Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke （59.6%） was the primary stroke type found in the young group, while ischemic stroke （60.0%） was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction （such as friendship） improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Exercise-with-melatonin therapy improves sleep disorder and motor dysfunction in a rat model of ischemic stroke

Exercise-with-melatonin therapy has complementary and synergistic effects on spinal cord injury and Alzheimer's disease,but its effect on stroke is still poorly understood.In this study,we established a rat model of ischemic stroke by occluding the middle cerebral artery for 60 minutes.We treated the rats with exercise and melatonin therapy for 7 consecutive days.Results showed that exercise-with-melatonin therapy significantly prolonged sleep duration in the model rats,increased delta power values,and regularized delta power rhythm.Additionally,exercise-with-melatonin therapy improved coordination,endurance,and grip strength,as well as learning and memory abilities.At the same time,it led to higher hippocampal CA1 neuron activity and postsynaptic density thickness and lower expression of glutamate receptor 2 than did exercise or melatonin therapy alone.These findings suggest that exercise-withmelatonin therapy can alleviate sleep disorder and motor dysfunction by increasing glutamate receptor 2 protein expression and regulating hippocampal CA1 synaptic plasticity.

Clinical study of different modes of repetitive transcranial magnetic stimulation in the treatment of post‑stroke executive dysfunction

Objective:To investigate the clinical efficacy of intermittent theta burst stimulation(iTBS)and high frequency repetitive transcranial magnetic stimulation(rTMS)on post‑stroke executive impairment(PSEI).Methods:Ninety patients with PSEI who were hospitalized in the rehabilitation department of Xuzhou Central Hospital and Xuzhou Rehabilitation Hospital from April 2021 to June 2022 were selected and divided into iTBS group,high‑frequency group and control group.All three groups of patients received routine rehabilitation training,given rTMS treatment with iTBS,10 Hz and shame stimulation for 4 weeks.Before and after treatment,all the patients were evaluated with the Montreal cognitive assessment(MoCA),the frontal assessment battery(FAB),troop color‑word test(SCWT),shape trails test(STT),digit span test(DST)and event related potential P300.Results:After treatment,MoCA,FAB,SCWT,STT,DST scores,P300 latency and amplitude were significantly better in the three groups than before treatment(P<0.05).MoCA,FAB,SCWT,STT‑B,DST scores,P300 latency and amplitude in the iTBS group and high‑frequency group were better than in the control group,with significant differences(P<0.05).The difference between iTBS group and high‑frequency group was not statistically significant(P>0.05).Conclusion:iTBS can improve PSEI,and the efficacy is comparable to 10Hz rTMS.iTBS takes less time with better efficiency,and it is worth popularizing and applying in clinic.

Increased activation of the caudate nucleus and parahippocampal gyrus in Parkinson's disease patients with dysphagia after repetitive transcranial magnetic stimulation:a case-control study

Repetitive transcranial magnetic stimulation(r TMS)has been shown to effectively improve impaired swallowing in Parkinson's disease(PD)patients with dysphagia.However,little is known about how r TMS affects the corresponding brain regions in this patient group.In this casecontrol study,we examined data from 38 PD patients with dysphagia who received treatment at Beijing Rehabilitation Medicine Academy,Capital Medical University.The patients received high-frequency r TMS of the motor cortex once per day for 10 successive days.Changes in brain activation were compared via functional magnetic resonance imaging in PD patients with dysphagia and healthy controls.The results revealed that before treatment,PD patients with dysphagia showed greater activation in the precentral gyrus,supplementary motor area,and cerebellum compared with healthy controls,and this enhanced activation was weakened after treatment.Furthermore,before treatment,PD patients with dysphagia exhibited decreased activation in the parahippocampal gyrus,caudate nucleus,and left thalamus compared with healthy controls,and this activation increased after treatment.In addition,PD patients with dysphagia reported improved subjective swallowing sensations after r TMS.These findings suggest that swallowing function in PD patients with dysphagia improved after r TMS of the motor cortex.This may have been due to enhanced activation of the caudate nucleus and parahippocampal gyrus.The study protocol was approved by the Ethics Committee of Beijing Rehabilitation Hospital of Capital Medical University(approval No.2018 bkky017)on March 6,2018 and was registered with Chinese Clinical Trial Registry(registration No.Chi CTR 1800017207)on July 18,2018.

