Acupuncture for ischemic stroke:where are we now?

Acupuncture is an effective treatment for ischemic stroke(IS)and plays a key role in neurological rehabilitation after IS.Acupuncture can improve the clinical symptoms of various complications after IS,including motor dysfunction,swallowing disorders,speech disorders,cognitive impairment,depression,insomnia,and fatigue.However,the mechanisms underlying the effects of acupuncture in IS remain unclear.Available evidence suggests that acupuncture may exert neuroprotective effects through neuroplasticity(neurogenesis and synaptogenesis),angiogenesis,cell proliferation and apoptosis,and regulation of oxidative stress,inflammation,and immunity.Further studies should be conducted to improve the high-quality evidence-based system of acupuncture intervention for IS,by focusing on the clinical and basic research design,increasing the sample size,standardizing and quantifying the standards of acupuncture operations,using multidisciplinary techniques and methods to systematically explore the key targets of acupuncture intervention for IS,and reveal the efficacy and mechanism of acupuncture in the treatment of IS.

Impact of task-oriented training based on acupuncture rehabilitation on upper extremity function and quality of life of patients with early stroke

BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke.METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group,each with 50 cases.The control group underwent head acupuncture plus routine upper limb rehabilitation training(acupuncture therapy).In addition to acupuncture and rehabilitation,the observation group underwent upper limb task-oriented training(30 min).Each group underwent treatment 5 d/wk for 4 wk.Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Rating Scale(WMFT),modified Barthel Index(MBI),and Canadian Occupational Performance Measure(COPM).Quality of life was evaluated using the Short-Form 36-Item Health Survey(SF-36).Clinical efficacy of the interventions was also evaluated.RESULTS Before intervention,no significant differences were observed in the FMA-UE,MBI,and WMFT scores between the two groups(P>0.05).After intervention,the FMA-UE,WMFT,MBI,COPM-Functional Mobility and Satisfaction,and SF-36 scores increased in both groups(P<0.05),with even higher scores in the observation group(P<0.05).The observation group also obtained a higher total effective rate than the control group(P<0.05).CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility,quality of life,and clinical efficacy in patients with early stroke.

Qixue Shuangbu decoction and acupuncture combined with Western medicine in acute severe stroke patients

BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.

Acupuncture for stroke cohort construction:a protocol describing a multicenter,prospective,real-world cohort construction study

Background:Acupuncture for stroke has been endorsed by the World Health Organization,and the Chinese Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke 2018 lists acupuncture for stroke as a Level II recommendation with Level B evidence.The efficacy of acupuncture in the treatment of acute ischaemic stroke needs to be approved by more high-quality studies.However,there are currently no real-world studies of acupuncture for stroke.Methods:Stroke patients who meet the study criteria and are hospitalized from February 2021 to March 2022 in 23 medical institutions across China,including the First Teaching Hospital of Tianjin University of Chinese Medicine.The number of patients planned to be recruited is 3,000.Due to the impact of COVID-19,we have applied to the competent authorities for an extension(recruit patients until December 2022).Basic patient information and treatment information will be registered at admission,at discharge,and on the following dates after the onset of the disease:90±7 days,180±7 days,and 360±7 days after the onset of the disease.Establish a database for statistical analysis.Discussion:This study proposes to conduct a prospective cohort study of acupuncture intervention for stroke in a real-world medical setting.Analysis of the effect pattern of acupuncture intervention on the recovery of neurological function system and swallowing disorder in stroke patients.Evaluate the long-term effects of acupuncture intervention for stroke and recurrence of cardiovascular and cerebrovascular events.

Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan （TE5）. In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamiilary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11,20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.

Mechanism underlying treatment of ischemic stroke using acupuncture:transmission and regulation

The inflammatory response after cerebral ischemia/reperfusion is an important cause of neurological damage and repair.After cerebral ischemia/reperfusion,microglia are activated,and a large number of circulating inflammatory cells infiltrate the affected area.This leads to the secretion of inflammatory mediators and an inflammatory cascade that eventually causes secondary brain damage,including neuron necrosis,blood-brain barrier destruction,cerebral edema,and an oxidative stress response.Activation of inflammatory signaling pathways plays a key role in the pathological process of ischemic stroke.Increasing evidence suggests that acupuncture can reduce the inflammatory response after cerebral ischemia/reperfusion and promote repair of the injured nervous system.Acupuncture can not only inhibit the activation and infiltration of inflammatory cells,but can also regulate the expression of inflammation-related cytokines,balance the effects of pro-inflammatory and anti-inflammatory factors,and interfere with inflammatory signaling pathways.Therefore,it is important to study the transmission and regulatory mechanism of inflammatory signaling pathways after acupuncture treatment for cerebral ischemia/reperfusion injury to provide a theoretical basis for clinical treatment of this type of injury using acupuncture.Our review summarizes the overall conditions of inflammatory cells,mediators,and pathways after cerebral ischemia/reperfusion,and discusses the possible synergistic intervention of acupuncture in the inflammatory signaling pathway network to provide a foundation to explore the multiple molecular mechanisms by which acupuncture promotes nerve function restoration.

