Afferent Impulses Research Articles

Reduced Thalamic γ-Aminobutyric Acid (GABA) in Painless but Not Painful Diabetic Peripheral Neuropathy.

Alterations in the structure, function, and microcirculation of the thalamus, a key brain region involved in pain pathways, have previously been demonstrated in patients with Painless- and Painful-diabetic peripheral neuropathy (DPN). However, thalamic neurotransmitter levels including GABA (inhibitory neurotransmitter) and glutamate (excitatory neurotransmitter) in different DPN phenotypes are not known. We performed a Magnetic Resonance Spectroscopy study and quantified GABA and glutamate levels within the thalamus, in a carefully characterised cohort of participants with Painless- and Painful-DPN. Participants with DPN (Painful- and Painless combined) had a significantly lower GABA:H2O ratio compared to those without DPN (Healthy volunteers [HV] and diabetes without DPN [No-DPN]). Participants with Painless-DPN had the lowest GABA:H2O ratio, which reached significance compared with HV and No-DPN, but not Painful-DPN. There was no difference in GABA:H2O in Painful-DPN compared with all other groups. A significant correlation with GABA:H2O and neuropathy severity was also seen. This study demonstrates that lower levels of thalamic GABA in participants with Painless-DPN may reflect neuroplasticity due to reduced afferent pain impulses. Whereas partially preserved levels of GABA in Painful-DPN may indicate that central GABAergic pathways are involved in the mechanisms of neuropathic pain in diabetes.

A Critical Examination of Ligamentous Pathogenesis of Bladder Pain/Lower Urinary Tract Symptoms Using the UEDA Criteria.

To critically analyse the relationship of bladder pain syndrome (BPS/IC), as defined, to the posterior fornix syndrome, "PFS" predictably co-occurring bladder urgency, frequency, nocturia, chronic pelvic pain, emptying symptoms/retention, caused by uterosacral ligament (USL) laxity and cured by USL repair. The starting and end points of this paper are the questions, "Are there arguments that BPS/IC can, in some cases, be linked to PFS?" And if so, "To what extent?" We used the criteria required by Ueda for proper diagnosis: "understanding symptoms, detecting abnormal findings and verifying them as a cause of the symptoms." Literature, diagnostic and surgical, indicate that chronic pelvic pain "of unknown origin" can be caused by unsupported visceral pelvic plexuses because of weak USLs; these cause fire of afferent impulses, which the brain mistakenly interprets as coming from the end-organ itself (i.e., genitourinary pain, lower urinary tract symptoms). The same lax USLs can also weaken the pelvic muscles which contract to stretch the vagina to support the urothelial stretch receptors from below: these may prematurely fire off afferent impulses to activate micturition at lower bladder volumes, interpreted as urgency. A speculum placed in the vagina can relieve pain and urgency by mechanically supporting the vaginal wall and USLs, thus predicting an eventual cure by USL repair. There is need to evaluate what percentage of women with known BPS/IC also pass the criteria for PFS. Identifying a significant percentage of BPS/IC women with the causative relation between PFS pathogenesis and BPS/ IC may open a new way of diagnosing and treating BPS/IC in some women.