Pathological verification of corticospinal tract Wallerian degeneration in a rat model of brain ischemia

Although neuroimaging is commonly utilized to study Wallerian degeneration, it cannot display Wallerian degeneration early after brain injury. In the present study, we attempted to examine pathologically the process of Wallerian degeneration early after brain injury. Cerebral peduncle demyelination was observed at 3 weeks post brain ischemia, followed by demyelination in the cervical enlargement at 6 weeks. Anterograde tracing of the corticospinal tract with biotinylated dextran amine showed that following serious neurologic deficit, the tracing of the corticospinal tract of the intemal capsule, cerebral peduncle, and cervical enlargement indicated serious Wallerian degeneration.

Roles of Eph/ephrin bidirectional signaling during injury and recovery of the central nervous system

Multiple cellular components, including neuronal, glial and endothelial ceils, are involved in the sophis- ticated pathological processes following central nervous system injury. The pathological process cannot reduce damage or improve functional recovery by merely targeting the molecular mechanisms of neuronal cell death after central nerve system injuries. Eph receptors and ephrin ligands have drawn wide attention since the discovery of their extensive distribution and unique bidirectional signaling between astrocytes and neurons. The roles of Eph/ephrin bidirectional signaling in the developmental processes have been re- ported in previous research. Recent observations suggest that Eph/ephrin bidirectional signaling continues to be expressed in most regions and cell types in the adult central nervous system, playing diverse roles. The Eph/ephrin complex mediates neurogenesis and angiogenesis, promotes glial scar formation, regulates endocrine levels, inhibits myelin formation and aggravates inflammation and nerve pain caused by injury. ~lhe interaction between Eph and ephrin is also considered to be the key to angiogenesis. This review focus- es on the roles of Eph/ephrin bidirectional signaling in the repair of central nervous system injuries.

Electro-acupuncture at Zusanli(ST 36) to improve lower extremity motor function in sensory disturbance patients with cerebral stroke A randomized controlled study of 240 cases

BACKGROUND： Studies have shown that sensory transduction is a way to introduce needle sensation. OBJECTIVE： To observe the influence of electro-acupuncture at the ＂Zusanll＂ （ST 36） point on lower extremity motor function in various sensory disturbance patients with cerebral stroke. DESIGN, TIME AND SETTING： A randomized, controlled, clinical study was performed at the Department of Neurological Rehabilitation, China Rehabilitation Research Centre from September 2006 to June 2008. PARTICIPANTS： Patients with first-time cerebral infarction or hemorrhage, or with a stroke history, but no neurodysfunction （single damage）, were selected for this study. The subjects were right-handed and disease state was stable. A total of 240 inpatients were randomly assigned to the following groups： electro-acupuncture （n = 124） and control （n = 116）. The two groups were further assigned into sub-groups： no sensory disturbance, superficial sensory disturbance, deep sensory disturbance, and deep and superficial sensory disturbance. METHODS： On the basis of routine limb function training, the acupoint Zusanliwas utilized in all patients from the electro-acupuncture group. Perpendicular acupuncture was 3.0-4.0 cm deep. An electric acupuncture instrument was connected when patients developed the needle sensation, deqi. A stimulation pattern consisting of distant and dense waves of 50 Hz was used to elicit slight dorsal foot extension. Acupuncture was administered 5 times per week, 30 minutes per session, for 6 weeks in total. MAIN OUTCOME MEASURES： FugI-Meyer assessment （FMA） was used to evaluate lower extremity motor function; Ver.1.0 gait analysis to estimate gait （step frequency, step speed, and step scope）; lower extremity Composite Spasticity Scale （CSS） to estimate muscle spastic degree. RESULTS： Following treatment, motor function improved in both groups. Compared with the control group, FMA score, step speed, step frequency, and step scope were increased in the electro-acupuncture group, but there was no difference in lower extremity CSS scores between the electro-acupuncture and the control groups （P 〉 0.05）. Compared with the control group, Zusanli （ST 36） electro-acupuncture improved motor function indices as follows： FMA score, step frequency, step speed, and step scope of patients with no sensory disturbance （P 〈 0.05-0.01）, step frequency of patients with superficial sensory disturbance （P 〈 0.05）, and step frequency and step speed of patients with deep sensory disturbance （P 〈 0.05）. CONCLUSION： Zusanfi （ST 36） electro-acupuncture effects on lower extremity motor function in stroke patients were improved with no muscle tone rise. Therefore, this form of treatment can be used in convalescent treatment, Moreover, effects were different according to various sensory disturbance types, which suggested that sensory input influenced acupuncture effects.

