Recovery after ischemic stroke:Effects of FuekFone home-based program on upper limb and cognitive function

Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-test design was conducted.A total of 40 patients with recovery after ischemic stroke were recruited from two university hospitals in Thailand.The study was conducted between June 2022 and January 2023.Participants underwent a six-week“F.F.home-based program,”which combined an upper limb and cognitive function rehabilitation device with Android games,including stationary barrel,adventure walk,adventure stroll,sliding barrel,sauce squeeze,and cut objects.Each game has different difficulty levels.Patients can perform corresponding exercises through the games according to their conditions under the guidance of medical staff.The patients played for 24 min per time,4 min each game,three days a week.The second week,let the patients play games for 30 min per time,5 min each game,3 days a week.Then,in the 3e6 weeks,let the patients play games for 1 h per time,10 min each game,5 days a week.At the pre-and post-intervention,the Thai version of the National Institutes of Health Stroke Scale(NIHSS),the Motor Assessment Scale,and the Montreal Cognitive Assessment(MoCA score)were administered to patients at discharge and at 2,4,and 6 weeksafter discharge,and the results were compared.Results:All participants completed this program.Participants had statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 2,4,and 6 weeks after discharge(P<0.001).In the comparison of upper limb function and cognitive function at each of the study times,we found statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 4,and 6 weeks after discharge when compared to after discharge and 2 weeks after discharge,respectively(P<0.05).Conclusions:Continuing care of patients post-stroke after discharge from hospital,such as F.F.homebased program should be applied at home to enhance upper limb and cognitive function.

针灸治疗缺血性中风后遗症期肢体运动功能障碍的研究概况

为探究针灸治疗中风后肢体运动功能障碍的临床优势,选取较有疗效的相关文献,对不同的治疗方法进行分类总结、分析对比,发现临床上针灸治疗有效,但不能有效减轻患者的致残、复发等问题。

神经肌肉电刺激治疗脑卒中后吞咽障碍的疗效观察

目的探讨神经肌肉电刺激对脑卒中后吞咽障碍的临床疗效。方法将急性脑卒中后吞咽障碍患者98例按随机数字表法分为神经肌肉电刺激（NMES）组（38例）、康复训练组（30例）和对照组（30例），对照组给予药物治疗，NMES组在对照组治疗方案的基础上给予神经肌肉电刺激疗法，康复训练组在对照组治疗方案的基础上进行吞咽康复训练。3组患者均于治疗前和治疗3周后（治疗后）采用吞咽障碍程度评分评定疗效，同时观察并发症和不良反应，并于治疗3个月后随访胃管的留置率。结果治疗后，NMES组的吞咽障碍程度评分为（7．74±1．39）分，康复训练组为（6．73±2．13）分，与组内治疗前[分别为（5．39±1．64）分和（5．57±1．70）分]和对照组治疗后的（5．50±1．94）分比较，差异均有统计学意义（P〈0．05），且治疗后，NMES组的吞咽障碍程度评分显著高于康复训练组，差异有统计学意义（P〈0．05）。治疗后，NMES组吸入性肺炎发病率为21．05％，低于康复训练组的43．33％和对照组的56．67％，差异均有统计学意义（P〈0．05）；3组营养不良发生率组间比较，差异无统计学意义（P〉0．05）。治疗3个月后，NMES组的胃管留置率为10．53％，显著低于对照组的36．67％（P〈0．05），而与康复训练组的16．67％比较，差异无统计学意义（P〉0．05）。结论神经肌肉电刺激能有效地改善急性卒中后的吞咽障碍，减少误吸的发生，且短期疗效优于吞咽康复训练，但远期疗效与康复训练结果相当。

舒适护理干预对脑梗死患者临床康复的影响研究

脑梗死又被称之为缺血性脑卒中,是多种原因引起的脑部血液供应障碍,使局部脑组织发生不可逆性损害, 致使脑组织缺血、缺氧性坏死,进而引起局灶性的症状和体征,表现为明显的神经功能缺损综合征.研究报道,近年来脑卒中的发病率、死亡率及致残率均有增高趋势,与心脏病、恶性肿瘤构成人类的三大致死病因,其致残率在存活者中达80% 以上[1],给家庭和社会带来沉重的负担.舒适护理是一种整体性的、个性化的、具有创造性和有效性的新型护理模式,已成为提高整体护理水平的重要措施[2] .近年来,笔者根据脑梗死患者的特殊性,在常规专科护理基础上,对其施行舒适护理干预,取得了较为满意的效果.

