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Objective To explore the efficacy of early hyperbaric oxygen therapy(HBOT)combined with median nerve electrical stimulation(MNES)in the treatment of severe traumatic brain injury(sTBI)and its impact on hemodynamics,coma degree,and neurological function of patients.Methods A total of 78 patients with sTBI admitted to the General Hospital of Western Theater Command from March 2020 to October 2021 were selected as the research subjects.The patients were randomly divided into the control group and the observation group,with 39 patients in each group.The patients in both groups underwent basic treatments such as water,electrolyte and acid-base balance,nutritional support,anti-infection,and decompressive craniectomy.On this basis,patients in the control group received early HBOT,while patients in the observation group received both HBOT and MNES.Their clinical efficacy was compared between the two groups.Before and after treatment,dual-channel transcranial Doppler ultrasound was performed to detect hemodynamic indicators such as peak systolic blood flow velocity(Vs),mean blood flow velocity(Vm),and pulsatility index(PI)in the middle cerebral artery of patients in the two groups.The Glasgow Coma Scale(GCS)score was used to evaluate the degree of coma of patients in the two groups,the National Institutes of Health Stroke Scale(NIHSS)score was used to assess the neurological deficits of patients in the two groups,and the enzyme-linked immunosorbent assay was used to measure the levels of central nervous system specific protein(S100-β),glial fibrillary acidic protein(GFAP),and myelin basic protein(MBP).Complications during treatment of patients in the two groups were recorded,and their incidence was compared.Results The total effective rate of patients in the control and observation groups was 79.49％(31/39)and 92.31％(36/39),respectively.The total effective rate in the observation group was significantly higher than that in the control group(x2=8.971,P＜0.05).There was no significant difference in Vm,Vs,and PI between the two groups before treatment(P＞0.05).After treatment,the Vm and Vs in both groups were significantly higher than those before treatment,while the PI was significantly lower than that before treatment(P＜0.05);and the Vm and Vs in the observation group were signifi-cantly higher than that those in the control group,while the PI was significantly lower than that in the control group(P＜0.05).There was no significant difference in GCS and NIHSS scores between the two groups before treatment(P＞0.05).After treatment,the GCS score in both groups was significantly higher than that before treatment,while the NIHSS score was significantly lower than that before treatment(P＜0.05);and the GCS score in the observation group was significantly higher than that in the control group,while the NIHSS score was significantly lower than that in the control group(P＜0.05).There was no significant difference in S100-β,GFAP,and MBP levels between the two groups before treatment(P＞0.05).After treatment,the S100-β,GFAP,and MBP levels in both groups were significantly lower than those before treatment(P＜0.05),and the S100-β,GFAP,and MBP levels in the observation group were significantly lower than those in the control group(P＜0.05).During treatment,the incidence of complications in the control and observation groups was 23.08％(9/39)and 20.51％(8/39),respectively,showing no significant difference(x2=2.328,P＞0.05).Conclusion Early HBOT combined with MNES shows good efficacy in treating sTBI,which can effectively improve the patients'hemodynamic level,alleviate the severity of coma,enhance neurological function,and promote early recovery of consciousness,without increased risk of complications.
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Objective To investigate the effects and mechanisms of median nerve electrical stimulation on synaptic plasticity in ischemic stroke rats.Methods 18 healthy male SD rats were randomly divided into Sham group(n = 6),ischemic stroke group(MCAO group,n = 6)and median nerve electrical stimulation group(MNES group,n = 6).The left middle cerebral artery occlusion model of rats was established by thread plug method.Thread plug was not inserted in sham group.The median nerve electrical stimulation group was given median nerve electrical stimulation intervention on the 3rd day after modeling,and intervention on the next day.After intervention for 7 times,behavioral detection,HE staining was used to detect median nerve injury.Nissl staining was used to detect cerebral infarction volume.Western blot was used for detection of the expression level of proteins related to synaptic plasticity,and electron microscopy was performed.Results HE staining showed that median nerve electrical stimulation did not cause damage to the median nerve in stroke rats,and the median nerve membrane was intact without obvious inflammatory cells.Compared with MCAO group,the neural function,motor function and coordination of the injured forelimb in MNES group were significantly improved(P<0.01).Compared with MCAO group,cerebral infarction volume in MNES group was significantly reduced(P<0.05),the pyknosis of Nissl bodies in ischemic penumbra decreased.Compared with MCAO group,the expression levels of synaptic plastication-related proteins PSD95 and synI in the cortex of MNES group were significantly up-regulated after median nerve electrical stimulation(P<0.05),the number of synapses in the ischemic cortex increased significantly(P<0.01).Conclusion Median nerve electrical stimulation is a safe and effective therapeutic measure to improve nerve function after stroke,and its mechanism is related to promoting synaptic plasticity.