Can long-term thiamine treatment improve the clinical outcomes of myotonic dystrophy type 1？

Myotonic dystrophy type 1, also known as Steinert＇s disease, is an autosomal dominant disorder with multisystemic clinical features affecting the skeletal and cardiac muscles, the eyes, and the endocrine system. Thiamine （vitamin B1） is a cofactor of fundamental enzymes involved in the energetic cell me- tabolism; recent studies described its role in oxidative stress, protein processing, peroxisomal function, and gene expression. Thiamine deficiency is critical mainly in the central and peripheral nervous system, as well as in the muscular cells. Our aim was to investigate the potential therapeutical effects of long-term treatment with thiamine in myotonic dystrophy type 1 in an observational open-label pilot study. We de- scribed two patients with myotonic dystrophy type 1 treated with intramuscular thiamine 100 mg twice a week for 12 or 11 months. We evaluated the patients using the grading of muscle strength according to Medical Research Council （MRC）, the Muscular Impairment Rating Scale （MIRS）, and the Modified Barthel index. High-dose thiamine treatment was well tolerated and effective in improving the motor symptomatology, particularly the muscle strength evaluated with the MRC scale, and the patients＇ activi- ties of daily living using the Modified Barthel Index. At the end of treatment, the MRC score was 5 in the proximal muscles and 2-4 in the distal muscles （the MRG score before the treatment was 3-4 and 1-3, re- spectively）. The MIRS grade improved by 25% compared to baseline for both patients. In patient #1, the Modified Barthel Index improved by 44%, and in patient #2 by 29%. These findings suggest that clinical outcomes are improved by long-term thiamine treatment.

Magnetic resonance imaging diagnosis of acute Guillain-Barré syndrome in children

The present study examined 24 children with acute Guillain-Barre syndrome using magnetic resonance imaging （MRI） plain scans and fat-suppressed enhanced Tl-weighted imaging （T1WI） scans. Axial MRI plain scans centering on the medullary conus were positive in nine patients （38%）. These displayed variable thickening involving the cauda equina with isointensity on T1WI and isointensity or slight hyperintensity on T2WI. False negatives were obtained in patients with cervical and cranial nerve symptoms. Contrast enhancement of T1WI with fat suppression was positive in all patients in the cauda equina with varied thickening and enhancement centering on the medullary conus. Five patients （36%） were positive in the cervical nerves and 3 patients （50%） were positive in the cranial nerves. These patients had corresponding cervical and cranial nerve symptoms, respectively. Patients with serious clinical symptoms in the lower limbs exhibited obvious involvement of the cauda equina by MRI. Statistical analysis revealed a positive correlation between the extent of enlargement of the cauda equina, centering on the medullary conus, and cerebrospinal fluid protein concentration.

Clinical Study on Evaluation of Autonomic Nervous Dysfunction Based on Imaging Urodynamic Examination with Slow Filling and Synchronous Blood Pressure Monitoring in the Patients with Cervicothoracic Spinal Cord Injury

Objective: Explore the rule of autonomic nervous dysfunction in the patients with urination disorder after high level spinal cord injury, and seek a safe, objective and accurate method to evaluate autonomic nervous function. Patients and Method: 48 patients with dysuria after cervicothoracic SCI were selected. Before, during and after imaging urodynamic examination with slow filling in supine position, blood pressure and ECG were monitored simultaneously. The symptoms of sweating, shivering, headache, flushing and chills were observed and recorded. The study of the relationship among the changes of blood pressure, heart rate and urodynamic indexes and the above symptoms was analyzed. Results: They were divided into three groups: group A (no obvious abnormality), group B (hyperactivity) and group C (hypoactivity) according to their BP, HR and existing the symptoms or not. Conclusion: The incidence of autonomic dysfunction in the high level SCI patients with dysuria was very high (79.17%), most of them were hyperactivity, and a few were low function. The changes of SBP and DBP in the hypoactivity group all appeared an increasing and then declining trend, while the change of HR in the low function one was lower than normal and decreased continuously. The main inducements of AD are neurogenic detrusor overactivity, detrusor sphincter dyssynergia, elevated abdominal pressure and abnormal bladder sensitivity. The asymptomatic patients had a higher occurrence rate (43.75%). Only by imaging urodynamic examination with slow filling and synchronous blood pressure monitoring, can autonomic nervous function of the patients be evaluated safely, objectively, early and accurately.