Comparison Between Hypnoanesthesia and Local Anesthesia in Minor Surgery

Background: Hypnoanesthesia is a state of anesthesia achieved through hypnosis techniques. Meanwhile, local anesthesia is anesthesia carried out by injecting local anesthetic drugs in or around the surgical site which causes temporary obstruction to the conduction of afferent impulses. Objective: This research was conducted to prove that there is no difference between hypnoanesthesia and local anesthesia in minor surgical procedures, with the indication of pain relief. Methods: The research subjects were patients with benign soft tissue tumors consisting of 40 people who were divided into 2 groups, namely treatment and control. Minor surgical procedures with hypnoanesthesia were performed in the treatment group, while in the control group, minor surgical procedures were performed with local anesthesia using 2% lidocaine. Pain is measured with FPS (Face Pain Scale) and monitored with a vital sign monitor. The intervention process was recorded with camcorder video. Changes in serum levels of excitatory neurotransmitters (Glutamic Acid and Substance P) and inhibitory (Beta Endorphin, Enkephalin, and Serotonin) before and after intervention were analyzed using ELISA (Enzym-Link Immunosorbent Assay) in both groups. Results: In the treatment group, it was discovered that patients did not feel pain after undergoing hypnoanesthesia intervention by providing suggestions for the relief of pain in the area where surgery would be performed. In the control group, patients also did not feel pain after local anesthetic intervention in the area to be operated on. However, the results of research and statistical tests showed that there was no significant difference in changes in Beta Endorphins, Enkephalin, and Serotonin as inhibitory neurotransmitters (p > 0.05) or Glutamic Acid and Substance P as excitatory neurotransmitters (p > 0.05) before and after the intervention in both groups of research subjects. Conclusion: the results of this study show that there is no significant difference between the treatment and control groups, they have equality in the final result, namely the relief of pain.

Peripheral muscle force balance/imbalance in neurological binary control of bladder function and dysfunction.

Bladder control is not from the bladder itself but from muscles and ligaments outside of it. Bladder control is binary, either closed or open. Control is exerted cortically, directly and via a peripheral pelvic mechanism comprising three reflex pelvic muscles which contract (variously) against pubourethral ligaments (PULs) anteriorly and uterosacral ligaments (USLs) posteriorly. Directed efferent impulses from the cortex close the urethra, open it, and stretch the vagina in opposite directions to prevent urothelial impulses inappropriately activating micturition (urge incontinence). Normally, the opposite muscles are equivalent in force, and balance at the bladder neck. Weak PULs weaken the forward closure force: the posterior forces become relatively more powerful; balance shifts behind bladder neck; the posterior urethral wall is pulled open like a trapdoor, and urine is lost on effort (stress urinary incontinence). Weak USLs weaken the posterior muscle forces; the balance of forces shifts forwards, and the urethra is closed relatively more tightly by slow-twitch forward muscle vector forces (pubococcygei), which stretch each side of the distal vagina forwards to compress the posterior urethral wall; in consequence, the weakened posterior muscle forces cannot easily open the posterior urethral wall; the bladder has to contract against a relatively unopened urethra, perceived as "obstructed micturition". Nor can weakened posterior forces stretch the vagina sufficiently to support the urothelial stretch receptors from below; these may fire off excess afferent impulses to cause urgency. As bladder control is strictly binary, in women with urgency, control swings between open and closed modes. This condition is known as an "unstable bladder", which is defined symptomatically as "overactive bladder", and urodynamically as "detrusor overactivity". In summary, bladder control is binary, either closed or open. How the cortex integrates and computes multiple inputs determines the type of closure, opening or unstable control which is experienced by the patient.

Interstitial cystitis/bladder pain syndrome: when part of the posterior fornix syndrome is potentially curable surgically.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as chronic pelvic pain plus a bladder symptom, usually urge. Evidence is offered to show IC/BPS forms part of the posterior fornix syndrome (PFS), which was defined in 1993 as: chronic pelvic pain (CPP), urge, frequency, nocturia, abnormal emptying, post-void residual urine, caused by uterosacral ligament (USL) laxity and cured or improved by USL repair. The IC/BPS definition implies that the urge and pain of IC/BPS is from a single (as yet unknown) pathogenic origin. However, when urge and pain are viewed from the perspective of the PFS, though both have the same lax USL origin, the anatomical pathway from lax USL to symptom manifestation is very different manifestation. For CPP the anatomical pathway is the inability of loose USLs to support pelvic visceral plexuses (VPs); it is hypothesized that inability of weak USLs to mechanically supports VPs, the afferent nerve synapse from end organs may fire off autologous afferent impulses to the brain which interprets them as pain from end organs such as urothelium, vulva, lower abdomen. For urge, the anatomical pathway is very different: lax USLs weaken the directional pelvic muscle forces which stretch the vagina to support the urothelial stretch receptors. The receptors fire off afferent impulses to the cortex at a lower bladder volume, and these are interpreted as "urge to go". Mechanical support of USLs relieves both pain and urge, as does USL repair.