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ObjectiveTo investigate the effect of combination with repetitive transcranial magnetic stimulation (rTMS) and median nerve electrical stimulation (MNS) on patients with prolonged disorders of consciousness (pDOC) in different age. MethodsFrom January, 2021 to May, 2023, 93 patients with pDOC in the First Affiliated Hospital of Nanchang University were divided into young group (≤ 45 years old), middle-aged group (46 to 60 years old) and elderly group (> 60 years old). All the groups were treated with rTMS and MNS for four weeks. The Coma Recovery Scale-Revised (CRS-R), Glasgow Coma Scale (GCS), and Full Outline of Unresponsiveness Scale (FOUR) were used to evaluate the efficiency of awakening after treatment and the awakening ratios were compared among three groups weekly. Four weeks after treatment, regional cerebral blood flow (rCBF) was measured with CT perfusion imaging. The score of Glasgow Outcome Scale Extended (GOS-E) was compared six months after treatment. ResultsFrom three weeks after treatment, the scores of CRS-R, GCS and FOUR increased in all groups (P < 0.05). After weekly treatment, there was no significant difference in the composition ratio of consciousness level and the awakening ratio among three groups (χ2 < 11.057, P > 0.05). After four weeks of treatment, rCBF improved in three groups (|t| > 2.495, P < 0.05), however, there was no difference among three groups (F < 1.887, P > 0.05). There was no difference in the score of GOS-E at six months after treatment (F = 3.083, P = 0.055). ConclusionrTMS combined with MNS is effective on pDOC patients in different ages, and elderly patients could also benefit from it.
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Objectives @#To investigate the effect of sciatic nerve electrical stimulation ( SNES) on motor function recovery in rats with incomplete spinal cord injury (SCI) and its possible mechanism.@*Methods @#The incomplete SCI model was constructed by modified Allen ′s method. Forty⁃five Sprague⁃Dawley (SD) rats were randomly divided into three groups : Sham , SCI , and SNES. Electrical stimulation parameters were 1 ms pulse width and 100 Hz , with 20 mins each time , once a day for 21 days. The motor function was assessed by Basso⁃Beattie⁃Bresnahan (BBB) locomotor function scale , and the action potential conduction was detected by electrophysiology. Hematoxy⁃lin⁃eosin (HE) staining was used to observe the pathological changes in the spinal cord and the average cross⁃sectional area (CSA) of biceps femoris muscle fibers. The number of brain⁃derived neurotrophic factor (BDNF) and tropomyosin⁃related kinase B (TrkB) positive cells , relative mRNA and protein expression were analyzed by immunohistochemistry , reverse transcription polymerase chain reaction (RT PCR) and Western blot separately.@*Results@#On 21 d , the BBB score and average amplitude of action potential of SNES group were higher than those of SCI group , and the difference was statistically significant (P < 0. 05) . Compared with SCI group , the pathological injury of spinal cord tissue in SNES group was significantly improved , and the average CSA of biceps femoris muscles had a statistical difference (P < 0. 05) . The number of BDNF and TrkB positive cells in SNES group was higher than that in SCI group , and there were statistical differences (P < 0. 05) . The relative mRNA and protein expressions of BDNF and TrkB in SNES group were higher than those in SCI group , with statistical differences ( P <0. 05) . The relative mRNA and protein expressions of BDNF and TrkB in SNES group were higher than those in SCI group , with statistical differences ( P <0. 05) . @*Conclusion @#These results show that SNES contributes to alleviating spinal cord tissue injury , promoting the recovery of motor function and delaying the atrophy of muscles below the injury level. The possible mechanism is related to the increased expression of BDNF⁃TrkB proteins.