Characteristics of elevated cardiac troponin I in patients with acute ischemic stroke

Objective To study prognostic characteristics of cardiac troponin I （cTnI） elevation in acute ischemic stroke. Methods We retrospectively studied patients （n = 248） with acute ischemic stroke, acute ST-segment elevation myocardial infarction, and acute non-ST-elevation myocardial infarction who were treated between January 2013 and October 2015. Baseline demographic data and changes in cTnI levels among these three groups were compared. Patients with acute ischemic stroke were assigned to either the cTnI elevation group （cTnI 〉 0.034 ng/mL） or the no cTnI elevation group （cTnI ≤ 0.034 ng/mL）. Logistic regression analysis was used to identify risk factors associated with elevated serum cTnI in patients with acute ischemic stroke. Moreover, the duration of hospital stay and incidence of major cardiovascular outcomes were compared in patients with acute ischemic stroke, with or without elevated cTnI. Results In this study population of patients with acute ischemic stroke （n = 178）, acute ST-segment elevation myocardial infarction （n = 35）, and acute non-ST-elevation myocardial infarction （n = 35）, patients with acute ischemic stroke with elevated cTnI comprised 18.54% of subjects. Patients with elevated cTnI were older and more likely to have a history of hypertension. In addition, these patients had higher levels of inflammatory markers, reduced renal functions, increased D-dimer levels, higher NIH stroke scores, and lower left ventricular ejection fractions. Logistic regression analysis showed that both percentage of neutrophil and NIH stroke scores were elevated; estimated glomerular filtration rate and left ventricular ejection fraction were decreased in patients with acute ischemic stroke who had elevated cTnI, and they had more frequent major cardiovascular events during hospital stay. Conclusion Elevated cTnI detected in patients with acute ischemic stroke, indicated a greater likelihood of poor short-term prognosis during hospital stay.

CLINICAL STUDY ON TREATMENT OF ACUTE ISCHEMIC STROKE WITH ACUPUNCTURE OF ACUPOINTS OF THE PERICARDIUM MERIDIAN AND THE HEART MERIDIAN

Objective: To research the protective effect of acupuncture on the cardiac performance and cerebral function in acute ischemic stroke (AIS) patients. Methods: Forty AIS patients were randomly divided into acupuncture group (n=20) and medication group (n=20) according to their admission sequence. Acupoints, bilateral Neiguan (PC 6) and Tongli (HT 5) were punctured with Gauge-28 filiform needles, once daily, with 10 sessions being a therapeutic course. Patients of the medication group were treated with oral administration of persantine and aspirin as well as intravenous drip of 20% mannitol, low molecular dextran and compound Danshen (red sage root) injectio. Cerebral infarction volume, ECG (heart rate, ST Ⅱ and T Ⅱ), plasma CGRP, thromboxane (TX) B 2 and 6-Keto-prostanglandin (PG) F1a and scores of the neurological deficit were used as the indexes. Results: After 2 courses of treatment, self comparison of pre-and post treatment of each group showed that the therapeutic effects of acupuncture in reducing infarction volume ( P<0.01), lowering heart rate (HR, P<0.01) and ST Ⅱ ( P<0.01), raising T Ⅱ wave amplitude ( P<0.01), elevating plasma CGRP ( P<0.001) and 6-keto-PGF 1a ( P<0.01) and reducing plasma TXB 2 ( P< 0.01) were superior to those of medication group. Conclusion: Acupuncture of acupoints of the Pericardium Meridian and Heart Meridian has a significant protective action on the cardiac performance and cerebral function in acute ischemic stroke patients.