Acupuncture for ischemic stroke:cerebellar activation may be a central mechanism following Deqi

The needling sensation of Deqi during acupuncture is a key factor of influencing acupuncture outcome.Recent studies have mainly focused on the brain function effects of Deqi in a physiological state.Functional magnetic resonance imaging（f MRI）on the effects of acupuncture at Waiguan（SJ5）in pathological and physiological states is controversial.In this study,12 patients with ischemic stroke received acupuncture at Waiguan（SJ5）and simultaneously underwent f MRI scanning of the brain,with imaging data of the activated areas obtained.Based on the patient＇s sensation,imaging data were allocated to either the Deqi group or non-Deqi group.In the Deqi group,the activated/deactivated areas were the left superior temporal gyrus（BA39）/right anterior lobe of the cerebellum and left thalamus.In the non-Deqi group,the activated areas included the medial frontal gyrus of the right frontal lobe（BA11）,right limbic lobe（BA30,35）,and left frontal lobe（BA47）,while the only deactivated area was the right parietal lobe（BA40）.Compared with the non-Deqi group,the Deqi group exhibited marked activation of the right anterior lobe of the cerebellum and right limbic lobe（BA30）.These findings confirm that the clinical effect of Deqi during acupuncture is based on brain functional changes.Cerebellar activation may be one of the central mechanisms of acupuncture in the treatment of ischemic stroke.

Acupuncture at Waiguan(SJ5) and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study

Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group （true acupuncture at right Waiguan （SJ5）） and sham point group （sham acupuncture）. Results of functional magnetic resonance imaging revealed activation in right parietal lobe （Brodmann areas 7 and 19）, the right temporal lobe （Brodmann area 39）, the right limbic lobe （Brodmann area 23） and bilateral oc-cipital lobes （Brodmann area 18）. Furthermore, inhibition of bilateral frontal lobes （Brodmann area 4, 6, and 45）, right parietal lobe （Brodmann areas 1 and 5） and left temporal lobe （Brodmann area 21 ） were observed in the true point group. Activation in the precuneus of right parietal lobe （Brodmann area 7） and inhibition of the left superior frontal gyrus （Brodmann area 10） was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex （Brodmann area 5） is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.

Observation on the Curative Effect of"Hand and Foot 12 Needle Acupuncture"on Stroke in Convalescent Period of Phlegm-Dampness Constitution

Objective:To observe the clinical effects of"hand and foot 12 needle acupuncture"on stroke in convalescent period of phlegm-dampness constitution.Methods:The 90 patients were divided into the treatment group(n=45)and the control group(n=45)according to the random number table method.The control group received basic Western medicine treatment+rehabilitation treatment of Western medicine,and the treatment group was additively treated with"hand and foot 12 needle acupuncture"on the basis of the control group.NIHSS score,MRS score and Barthel index(BI)before and after treatment were observed in the two groups,and the clinical efficacy of the two groups was compared.Results:The clinical efficacy of stroke patients in the convalescent period of phlegm-dampness constitution after treatment:the total effective rate of the treatment group was 93.33%,and the total effective rate of the control group was 66.67%.After statistical processing,the clinical efficacy of the treatment group was significantly better than the control group;NIHSS score,MRS score and Barthel index(BI)were better than the control group,and the differences were statistically significant(P<0.05).Conclusion:"Hand and foot 12 needle acupuncture"treatment of phlegm-dampness constitution convalescent stroke clinical effect is remarkable.

Effects of different acupuncture methods combined with routine rehabilitation on gait of stroke patients

