with the normal group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were increased significantly in the model, sham-HPM and DMSO groups(P < 0.01 or < 0.05). Compared with the model group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). Compared with the sham-HPM and DMSO groups, expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). CONCLUSION HPM down-regulates protein phosphorylation of MEK1, ERK1/2 and CREB, and m RNA expression of MEK, ERK and CREB, inhibiting activation of the MEK/ERK/CREB signaling pathway in the spinal cord of CIVP rats, which is possibly a critical central mechanism of the analgesic effect of HPM.

Clinical Application of Same-Name Channel Point Selection

The namesake channel point selection is a method adopted in acupuncture treatment, in which the points on the six pairs of channels on the upper and lower extremities with same names are selected and needled. Clinically, this method is mainly used for some acute soft tissue injuries, for instance, needling point Yangchi (TE 4) with reducing method for sprain of external malleolus, needling Qiuxu (GB 40) with reducing method for sprain of dorsal carpus, and needling Tiaokou (ST 38) for lateral shoulder pain. The therapeutic effect given by this point selection method is often superior to that given by the conventional needling method. In clinical practice, the author has found some typical cases, which respond well to this method, and reports them below.

EFFECTS OF ACUPUNCTURE ON IMMUNE RESPONSE RELATED TO OPIOID-LIKE PEPTIDES

Experimental research has recently shown that acupuncture induces the formation of opioid-like peptides (OLPs) in animals. In order to provide further evidence, we tested the beta-endorphin levels and other parameters (VIP, lymphocyte subsets, NK cells and monocyte phagocytosis) in a group of 90 patients suffering from various painful disorders treated with acupuncture. Zusanli (St 36) and Hegu (LI 4) acupoints were selected. A homogeneous group of 30 subjects was used as control. Evaluation of the above parameters was made with 3 series of blood tests before treatment, 30 minutes and 24 hours after acupuncture treatment. In the acupuncture group, the following results were achieved: 1) A considerable increase in beta-endorphin levels remained high even 24 hours after acupuncture treatment. In addition, we demonstrated an inverted correlation between beta-endorphins and VIP; 2) 30 minutes after acupuncture session, 80% of the treated patients showed a significant increase of CD3 and CD4 values and an increase of CD8 24 hours after stimulation; 3) Monocyte phagocytosis was increased in 45% of the treated subjects 30 minutes from starting treatment, and in 100% of them after 24 hours. The percentage of NK cells was also increased in 40% of cases after 30 minutes, and in 50% after 24 hours. However, in the control group, no such significant changes in immune parameters were found.

Role of muscle spindle in weightlessness-induced amyotrophia and muscle pain

To date, the medium and long-term space flight is urgent in need and has become a major task of our manned space flight program. There is no doubt that medium and long-term space flight has serious damaging impact upon human physiological systems. For instance, atrophy of the lower limb anti-gravity muscle can be induced during the space flight. Muscle atrophy significantly affects the flight of astronauts in space. Most importantly, it influences the precise manipulation of the astronauts and their response capacity to emergencies on returning to the atmosphere from space. Muscle atrophy caused by weightlessness may also seriously disrupt the normal life and ＇work of the astronauts during the re-adaptation period. Here we summarize the corresponding research concentrating on weightlessness-induced changes of muscular structure and function. By combining research on muscle pain, which is a common clinical pain disease, we further provide a hypothesis concerning a dynamic feedback model of ＂weightlessness condition → muscular atrophy ←→ muscle pain＂. This may be useful to explore the neural mechanisms underlying the occurrence and development of muscular atrophy and muscle pain, through the key study of muscle spindle, and furthermore provide more effective therapy for clinical treatment.

Research Progress of Acupuncture Analgesia for Labor

Labor pain is a kind of severe pain the lying-in women of natural childbirth must undergo. The labor quality is decided by the tolerance to pain. Acupuncture analgesia for labor pain has been increasingly concerned and applied by more and more clinical workers because of its safety and efficacy. By summarizing and analyzing the choice and applications of various factors of acupuncture analgesia for labor pain such as acupoint selection, instrument analgesic coefficient, and the needling techniques in acupuncture analgesia for labor pain in the recent 12 years, this study aims to provide a theoretical foundation for the clinical application of acupuncture analgesia for labor pain.

一曲封建社会的挽歌──简析“哀感顽艳”的纳兰性德词风的形成原因

历来认为＂衷感顽艳＂是纳兰性德的词风，但就其形成原因却很少有人深究，本文不同意＂不健康的情绪＂、＂隐逸和享乐的表现＂、＂消极思想＂的陈说，从时代社会、家世、个人三方面剖析了纳兰词风的形成原因，从而理解纳兰隐蔽幽微的内心世界。悲伤的时代精神给纳兰词笼上了一层厚厚的愁云惨雾，表面高贵实际已矛盾重重的家世，又让纳兰＂微察忧危＂、＂警于满盈＂；人生理想不能实现，再加上失妻之痛等人生不如意之事，更让他悲从中来，不可抑止。所有这一切便是形成纳兰词风的内外因。

Clinical Application of Moxibustion on Guanyuan(CV 4)

Guanyuan （CV 4） is located 3 cun below the umbilicus, on the midline of abdomen. It is the Front-Mu Point of the Small Intestine, a crossing point of Three Yin Meridians of Foot and Conception Vessel. It can warm the kidney to invigorate yang, tonify the Yuan-Primordial qi, dredge and regulate Thoroughfare and Conception Vessels,

Study on the Relation Between MRI Findings and Acupuncture Effect in Trigeminal Neuralgia Patients

Objective： To observe the relationship between acupuncture and MRI （Magnetic Resonance Imaging） findings in patients with trigeminal neuralgia （TN）. Methods： A total of 32 idiopathic TN patients who completed acupuncture treatment protocol were recruited in this trial. The relationship between acupuncture effect and MRI findings were analyzed by using MRI-B-FFE （Balanced Fast Field Echo） technique to record MRI information, such as the distance from the brainstem to the contact point of offending vessels and trigeminal nerve, the contact angle of offending vessels and trigeminal nerve, and the ratio of the diameter of the contact vessel to trigeminal nerve width. Results： After acupuncture treatment, 9 cases got marked effect, 19 got improvement, and 4 got no effect. Acupuncture effect was neither associated with the distance from the brainstem to the contact point of the offending vessel and trigeminai nerve （P〉0.05） nor the ratio of the diameter of the offending vessel to trigeminal nerve width （P〉0.05）; however, it was indeed associated with the running course of the offending vessels （P〈0.05）. Conclusion： The bigger the angle between the offending vessels and trigeminal nerve, the poorer the acupuncture effect. The B-FFE technique can be used for screening acupuncture-indicated TN patients.