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@#Patients with impaired quality of life associated with xerostomia need long-term treatment, and a nerve stimulator has the advantage of providing natural saliva and long-term management for patients with xerostomia by electrically stimulating the relevant secretory nerves to promote saliva production. A number of clinical trials have preliminarily demonstrated the efficacy of nerve electrical stimulation in the treatment of xerostomia. However, electrical stimulation has not yet become the mainstream treatment for xerostomia. Large prospective randomized controlled clinical trials are still needed to confirm its long-term effectiveness and safety. In addition, the design of nerve stimulators is of great significance for clinical application. The large volume and inconvenient treatment associated with the extra oral nerve stimulator and the first generation intraoral nerve stimulator hinder their clinical application and popularization. The second- and third-generation intraoral nerve stimulator devices are small, convenient to use and have great application prospects. Research on electrical nerve stimulators for xerostomia treatment is mainly concentrated in European and American countries, while there is very little domestic research. It is urgent to master the core technology for the research and development of electrical nerve stimulators. The innovation of miniaturization, efficient power supply, data feedback and packaging will be the key issues of electrical nerve stimulators in the future. In this paper, the treatment and research of electrical nerve stimulation for xerostomia are reviewed to provide a reference for related basic research and the clinical application of electrical stimulators treating xerostomia in China.
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Objective:To observe the effect of external phrenic nerve electrical stimulation on respiratory function for convalescent stroke patients. Methods:From October, 2017 to July, 2018, 27 convalescent stroke patients were randomly divided into control group (n = 14) and observation group (n = 13). Both groups received routine rehabilitation, while the observation group accepted external phrenic nerve electrical stimulation additionaly. Their ventilation and respiratory muscle strength were measured before and four weeks after treatment. Results:The forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) improved in both groups after treatment (t > 5.075, Z = -3.366, P < 0.001), and improved more in FVC, FEV1, PEF and MIP in the observation group than in the control group (t > 0.921, Z = -2.746, P < 0.05). Conclusion:External phrenic nerve electrical stimulation can improve ventilation and inspiratory muscle strength for convalescent stroke patients.
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Objective:To observe the effect of external phrenic nerve electrical stimulation on respiratory function for convalescent stroke patients. Methods:From October, 2017 to July, 2018, 27 convalescent stroke patients were randomly divided into control group (n = 14) and observation group (n = 13). Both groups received routine rehabilitation, while the observation group accepted external phrenic nerve electrical stimulation additionaly. Their ventilation and respiratory muscle strength were measured before and four weeks after treatment. Results:The forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), peak expiratory flow (PEF), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) improved in both groups after treatment (t > 5.075, Z = -3.366, P < 0.001), and improved more in FVC, FEV1, PEF and MIP in the observation group than in the control group (t > 0.921, Z = -2.746, P < 0.05). Conclusion:External phrenic nerve electrical stimulation can improve ventilation and inspiratory muscle strength for convalescent stroke patients.
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Objective To observe the effect of phrenic nerve electrical stimulation combined with respiratory training on the pulmonary function,trunk stability and balance of stroke survivors.Methods Thirty-six stroke survivors were randomly divided into a control group and a training group,each of 28.Both groups were given routine rehabilitation treatment (including physical agent therapy and combined training of the limbs),while the training group was additionally provided with phrenic nerve electrical stimulation combined with respiratory training once a day for six weeks.Before and after the treatment,the forced vital capacity (FVC),forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) of both groups were recorded.The Sheikh trunk control scale (TCT) was used to quantify their trunk stability,and balance was quantified using the Berg balance function scale (BBS).Results After six weeks of treatment the average FVC,FEV1 and PEF values of the training group were significantly higher than before the treatment,and significantly better than those of the control group after the treatment.Moreover,significant improvement was observed in the average TCT and BBS scores of both groups after the intervention,with the training group's average significantly higher than that of the contrcl group.Conclusion Phrenic nerve electrical stimulation combined with respiratory training can further improve the pulmonary function and balance function of stroke survivors as a supplement to routine rehabilitation treatment.Therefore,it is worth popularizing in clinical practice.