Simulating of human physiological supersystems: modeling of kidney and bladder functions

A quantitative model describing the functions of human kidney and bladder is created. The model is realized and tested as an autonomous C# software module (SM) functioning under given dynamic input characteristics. Finally, SM will be incorporated into our specialized general software capable of simulating the main modes of human integrative physiology, namely, interactions of physiological super-system (PSS). The model of the kidney describes mechanisms of blood filtration in Bowman’s capsule, reabsorption in collecting tubules, as well as the central renin-angiotensin system mechanism. The model of the bladder describes the dynamics of its filling and periodic emptying. Each act of bladder emptying is initiated by a signal generated by the brain in response to afferent impulse patterns from the bladder’s mechanoreceptors. Models have been tested using algorithms that design scenarios, including simulation of either short-time or long-time (hours or days) observations. Input data include different combinations of pressure in renal afferent arterioles, osmotic, and oncotic blood pressures. Output data includes dynamics of primary urine, final urine, bladder volume, urine pressure, mechanoreceptors’ activity, renin production velocity, blood renin concentration, angiotensin2 production velocity, and blood angiotensin2 concentration, as well as blood albumin and sodium concentrations. Both student-medics and physiologists interested in providing theoretical research can be users of SM.

Simulating of human physiological supersystems: interactions of cardiovascular, thermoregulatory and respiratory systems

Special quantitative model of the human thermoregulatory system (MTS) functioning with cardiovascular and lung systems is created. These systems form a human physiological supersystem (HPSS). MTS describes thermoregulatory responses to alterations of both external environmental physical characteristics and internal biological characteristics. Algorithms provide designing of scenarios including simulation of either short-time or long-time (hours or days) observations. Input data include different combinations of environmental variables (air or water temperature, air humidity, wind or water flow speed, light intensity, infrared radiation) for a naked or wear human, as well as for given dynamics of biological characteristics (rate of heat production including its components associated with metabolism and ATP molecules leasing during mental and physical activities). Human body is presented by a core, blood, and a skin compartments. Skin and lung evaporation are under hypothalamic control based on afferent impulse patterns from internal, and skin heat and cold receptors. Dynamic output data include blood, hypothalamic, and skin temperatures, hemodynamic parameters like heart rate, cardiac output, regional blood flows, vascular resistances, blood pressures, and regional blood volumes. Serotonin and melatonin concentrations modulating biological heat production rate are associated with a day/night light intensity. Currently, the PCbased simulator is autonomous software to be used both for educational purposes and for providing of special computer research. In a near future, this simulator has to be widened by models of kidneys, and a mechanism of liverpancreas interaction.

Neurogenic Hyperprolactinemia

Neurogenic hyperprolactinemia is a rather rare clinical form of hyperprolactinemia, therefore, this pathology may escape the attention of clinicians. At the same time, a high level of prolactin in blood can result in severe metabolic disorders, infertility, decreased bone tissue density, obesity, increased insulin resistance, and poor lipid metabolism. If the disease is not diagnosed in time, it will lead not only to the significantly decreased health and life quality level, but can also contribute to the increased risk of breast cancer formation. The main reason for the development of neurogenic hyperprolactinemia can be various pathological processes in chest, spinal cord and mammary glands. The neurogenic mechanism is triggered by the activation of afferent impulses going to the posterior sections of the spinal cord. The main diagnostic tactics is the exclusion of the most common causes of hyperprolactinemia, identification of the pathological process in the thoracic region, and detection of high prolactin level in the blood serum. Taking the pathogenetic mechanism into account, the treatment of neurogenic hyperprolactinemia consists in eliminating the pathological focus and prescribing dopamine agonists. The purpose of this article is to define the main clinical features associated with the diagnosis and treatment of neurogenic hyperprolactinemia.