Effects of Sofren injection combined with oxygen free radical scavenger on neural function and apoptosis in patients with acute cerebral infarction

Objective:To investigate the effects of Sofren injection combined with oxygen free radical scavenger on neural function and apoptosis in patients with acute cerebral infarction.Methods:The patients with acute cerebral infarction who received treatment in Xi'an Union Hospital between September 2016and February 2018 were selected as the study subjects and divided into the control group and Sofren injection group by random number table method. Control group received both conventional treatment and oxygen free radical scavenger treatment, and Sofren injection group received both conventional treatment and Sofren injection combined with oxygen free radical scavenger treatment. The differences in serum levels of neurotrophy indexes, nerve injury indexes and neural apoptosis indexes were compared between the two groups before treatment (T0), after 1 week of treatment (T1), and after 2 weeks treatment (T2).Results: At T0, serum levels of neurotrophy indexes, nerve injury indexes and neural apoptosis indexes were not significantly different between the two groups. At T1 and T2, serum neurotrophy indexes IGF-1, bFGF, BDNF and GDNF levels of Sofren injection group were higher than those of control group;serum nerve injury indexes RBP4, H-FABP, SAA and NPY levels were lower than those of control group;serum neural apoptosis index Bcl-2 level was higher than that of control group whereas Bax and caspase-3 levels were lower than those of control group.Conclusion: Sofren injection combined with oxygen free radical scavenger therapy can effectively optimize the neural function and inhibit the neural apoptosis in patients with acute cerebral infarction.

An open-label pilot study with high-dose thiamine in Parkinson's disease

Parkinson’s disease（PD）is a progressive neurodegenerative disorder clinically characterized by motor symptoms（bradykinesia,tremor,rigidity,postural instability）and non-motor symptoms（hyposmia,sleep disorders,autonomic and sphincteric dysfunctions,fatigue,pain,depression,and cognitive disorders）（Sprenger and Poewe,2013）.

Botulinum toxin type A combined with robot-assisted training for upper limb spasticity and motor function after stroke:a case report

This study is to report the clinical experience of of Botulinum toxin type A in combination with robot-assisted training on upper limb spasticity and motor function in stroke patient through a case report.The patient underwent combined treatment with Botulinum toxin type A and robot-assisted training of the upper limb for 3 weeks.Evaluation was performed before and after combined treatment,and 3 months follow-up after discharge.The following outcomes were measured:spasticity by the modified Ashworth scale,pain by the numeric rating scale,motor function by the Fugl-Meyer assessment in upper limb,and activity of daily living by the modified barthel index.The combined Botulinum toxin type A and robot-assisted training treatment had an obvious improvement in upper limb spasticity,pain,motor function and activity of daily living.Botulinum toxin type A combined with robot-assisted training therapy is worthy of further application in patients with spastic stroke.

A patient with typical Wallenberg syndrome:a case report and literature review

Wallenberg syndrome is a special type of medulla oblongata infarction with many and severe clinical dysfunction,which is dorsolateral medullary syndrome.Wallenberg syndrome can have various initial symptoms due to different damaged parts.Typical clinical manifestations of the syndrome include dizziness,vomiting,dysphagia,cross sensory disturbance,ataxia,etc.Based on the complexity of functional anatomy,infarction in the medulla oblongata can produce various types of clinical symptoms or signs depending on the location.We describe the clinical comprehensive management of a 71-year-old man who presented with typical Wallenberg syndrome.Through early diagnosis and comprehensive clinical management,the prognosis of patient can be effectively improved.

Clinical application of Chinese Nanjing persistent vegetative state scale

Background:It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors.We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale(CNPVSS)which was first set up in 1996 and modified in 2001 and 2011.Methods:The concurrent validity,inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised(CRS-R)were investigated by assessment of 380 patients with severe disorders of consciousness.Results:Total scores of the CNPVSS were correlated significantly with that of the CRS-R,indicating acceptable concurrent validity.Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability.CNPVSS was superior to CRS-R on the diagnosis sensitivity.The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state(MCS)by the CRS-R,and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.Conclusion:The CNPVSS is an appropriate measurement and is sensitive to distinguish the MCS patients from the VS patients.