Effects of acupuncture intervention on omalgia incidence rate of ischemic stroke in acute stage

Objective To explore whether acupuncture intervention can reduce the concurrent omalgia of ischemic stroke patients and initially explore the feasibility of follow-up research on long-term acupuncture. Methods Three hundred pa ents who conformed to the research criteria and voluntarily took part in the research were randomized into an acupuncture group and a regular therapy group with envelope method. The 150 cases in the acupuncture group received the combined treatment of electroacupuncture（EA） and moxibus on based on regular treatments for a total of 4 weeks. The 150 cases in the regular therapy group received regular treatments. The omalgia incidence number were observed at 1,2,3,6,12 months follow-up,simplified Fugl-Meyer of the upper-extremity was evaluated 4 weeks after treatment,modified Rankin Scale was conducted to assess the number of rela vely independent patients and the patients acceptance for acupuncture therapy at 6 months follow-up. Results After 4 weeks of treatments,although the comparative devia ons of the omalgia incidence number and the simplified Fugl-Meyer in the two groups had no sta s cal significance（P0.05）,the omalgia incidence numbers in the acupuncture group at 2nd,3rd,6th and 12th month followups were different significantly compared with those in the regular therapy group（P0.05）; meanwhile,at 6 months follow-up,the rela vely independent number of the pa ents assessed by modified Rankin Scale in the acupuncture group was superior to that in the regular therapy group（P0.05）. The number of pa ents who adhered to the acupuncture rehab therapy in the acupuncture group was greater than that in the regular therapy group（P0.05）. Conclusion Acupuncture intervention during the acute stage of ischemic stroke can not only effectively reduce the incidence of omalgia complication,but also play an assisting role in improving the patients＇ ability of independent living; meanwhile,the systema c visits and treatments of acupuncture may feature assis ng significance in the construc on of the special disease and special skills of the acupuncturology.

Clinical efficacy and safety of Traditional Chinese Medicine combined with Western Medicine in patients with diabetic acute ischemic stroke

OBJECTIVE： To observe the clinical efficacy and safety of Traditional Chinese Medicine （TCM） com- bined with Western Medicine （WM） in patients with diabetic acute ischemic stroke. METHODS： Ninety patients with diabetic acute ischemic stroke were randomly divided into a treat- ment group and a control group. The 45 patients in the treatment group were given standardized treat- ment with TCM combined with WM. They received corresponding oral Chinese decoctions three times daily, according to their TCM syndromes, along with basic western medical treatment. The 45 patients in the control group were given non-stan- dardized treatment with TCM combined with WM. They received an oral Chinese decoction for promo- tion of blood circulation to inhibit hemostasis, regardless of their TCM syndromes, along with ba- sic western medical treatment. The treatments lasted for 4 weeks. Scores were evaluated on the National Institutes of Health Stroke Scale （NIHSS） score, activity of daily life （ADL） scores, and TCM symptoms before treatment and 2 and 4 weeks after treatment. RESULTS： Analysis of variance for repeated mea- surements showed that there were significant dif- ferences in NIHSS and ADL score before and after treatment in both groups （P〈0.05）. There were also significant differences between the scores at 2 and 4 weeks after treatment. There were signifi- cant differences in TCM syndrome scores before and after treatment in both groups （P〈0.05）. There were also significant differences between the scores at 2 and 4 weeks after treatment. The X2 test showed no statistically significant difference in the incidence of adverse reactions between the two groups （P〉0.05）. CONCLUSION： Standardized treatment was supe- rior to non-standardized treatment for clinical efficacy of TCM combined with WM in patients with diabetic acute ischemic stroke, and the superiority was more obvious in improving neural dysfunction, ADL score, and TCM symptoms. The adverse reactions were similar in the two treatment groups.