Вікові особливості функціонування вестибулярного аналізатора

The main importance of the vestibular system is to maintain the vertical position of a person and ensure the coordination of movements. The peculiarity of the structure of the vestibular apparatus prompts it to be constantly in a state of spontaneous activity. This is due to the effect on it of afferent impulses that come from the labyrinths to the vestibular centers. With proper excitability, this information indicates the normal course of physiological reactions. In this regard, persons with normal vestibular sensitivity have not experience symptoms of impaired vestibular function. However, in cases where this spontaneous impulse changes due to the influence of external and internal factors, and the inhibition mechanisms are not sufficiently activated, symptoms appear that indicate the insufficiency of vestibular afferentation compensation processes and are manifestations of increased excitability of the vestibular analyzer. It is known from literary sources that increased sensitivity of the vestibular analyzer is widespread among the population. At the same time, there is a tendency to increase the prevalence of increased sensitivity of the vestibular analyzer among people of different ages. The review presents modern views on the peculiarities of the functional activity of the vestibular analyzer in different age periods. We are describe features of development, structure and reflex activity to ensure the vital activity of the organism from the beginning of intrauterine development to old age. We considered functions of ensuring a sense of position and movement of the body in space, maintaining both a posture at rest and during movement in different age periods. We also analyzed data on the frequency of symptoms of a vestibular analyzer disorder.

Focus on host/organ unregulated response: a common cause of critical illness.

Focus on host/organ unregulated response: a common cause of critical illness.

Pulse Intensity Effects of Burst and Tonic Spinal Cord Stimulation on Neural Responses to Brushing in Patients With Neuropathic Pain

ObjectivesTonic spinal cord stimulation (SCS) is accompanied by paresthesia in affected body regions. Comparatively, the absence of paresthesia with burst SCS suggests different involvement of the dorsal column system conveying afferent impulses from low-threshold mechanoreceptors. This study evaluated cortical activation changes during gentle brushing of a pain-free leg during four SCS pulse intensities to assess the effect of intensity on recruitment of dorsal column system fibers during burst and tonic SCS. Materials and MethodsTwenty patients using SCS (11 burst, nine tonic) for neuropathic leg pain participated. Brushing was administered to a pain-free area of the leg during four SCS intensities: therapeutic (100%), medium (66%), low (33%), and no stimulation. Whole-brain electroencephalography was continuously recorded. Changes in spectral power during brushing were evaluated using the event-related desynchronization (ERD) method in theta (4–7 Hz), alpha (8–13 Hz), and beta (16–24 Hz) frequency bands. ResultsBrushing was accompanied by a suppression of cortical oscillations in the range 4–24 Hz. Stronger intensities of burst and tonic SCS led to less suppression of 4–7 Hz and 8–13 Hz bands in parietal electrodes, and in central electrodes in the 16–24 Hz band, with the strongest, statistically significant suppression at medium intensity. Tonic SCS showed a stronger reduction in 4–7 Hz oscillations over right sensorimotor electrodes, and over right frontal and left sensorimotor electrodes in the 8–13 Hz band, compared to burst SCS. ConclusionsResults suggest that burst and tonic SCS are mediated by both different and shared mechanisms. Attenuated brushing-related ERD with tonic SCS suggests a gating of cortical activation by afferent impulses in the dorsal column, whereas burst may engage different pathways. Diminished brushing-related ERD at medium and therapeutic intensities of burst and tonic SCS points towards a nonlinear effect of SCS on somatosensory processing.

Abdominal hysterectomy and postoperative quality of recovery: emphasis on pain relief

Hysterectomy is a widespread surgical intervention in gynecological practice. Open abdominal hysterectomy is accompanied by a significant algogenic afferent impulse from the site of surgical intervention. Therefore, the search for effective methods of combating postoperative pain is quite urgent. The article analyzes modern approaches to the preventive (preoperative) use of non-narcotic drugs for reliable pain control. Literature data suggest that the combined use of paracetamol, dexketoprofen, nalbuphin, as well as ropivacaine or bupivacaine allows to implement the concept of multimodal analgesia and optimize the recovery process after surgery. The clinical case is given as an example of the use of the specified Step-UP-analgesia of the postoperative period in an overweight patient with varicose veins of the lower extremities and severe history of septic shock. The review of literature and the experience of the authors testify to the considerable potential of multimodal anesthesia following abdominal hysterectomy.