BACKGROUND Stroke refers to a group of cerebrovascular diseases associated with organic braininjury. It is characterized by the sudden and rapid onset of focal or diffusedysfunction. In recent years, in addition to routine treatment, Chinese medicineacupuncture has been administered to patients with hemiplegia, and it can beconsidered a new treatment for rehabilitation.AIM To investigate the effects of eye acupuncture needle retention and bodyacupuncture combined with routine rehabilitation on gait performance andplantar pressure in patients recovering from stroke.METHODS Thirty-two stroke patients who met the inclusion criteria were randomly dividedinto an experimental group and a control group, with 16 patients in each group.Both groups underwent routine rehabilitation. The experimental group wastreated by eye acupuncture needle retention, and the control group was treated bybody acupuncture. Before and after 4 wk of treatment, both groups underwentkinematic and plantar pressure synchronous tests to assess gait performance.RESULTS The step length, gait speed, step frequency, joint angles of the lower limbs, andground reaction force impulse in the anterior region of the affected foot in bothgroups significantly increased from before to after treatment (P < 0.05);the center of mass displacement, peak pressure values, and impulse in the anterior region ofthe healthy foot and posterior regions of both the affected and healthy feetsignificantly decreased from before to after treatment (P < 0.05). The patients inthe experimental group showed greater improvement in the following parametersthan the control group: Step length, gait speed, step frequency, lower extremityjoint angles, center of gravity displacement, and peak pressure values andimpulse in the anterior and posterior regions of both the affected and healthy feet(P < 0.05).CONCLUSION Eye acupuncture needle retention and body acupuncture combined with routinerehabilitation can effectively improve the gait performance of patients recoveringfrom stroke. Between these two treatments, eye acupuncture needle retentioncombined with routine treatment is better than body acupuncture, and it can beconsidered a practical and effective clinical treatment.

Insight into Crosstalk Between Mitophagy and Apoptosis/Necroptosis:Mechanisms and Clinical Applications in Ischemic Stroke

Ischemic stroke is a serious cerebrovascular disease with high morbidity and mortality.As a result of ischemia-reperfusion,a cascade of pathophysiological responses is triggered by the imbalance in metabolic supply and demand,resulting in cell loss.These cellular injuries follow various molecular mechanisms solely or in combination with this disorder.Mitochondria play a driving role in the pathophysiological processes of ischemic stroke.Once ischemic stroke occurs,damaged cells would respond to such stress through mitophagy.Mitophagy is known as a conservatively selective autophagy,contributing to the removal of excessive protein aggregates and damaged intracellular components,as well as aging mitochondria.Moderate mitophagy may exert neuroprotection against stroke.Several pathways associated with the mitochondrial network collectively contribute to recovering the homeostasis of the neurovascular unit.However,excessive mitophagy would also promote ischemia-reperfusion injury.Therefore,mitophagy is a double-edged sword,which suggests that maximizing the benefits of mitophagy is one of the direction of future efforts.This review emphasized the role of mitophagy in ischemic stroke,and highlighted the crosstalk between mitophagy and apoptosis/necroptosis.

Advances in the application of optical coherence tomography in the assessment of ischemic stroke

Ischemic stroke has high morbidity,mortality,disability rate and recurrence.It is the one of the main diseases that threaten people's health in China.Its etiology,pathogenesis,and reaction mechanism has been the research hotspot and difficulty of related studies have shown that the optical coherence tomography technology is an effective measure to evaluate ischemic cerebral apoplexy.Optical coherence tomography(OCT)is a gradually developed and mature imaging technology in recent years,and there are related studies on internal carotid artery,retina and coronary artery.Based on the above background,this paper reviews the research progress of optical coherence tomography in the assessment of the etiology,pathogenesis and response mechanism of ischemic stroke.

OBSERVATION ON THERAPEUTIC EFFECT OF ELECTROACUPUNCTURE HEAD PONINT-THROUGH-POINT BY PENETRATING TWO POINT ON ISCHEIC STROKE

Objective To probe methods and therapeutic effects of Head Acupuncture on ischemic stroke. Methods One hundred and twelve cases were randomly divided into observation group (head acupuncture group) and control group (body acupuncture group). After treatment of 28 days, changes of linguistic function and paralysis level of limbs before and after treatment were investigated. Results The total effective rate was 96.6% in the observation group and 90.7%, in the control group, with a significant difference between the two groups (P<0.05). Conclusion The electroacupuncture head point-through-point by penetrating two point therapy is one of effective methods for ischemic stroke.

Study on the Protective Mechanism of Acupuncture Regulating ICAM-5 mRNA Expression in Rats with Ischemic Stroke

Objective: The objective is to investigate whether acupuncture can protect brain by regulating the expression of ICAM-5 mRNA in brain tissue. Methods: Male SD rats were used to construct a middle cerebral artery occlusion reperfusion injury (Middle cerebral artery occlusion, MCAO) model, and the rats were randomly divided into 4 groups, namely the normal group (group A) and the sham operation group (group B), MCAO group (group C), MCAO + acupuncture group (group D);real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the expression of ICAM-5 mRNA in the brain tissue of the ischemic area, and HE staining and TUNEL were used to detect the level of neuronal apoptosis to evaluate the therapeutic effect. Results: Acupuncture can improve neuronal morphology and reduce neuronal apoptosis in rats with ischemic stroke. RT-qPCR: compared with group A and group B, the expression level of ICAM-5 mRNA in the brain tissues of group C and group D decreased, while compared with group C, The expression of ICAM-5 mRNA in the brain tissue of group D was significantly up-regulated (P < 0.05). There was no statistical difference between group A and group B (P > 0.05). Conclusion: The effectiveness of acupuncture in the treatment of ischemic stroke may achieve neuroprotection by up-regulating the expression level of ICAM-5 mRNA.