Clinical observation of heat-sensitive moxibustion for acute ischemic stroke

Objective To observe the clinical efficacy of heat-sensitive moxibustion in intervening acute ischemic stroke.Methods A total of 112 patients were divided into a control group and an observation group by the random number table method,with 56 cases in each group.The control group was treated with conventional treatment,and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment in the control group.The National Institute of Health stroke scale(NIHSS)and modified Barthel index(MBI)were evaluated,and the intracranial hemodynamic indicators including mean velocity(Vm),pulsatility index(PI)and resistance index(RI)were recorded,and the serum levels of superoxide dismutase(SOD)and homocysteine(HCY)were measured before and after treatment.Clinical efficacy was evaluated after treatment.Results The total effective rate of the observation group was significantly higher than that of the control group(P<0.05).After treatment,the NIHSS scores in both groups decreased significantly(both P<0.05),and the MBI scores increased significantly(both P<0.05).The improvements of NIHSS and MBI scores in the observation group were superior to those in the control group(both P<0.05).Vm in both groups increased significantly(both P<0.05),PI and RI decreased(all P<0.05),and Vm,PI and RI in the observation group were superior to those in the control group(all P<0.05).The serum levels of SOD and HCY in the observation group were significantly improved,and were statistically different from those in the control group(both P<0.05).Conclusion Conventional treatment plus heat-sensitive moxibustion is effective in intervening acute ischemic stroke.It can promote the recovery of neurological function,improve daily activities,and improve intracranial blood flow,which may be related to the regulation of serum SOD and HCY levels.

Efficacy observation of Zhi Shen Tiao Sui acupuncture method for depression after ischemic stroke

Objective To observe the clinical efficacy of Zhi Shen Tiao Sui(regulating the mind and marrow)needling in treating depression after ischemic stroke.Methods A total of 145 patients with depression after ischemic stroke were recruited between January 2016 and January 2018 and divided into two groups using random number table method,with 72 cases in the control group and 73 cases in the observation group.The control group received conventional treatment for ischemic stroke and medication,while the observation group was given additional Zhi Shen Tiao Sui acupuncture.The two groups were treated for 4 successive weeks.Clinical efficacy was analyzed after treatment.The neurological function pertinent scores[Hamilton depression scale(HAMD),clinical neurological deficit score(CNDS),activities of daily living(ADL),Fugl-Meyer assessment scale(FMA)and Barthel index(BI)scores],as well as the levels of cortisol(CORT)and adrenocorticotropic hormone(ACTH)were recorded in the two groups.Adverse reactions that occurred during treatment were also observed.Results The clinical total effective rate was 82.2%in the observation group,significantly higher than 66.7%in the control group(P<0.05).After treatment,the HAMD and CNDS scores were markedly reduced in both groups(all P<0.05),and the ADL,FMA and BI scores were markedly increased(all P<0.05).The HAMD and CNDS scores were significantly lower in the observation group than in the control group after treatment(both P<0.05),and the ADL,FMA and BI scores were significantly higher in the observation group than in the control group(all P<0.05).The levels of CORT and ACTH declined significantly after treatment in the two groups(all P<0.05),and were markedly lower in the observation group than in the control group(both P<0.05).The adverse reaction rate was 2.7%in the observation group,versus 4.2%in the control group,and the between-group difference was statistically insignificant(P>0.05).Conclusion Compared with sole use of Western medication,medication combined with Zhi Shen Tiao Sui acupuncture can promote the recovery of neurological function,down-regulate the levels of CORT and ACTH and enhance the clinical efficacy in treating patients with depression after ischemic stroke,with a relatively high safety rating.

Effects of electroacupuncture on angiogenesis and cortical VEGF and BDNF expression in rats with focal cerebral ischemia