On the recovery of disorders of consciousness under intrathecal baclofen administration for severe spasticity-An observational study.

BackgroundOccasionally, patients show dramatic recovery from disorders of consciousness (DOC) under intrathecal baclofen (ITB), an established treatment option for severe supraspinal spasticity. Anecdotal explanations for ITB‐related recovery of cognition include modulation of afferent impulses at the spinal level, thereby reducing spasticity‐related proprioceptive information overload within cortico–thalamo–cortical connections.ObjectiveIn this retrospective patient chart analysis, we assessed whether a reduction in spasticity would be associated with an increase in Coma Recovery Scale revised (CRS‐R) scores in a larger sample of patients than previously published.MethodsFrom a hospital‐based ITB treatment register, we extracted data from 26 patients with DOC and severe supraspinal spasticity who improved by >2 points on the Coma Recovery Scale revised (CRS‐R) within 6 months after ITB treatment initiation. We assessed Modified Ashworth scale (MAS) scores and CRS‐R scores on admission (PRE) and 3 and 6 months after initiation of ITB treatment (3M, 6M). We performed correlation analysis of the scores and their respective changes (PRE to 3M, 3M to 6M). We also correlated the time from acute event until ITB initiation to CRS‐R scores at 3M and 6M.ResultsITB led to significant improvement in spasticity based on MAS scores, which did not correlate to the improvements seen in CRS‐R total and subscale scores. Daily ITB dose did neither correlate to MAS scores nor to CRS‐total scores in the whole patient group, but after 3 months, ITB dose correlated to some CRS‐R subscale scores in some patient subgroups. Time until ITB treatment did not correlate to CRS‐R scores later on.ConclusionsOur data confirm that ITB may exert beneficial effects in selected DOC patients with respect to improved cognitive functions, which, however, do not correlate to its antispastic effect. The lack of correlation between time to ITB and CRS‐R outcome, but significant CRS‐R improvements following pump implantation, renders spontaneous remissions unlikely and leaves room for alternative pharmacological mechanisms.

Thermographic diagnostics of instability of endoprostheses of large joints with assessment of somatosympathetic vasomotor reflex

Forty two patients with total hip (12 patients) and total knee (30 patients) replacements were examined by computer thermography method. Total joint replacement was performed after bone tumor resection. It was shown that additional afferent impulsation occured at implant loosening and the degree of vertical polysegmental irradiation of sympathic neurons excitation as well as the deficit of spinal cord inhibition on the side of arthroplasty incresed. Thermographic evaluation of the amplitute and volume of somatosympathic vasomotor reflex is an effective for the diagnosis of joint prosthesis loosening and it is subsidiary to the radiologic control.

Современные местные анестетики, применяемые для нейроаксиальной анестезии

Исследование проведено с участием 63 беременных женщин и рожениц в возрасте 18–40 лет. По варианту длительной эпидуральной аналгезии (ДЭАн) все беременные были разделены на две группы: I (31) ДЭАн выполняли 1,5% раствором лидокаина (1 мг/кг), II (32) ДЭАн выполняли 0,25% Лонгокаином (0,25–0,3 мг/кг). Сенсометрию выполняли с помощью гальванизатора «Поток-1», ГЭ-50-2. Определяли тактильный и болевой порог, порог выносливости. Проведенные исследования показали, что 0,25 % Лонгокаин значительно блокирует болевую афферентную импульсацию в зоне сегментарной блокады без выраженной моторной блокады по сравнению с 1,5% лидокаином и полностью избавляет рожениц от болевых ощущений в течение всего родового акта. Он безопасен для матери, плода и новорожденного в раннем периоде адаптации.

A Case Report on Heart Rate Variability Biofeedback and Postconcussion Syndrome: Healing the Autonomic Nervous System

Postconcussion syndrome is a devastating condition of the mind, body, and even personality. Mounting research demonstrates that heart rate variability biofeedback can help the concussed individual in three critical ways: (a) eliciting high amplitude oscillations in cardiovascular functions and thereby strengthening self-regulatory control mechanisms; (b) restoring autonomic balance; and (c) increasing the afferent impulse stream from the baroreceptors to restore balance between inhibitory and excitatory processes in the brain.