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Objective To compare the effects of median nerve electrical stimulation on coma patients after traumatic brain injury with different settings. Methods From 2013 to 2015, 161 patients with traumatic brain injury were randomly divided into control group (n=40), experimental group 1 (n=41), experimental group 2 (n=39) and experimental group 3 (n=41). The control group received routine conscious-ness-promoted methods, and the experimental groups received median nerve electrical stimulation with 200μs and 30 Hz, 100 Hz and 50 Hz in sequence, 60 minutes a day for 90 days. They were assessed with Glasgow Coma Scale (GCS) and Coma Recovery Scale-Revised (CRS-R) before, 30 days and 90 days after treatment. Results There was significant difference in the scores of CCS and CRS-R, times of treatment, number of sobered patients and coma time among groups (P0.05). The experimental group 3 was better than the experimental groups 1 and 2 (P<0.05). Conclusion Median nerve electrical stimulation with 200μs, 50 Hz could promote co-ma patients to wake up optimally.
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Objective:To investigate the expression of 5-HT 2A receptor in the prefrontal cortex of traumatic brain injuryinduced coma rats after median nerve electrical stimulation.Method:A total of 72 SD rats (weighing 250-300g) were randomly divided into 4 groups:a stimulationgroup,an antagonist group,a sham-stimulation group and a control group.This traumatic brain injury model was established by a weight-drop head injury,and we evaluated the change of behavior through the six classical levels of consciousness.The animals were sacrificed and their brain tissues were removed at 6,12,and 24 hours after injury.5-HT 2A protein expression was examined by immunohistochemistry.Result:Thirteen rats exhibited righting reflex in the stimulation group.In the antagonist group,9 rats exhibited righting reflex.5 rats in the sham-stimulation group had the same response.The mean rank of consciousness degree were degree 9.50 in the control group,degree 52.75 in the sham-stimulation group,degree 37.61 in the stimulation group,degree 46.14 in the antagonist group.Comparison among groups presented an increasing consciousness degree:control group＜stimulation group＜antagonist group＜sham-stimulation group(P＜0.01).Resuits from immunohistochemistry showed that significant differences in the 5-HT 2A expression among the four groups (sham-stimulation＜control＜antagonist＜stimulation))(P＜0.05),and a within-group comparison showed that the 5-HT 2A expression level was as follows:6 hours＜24 hours ＜12 hours(P＜0.05).Conclusion:Median nerve electrical stimulation might modulate wakefulness by promoting the 5-HT 2A expression via orexin-A in the prefrontal cortex of rats with traumatic brain injury-induced coma.
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Objective To investigate the effect of different frequencies of pudendal electrical nerve stimulation on female stress urinary incontinence.Methods 60 SUI female patients from Shanghai Research Institute of Acupuncture and Meridian affiliated Yue Yang Hospital were enrolled in a three-times-per-week treatment group (30 paients) and a twice-per-week treatment group (30 patients).Both groups were treated by pudendal nerve electrical stimulation for twelve times.The change of therapeutic effect,symptoms index were observed in both groups before and after the treatment.Results ① Comparison of clinical efficacy:The therapeutic rate of three-times-per-week treatment group was 63.3％ (19/30),the total effective rate was 90.0％ (27/30); the therapeutic rate of twice-per-week treatment group was 36.7％ (11/30),the total effective rate was 76.7％ (23/30).The therapeutic rate showed significant differences between the two groups (x2=4.267,P＜ 0.05); The total effective rate showed no differences between the two groups (x2 =l.920,P＞0.05).② Comparison of clinical symptom score and life quality score:the post-treatment clinical symptom scores of the both groups improved significantly compared with the pre-treatment (tthee-times-prt-week=7.972,ttwice-per-week=9.520,both P＜0.01).Clinical symptom score of three-times-per-week treatment group improved better than twice-per-week treatment group (P＜0.01).Conclusion Three-times-per-week of pudendal nerve electrical stimulation has a better effect on treating female SUI patients.