Objective To observe the effect of electroacupuncture(EA)of“concurrent treatment of the brain and heart”on angiogenesis and cortical vascular endothelial growth factor(VEGF)and brain-derived neurotrophic factor(BDNF)in rats with focal cerebral ischemia,and to explore the mechanism of EA in cerebral ischemia treatment.Methods A total of 108 Sprague-Dawley rats,27 rats were randomly selected as the sham-operation group,and the rest rats received the right middle cerebral artery occlusion operation for model preparation firstly,and then were divided into a model group,a traditional acupoint group,and a concurrent treatment of the brain and heart group,with 27 rats in each group.In the sham-operation group,only the carotid artery was isolated.EA at Shuigou(CV26),Quchi(LI11),Hegu(LI4),and Zusanli(ST36)in the traditional acupoint group,and EA at Fengfu(GV16),Baihui(GV20),Xinshu(BL15),and Neiguan(PC6)in the concurrent treatment of the brain and heart group were performed 4 h after the operation,once a day,for 14 consecutive days.Rats in the sham-operation group and the model group were identically fixed without any treatment.Before and after treatment,the modified neurological severity score(mNSS),regional cerebral blood flow(rCBF),and CD34 positive expression by immunohistochemistry were measured.The positive protein expression levels of VEGF and BDNF were detected by immunofluorescence,and the mRNA expression levels of VEGF and BDNF were detected by quantitative reverse transcription-polymerase chain reaction(qRT-PCR).Results Compared with the sham-operation group,the mNSS,rCBF,and ischemic side cortical micro-vessel density(MVD)decreased,and the protein and mRNA expression levels of VEGF and BDNF increased in the model group(P<0.01).Compared with the model group,the mNSS of the two EA groups decreased,and the mNSS of the concurrent treatment of the brain and heart group was lower than that of the traditional acupoint group on the 14th day(P<0.05).Compared with the model group,the rCBF in the two EA groups increased,and the rCBF reached the highest on the 14th day(P<0.05 or P<0.01),and the rCBF in the concurrent treatment of the brain and heart group was higher than that in the traditional acupoint group(P<0.05);the MVD of the two EA groups was higher than that of the model group,and the MVD of the concurrent treatment of the brain and heart group was higher than that of the traditional acupoint group on the 7th and 14th days(P<0.05 or P<0.01).Compared with the model group,the protein and mRNA expression levels of VEGF and BDNF in the two EA groups increased(P<0.01).The VEGF expression level was the highest on the 7th day in the concurrent treatment of the brain and heart group(P<0.05),and the BDNF expression level was higher on the 7th and 14th days than on the 3rd day(P<0.05).The mRNA expression levels of VEGF and BDNF in both EA groups reached the highest on the 7th day(P<0.05 or P<0.01).Conclusion EA therapy can up-regulate the VEGF and BDNF expression levels and increase the rCBF in the cortex of rats with focal cerebral ischemia,which may be one mechanism of EA in the cerebral ischemia treatment.The therapeutic effect is accumulated with the effective time,and the concurrent treatment of the brain and heart group is superior to the traditional acupoint group in promoting angiogenesis.

Design, preparation and activity evaluation of two novel proteins with thrombolysis or/and neuroprotection

We hypothesized that thrombolysis in combination with neuroprotection might have better therapeutic effects for ischemic stroke compared with thrombolysis alone.In order to verify such hypothesis,we designed a protein TBN by fusing NR6and BH4,which possibly had dual functions of thrombolysis and neuroprotection.NR6was obtained by introducing two RGD motifs to thrombolytic protein AcAP5to target thrombus.BH4is the key domain of anti-apoptotic protein Bcl-xL. The DNA fragments encoding TBN and NR6were synthesized and cloned into pET30a and pET16b vectors,respectively.Both proteins were expressed in E.coli.BL21(DE3),mainly in the form of inclusion bodies.With His-tag,NR6was purified by nickel affinity chromatography,while TBN was purified by ion exchange chromatography.Purified proteins were refolded by dialysis assay.The thrombolytic activity of both proteins was evaluated by the rat arteriovenous bypass model.Both NR6and TBN significantly reduced thrombus weight at higher dose (24nmol/kg),TBN showed similar effect to NR6.These results suggested that NR6was a thrombolytic protein,and fusion protein TBN reserved the thrombolytic activation of NR6.The effects of both proteins were also evaluated in thromboembolic middle cerebral artery occlusion (eMCAO)in mice.TBN exhibited better effect on reducing infarction volume and inhibiting apoptosis of cells than NR6,indicating that the introduction of BH4increased the protective effect of NR6.The hemorrhagic side effects of the two proteins were evaluated by tail bleeding in mice,and it was found that NR6and TBN showed shorter bleeding time compared with tPA.In conclusion,we designed and prepared the two novel proteins,and testified that they had.significant thrombolytic effect and protective effect on cerebral IR injury.The protective effect of TBN was more potent than NR6.Their bleeding side reaction might be weaker than tPA.These results suggested that these two novel proteins deserved to be further investigated as new thrombolytic candidate agents.