Ischaemic stroke etiological classification system: the agreement analysis of CISS, SPARKLE and TOAST

Background and purpose The ideal stroke classification system needs to have validity,high reliability and applicability among different stroke research settings.The Chinese Ischemic Stroke Subclassification(CISS)and the Subtypes of Ischemic Stroke Classification System(SPARKLE)have emerged recently but have not been tested using agreement analysis.As a result,the objective of this study is to investigate the level of agreement among stroke subtype classifications using CISS,SPARKLE and Trial of Org 10172 in Acute Stroke Treatment(TOAST).We also analyse the inter-rater reliability of CISS.Methods The data include 623 inpatients who have had an ischaemic stroke,accrued from Beijing Tiantan Hospital between 1 October 2015 and 19 April 2016.According to the diagnostic standards of the three subtype classification systems,299 inpatients who satisfied the requirements of our study were independently classified with etiological subtypes,and we compared the three subclassifications.Results There was substantial overall agreement among the three classification systems:CISS versus SPARKLE(kappa value=0.684,p<0.001),CISS versus TOAST(kappa value=0.615,p<0.001)and SPARKLE versus TOAST(kappa value=0.675,p<0.001).The inter-rater reliability of CISS was excellent(kappa value=0.857,p<0.001).Furthermore,among the three subtype classification systems,the variance analysis results of the etiological subtypes were not uniform.Conclusion There were generally substantial agreements among three ischaemic stroke etiological classification systems.CISS is a valid and reliable classification system,with which different stroke research centres can apply and compare data.

Effects of metoprolol treatment on a disintegrin metalloproteinase expression and extracellular matrix remodeling after myocardial infarction in rats

Ventricular remodeling （VR） after myocardial infarction （MI） makes a full impact on left ventricular dilation and dysfunction, severe arrhythmias and even sudden death. Thus it is very interesting and instructive to study the underlying regulatory mechanism for VR. Recently, evidenceI suggests that tumor necrosis factor-α （TNF-α） activity can independently influence VR, and aggravate myocardial dysfunction and cell death in the ventricle. The activation of pro-TNF〈t is adjusted by a disintegrin metalloproteinase （ADAM） 10 and ADAM17, the latter might take part in extracellular matrix （ECM） modulation in the borderline region of cardiac infarction.2 However, little is known about the relationship between ADAMsl0, 17 expressions and TNF-α activity in the process of VR after MI. The present study tested the hypothesis in rats that the interaction between ADAMsl0, 17 expressions and TNF-α activity was a contributory mechanism for VR of the healing myocardium, and metoprolol treatment might ameliorate VR inhibiting the mechanism.

Acupuncture for Chronic Dysphagic Stroke Evaluated by Fiberoptic Endoscopic Evaluation of Swallowing: A Case Report

Objective： To describe the effect of acupuncture with a new acupoint prescription in treating dysphagia from a chronic stroke patient by fiberoptic endoscopic evaluation of swallowing （FEES）. Methods： A case of chronic dysphagic stroke patient was treated by acupuncture with 5 established acupoints, and assessed by FEES before and after 4-week treatments. Results： There is improvement in swallowing and speech function after acupuncture treatment. Conclusion： There is evidence showing that new acupuncture points maybe beneficial for dysphagic stroke patients.

Effect of Governor Vessel-unblocking and mind- refreshing acupuncture plus functional training on neural development in infants with brain damage

Objective： To observe the effect of Governor Vessel-unblocking and mind-refreshing acupuncture plus functional training on neural development in infants with brain damage and seek an effective method for early intervention of infantile brain damage. Methods： Eighty infants with brain injury were recruited and allocated to a treatment group and a control group by their visiting sequence, with 40 cases in each group. The control group received exercise training, 40 min each session and 6 sessions a week, and tuina treatment, 30 min each time and 6 times a week. Based on the treatment protocol for the control group, the treatment group additionally received Governor Vessel-unblocking and mind-refreshing acupuncture, 3 times a week and 10 sessions as a course at a 2-week interval. Before the treatment and after 14-week treatment, the gross motor function measure （GMFM） and developmental quotient （DQ） of Bejing Gesell developmental scale were used to evaluate the development of the infants. Results： After the treatment, the GMFM score and DOs of Gesell scale all increased by different levels in the two groups, and the intra-group differences were statistically significant （all P〈0.05）; the scores of the treatment group were superior to those of the control group, and the between-group differences were statistically significant （all P〈0.05）. Conclusion： Governor Vessel-unblocking and mind-refreshing acupuncture plus functional training can significantly promote the development of gross motor and cognitive functions in infants with brain damage, and it is an early and effective intervention for infantile brain damage.