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ObjectiveTo evaluate the clinical benefits of early right median nerve electrical stimulation on coma patients following craniocerebral trauma. MethodsCraniocerebral trauma patients with up to two weeks of coma in the years 2005-2011 were involved in the study and were randomly divided into control group (received routine management ) and treatment group (routine management plus right median nerve electrical stimulation).The treatment lasted for a period of more than two weeks.The clinical efficacy of the right median nerve electric stimulation and the conscious status of the patients within six months after craniocerebral trauma were observed.ResultsA total of 456 patients were enrolled in the study,of whom 437 patients completed the treatment course,including 221 patients in the treatment group and 216 in the control group.There was no complication related to electric stimulation during the treatment.Cerebral blood flow (CBF) imaging and brain stem evoked potential (BEP) examination demonstrated significant improvement in the treatment group.A total of 386 patients were followed up for six months postoperatively,which showed that there were 122 patients with regained consciousness,46 in minimally conscious state and 36 in vegetative state in the treatment group (204 patients) and there were 84 patients with regained consciousness,40 in minimally conscious state and 58 in vegetative state in the control group ( 182 patients).The patients in the treatment group showed a higher ratio of regained consciousness and a lower ratio of vegetative state compared with the control group,but the ratio of minimally conscious state showed no statistical difference between two groups. ConclusionsRight median nerve electrical stimulation is a suitable coma awaking means at early stage after craniocerebral trauma.
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In recent years,biofeedback combined with nerve electrical stimulation therapy as a kind of new treatment has been generally applied in paediatrics,gastroenterology,proctology and rehabilitation.This paper is to review the application of the therapy in children with fecal incontinence,including its principle,clinical efficacy and prospects.
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@#Objective To investigate the effect of median nerve electrical stimulation on the activity, speech and quality of life in patients after severe traumatic brain injury. Methods 60 patients with severe traumatic brain injury were divided into 2 groups: the control group (A) and the treated group (B). The patients in Group A were treated with the routine medicine and rehabilitation. Based on the routine therapy, the patients in Group B were treated with the right median nerve electrical stimulation. Their outcome, activity, speech and quality of life were assessed. Results The scores of Glasgow Outcome Scale (GOS), speech assessment, and the quality of life in Group B improved compared with that in Group A (P<0.05), the activity seemed to improve, but not significantly. Conclusion The right median nerve electrical stimulation is effective to promote the recovery of neurological function and improve the quality of life in patients with severe traumatic brain injury.
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@#Objective To study the effect of electrical stimulation of vagus nerve on inflammatory response in septic shock rats. Methods SD rats were randomly divided into 5 groups: Group Ⅰ was the sham group, group Ⅱ with the cecal ligation and puncture (CLP) and the vagus nerve were isolated but not transected, group Ⅲ with bilateral cervical vagotomy following CLP, group Ⅳ with bilateral cervical vagotomy after CLP and the left vagus nerve trunks were stimulated with bipolar electrodes, group Ⅴ with bilateral cervical vagotomy after CLP and the right vagus nerve trunks were stimulated. The common carotid artery pressure was monitored, and the plasma tumor necrosis factor α (TNF-α), nitric oxide synthases (NOS) and nitric oxide (NO) were measured 2 h after stimulation. Results The mean arterial blood pressure (MAP) gradually decreased and the concentration of plasma TNF-α, NOS and NO significantly increased after CLP. Electrical stimulation of the left and right vagus nerve significantly increased the MAP and decreased the plasma TNF-α, NOS and NO levels. Conclusion Direct electrical stimulation of the left and right vagus nerve can significantly improve the blood pressure and reduced plasma TNF-α, NOS and NO levels during septic shock, which may play a role in anti-shock in rats.