Neurophysiological signs of changes in the functional state of the nervous system in patients with vibration disease associated with type 2 diabetes mellitus

Introduction. Neurofunctional state is an essential criterion in assessing the quality of the regulatory mechanisms of autonomic and somatic functions that determine the prognosis and course of vibration disease associated with type 2 diabetes mellitus (DM2). Objective of the study is to identify neurophysiological signs of changes in the functional state of the nervous system in patients with vibration disease caused by the combined effects of local and general vibration (VD com.) in combination with DM2. Materials and Methods. The group I included (n = 33) - VD com. patients, group II - 30 cases with VD com., burdened with DM2. We used neuroenergy mapping (NEM), registration of somatosensory evoked potentials (SSEP). Statistica software was used for statistical processing. Results. Analysis of the severity of changes in DC-potential level in both groups established a statistically significant predominance of persons with an increased average DC-potential level. In group II, when compared with group I, there was an increase in the latency of components N9, N10, N11, N13, N18, N20, N25, N30, bipolar DC-potential level Cz-Pz, local DC-potential level in the central lead of the right hemisphere, decrease in DC-potential level in the central parietal region, bipolar pote ntials Fpz -Ts, Cz-Td, Pz-Oz. As a result of discriminant analysis, the following signs were obtained: indices of the latent period of the peak N13, the duration of the interpeak interval N10-N13, DC-potential level of the central parietal, right central, frontal right, frontal central leads. Discussion. The presence of DM2 in VD com. patients accompanied by disturbances in the neurofunctional state caused by a slowdown in the passage of an afferent impulse at the peripheral and central levels, a decrease in energy exchange in the frontal, central-parietal regions with its increase in the occipital, temporal parts of both hemispheres. Conclusion. Neurophysiological signs of changes in the functional state of the nervous system in VD com. patients with DM2 are a decrease in DC-potential level in the parietal central, frontal central, an increase in the latent period of the peak N13, the duration of the inter-peak interval N10-N13, DC-potential level in the central and frontal regions of the right hemisphere of the brain.

Effectiveness of transcranial magnetic stimulation of the prefrontal cortex for the correction of autonomic disorders in miners with polyneuropathy

Introduction. Polyneuropathy is the most common occupational neurological pathology. Violation of the activity of the central links of autonomic regulation due to excessive afferent impulses from the receptors of the skin and other tissues of the extremities leads to sympathetic activation and angiospasm, the progression of polyneuropathy. A decrease in the parasympathetic influence is the cause of systemic trophic disturbances. The possibility of transcranial magnetic stimulation of the prefrontal cortex opens up new therapeutic opportunities to correct the autonomic disorders in occupationally caused polyneuropathy. The aim of the study was to evaluate the effect of transcranial magnetic stimulation of the dorsolateral zone in the prefrontal cortex of the right hemisphere for the correction of neuroautonomic disorders in miners with polyneuropathy. Material and methods. Forty-two miners of the Kuzbass coal mines with a proven diagnosis of upper extremity polyneuropathy were examined. To identify autonomic dysregulation, the “Questionnaire for revealing the signs of autonomic changes”, spectral and nonlinear indices of cardio rhythm were used. Low-frequency (1 Hz) transcranial magnetic stimulation of the dorsolateral zone of the prefrontal cortex of the right hemisphere was performed in the course of 5 procedures according to a specially elaborated methodology. Results. In the examined miners, a decrease in the nonlinear and spectral indices of heart rate variability was initially determined, which indicated reducing adaptive capabilities, an increase in sympathetic influence. After the magnetic stimulation course, there was an improvement in general well-being and normalization of autonomous regulation according to the questionnaire. An increase in the spectral indices of the heart rate variability, more pronounced in the range of very low frequencies, indicated the activation of suprasegmental autonomic centers and an increase in parasympathetic influence. Conclusions. Transcranial magnetic stimulation of the prefrontal cortex effectively corrects autonomic disorders in miners with polyneuropathy and promotes an increase in adaptive capabilities due to the activation of suprasegmental autonomic centres.

Rehabilitation Evaluation of Hemiplegic Patients with Anterior Circulation Cerebral Infarction Based on Cranial Magnetic Stimulation.

Cerebral infarction is a common cerebrovascular disease in clinical medicine. Cerebral infarction in the anterior circulation accounts for about 90% of cerebral infarction. Its treatment and rehabilitation has always been a research hotspot in the medical field. Functional retraining can enhance the afferent impulses received by receptors, make the plasticity development of cerebral cortex function, and improve the loss of function. Based on the patient's individual condition, exercise therapy carries out the corresponding comprehensive functional training plan, which also includes the training of patients' daily living ability, turning over, bridge exercise, trunk rotation, etc., in order to improve the motor function of patients. The other is psychotherapy, which can cause emotional fluctuations, depression, anxiety, and other negative emotions due to the occurrence of diseases. In the rehabilitation treatment, relevant personnel can conduct psychological counseling for patients through timely and effective communication, so as to better establish patients' confidence in rehabilitation and improve the effect of rehabilitation treatment. The third is acupuncture treatment. Acupuncture is a traditional rehabilitation treatment in China. The rehabilitation effect of stroke has been proved by a large number of clinical practice. Acupuncture at Hegu, Quchi, Zusanli, and Taichong points can dredge channels and improve blood circulation. This paper mainly studies and analyzes the effect of behavior rehabilitation of hemiplegic patients with cerebral anterior circulation infarction treated by cranial magnetic stimulation. The rehabilitation treatment status of hemiplegic patients with anterior circulation cerebral infarction in a hospital was selected, and 100 cases were studied. Among them, 50 cases were treated with conventional rehabilitation therapy, and the other 50 cases were treated with cranial magnetic stimulation. The motor function, activities of daily living, and language expression ability of the two groups were compared for statistical analysis. After transcranial magnetic stimulation treatment, the abilities of the study group were better than those of the control group, P < 0.05, with statistical significance. Based on the reliable experimental data, we can draw a conclusion that the treatment of cranial magnetic stimulation has a significant effect on the rehabilitation of hemiplegic patients with cerebral anterior circulation infarction, which is higher than the conventional treatment and rehabilitation methods, and can be popularized in clinical application.

English

BACKGROUND Post-operative pain is a ubiquitous finding following any surgeries. It has physiological and psychological effect in patients. The source and degree of nociceptive stimulation differ among individuals and type of surgeries. In this regard, multimodal analgesic approach has been encouraged for post-operative pain relief, local infiltration of wound site being simplest among them. This procedure reduces the sensitisation and consequent hyperalgesia by cutting down afferent impulses from site of incision and injury. METHODS This is a single blind randomized clinical trial conducted at surgery main operation theatre, surgery indoor wards for a duration of 2 years. 60 patients posted for routine surgeries under general anaesthesia were taken as study subjects and were randomly divided into 2 groups of 30 each. Before skin closure, skin wound site was infiltrated at 1ml/cm according to the following schedule - Group B: received Inj. Bupivacaine plain (0.2 %), Group R: received Inj. Ropivacaine plain (0.2 %). All the patients were followed up for 24 hours and post-operative pain score parameters (Visual Analogue Score) were taken at 1 hour, 2-hour, 6-hour, 10 hour and 24 hours. The time duration till the requirement of first dose of rescue analgesia was noted down. Data was analysed using chi-square test, student t - test and statistical significance was set at P &lt; 0.05. RESULTS Hemodynamic stability was more with Ropivacaine as the fall in blood pressure and heart rate was not drastic. Duration of analgesia was longer with Ropivacaine. Analgesia was better with Ropivacaine. Both the drugs caused analgesia of significant extent. No cardiotoxicity or any other adverse reaction was observed with either drug in this study. CONCLUSIONS Ropivacaine is having longer duration of analgesia and better analgesic effect than bupivacaine. KEYWORDS Postoperative, Analgesic, Wound, Infiltration, Bupivacaine, Ropivacaine