Evaluation of the Curative Effect of "Xingnao Kaiqiao" Acupuncture Based on Brunnstrom Staging on Upper Limb and Hand Motor Function in the Recovery Period after Stroke

Objective: To observe the effects of Xingnao Kaiqiao acupuncture(醒脑开窍针) on the motor function of upper limb and hand in the recovery period after stroke. Methods: Seventy-six cases of hemiplegia patients with ischemic stroke were divided into the treatment group and the control group(n=38 in each). Based on the Brunnstrom's stage of Xingnao Kaiqiao acupuncture combined with rehabilitation training was used in the treatment group, and the control group was given rehabilitation training. FuglMeyer Assessment of the upper extremity(FMA-UE), Action Research Arm Test(ARAT) and Simple Test for Evaluating hand Function(STEF) were adopted separately to compare scores before treatment and 8 weeks after treatment. Results: The difference was not statistically significant in the two groups of patients for comparison of FMA-UE, ARAT and STEF scores before treatment(P>0.05). The difference was statistically significant in the two groups of score comparison of FMA-UE, ARAT and STEF after treatment(P<0.05). Conclusion: The Xingnao Kaiqiao acupuncture has its unique advantages in improving recovery of motor function of upper limb and hand in recovery period after stroke.

Experimental Study on the Effect of Acupuncture on ERM/PI3/Akt Signal Pathway in Rats with Ischemic Stroke

Objective: To observe the effect of acupuncture on the expression of ERM/PI3K/Akt signaling pathway in the brain tissue around the infarct focus of ischemic stroke model rats. Methods: According to the block randomization method, 80 male SD rats were divided into normal group (n = 10), sham operation group (n = 24), model group (n = 23) and acupuncture group (n = 23). The normal group was bred routinely without any intervention. In the sham operation group, only the skin was cut to find and the nerves and blood vessels were stripped and sutured. The model group and the acupuncture group were sutured to prepare the MCAO model. After the model was successfully established, acupuncture of the acupuncture group rats was given once a day, and the needles were kept for 30 minutes each time. The rats in the sham operation group and the model group only imitated capture and return, and were treated with acupuncture for 2 consecutive courses, each course was 5 days, and the two courses were rested for 2 days. After that, Western blot was used to detect ERM, changes in the concentration of PI3K and Akt proteins. Results: Compared with the normal group, the expression levels of ERM, PI3K, and Akt proteins in the sham operation group were reduced. Compared with the sham operation group, the expression levels of ERM, PI3K, and Akt proteins in the model group were significantly down-regulated. Compared with the model group, the protein expression levels of ERM, PI3K and Akt were significantly up-regulated in the acupuncture group, and the difference was statistically significant (P < 0.05). Conclusion: Acupuncture can significantly up-regulate the expression of ERM, PI3K and Akt proteins, and its effect mechanism may be related to the transduction of ERM/PI3K/Akt signaling pathway in cells.

Clinical observation of body acupuncture combined with FANG’s scalp acupuncture for limb dysfunction in the remission stage of stroke

Objective:To observe the clinical efficacy of body acupuncture combined with FANG’s scalp acupuncture in treating limb dysfunction in the remission stage of stroke and explore the mechanism.Methods:Sixty patients in the remission stage of stroke with limb dysfunction were divided into a control group and a treatment group using the random number table method,with 30 cases in each group.The control group was treated with ordinary acupuncture based on the conventional rehabilitation treatment,and the treatment group was additionally offered FANG’s scalp acupuncture.The interventions were conducted once daily with 10 sessions as 1 course.The Fugl-Meyer assessment(FMA)and Barthel index(BI)scores and serum malondialdehyde(MDA)and superoxide dismutase(SOD)levels were compared after 2 treatment courses,and the clinical efficacy was evaluated.Results:After treatment,the FMA and BI scores increased in both groups(P<0.05)and were higher in the treatment group than in the control group(P<0.05).Both groups showed a decreased MDA level and an increased SOD level after the intervention,all showing statistical significance(P<0.05);there were significant differences between the two groups(P<0.05).Conclusion:Based on the conventional rehabilitation treatment,ordinary acupuncture used alone or in combination with FANG’s scalp acupuncture can lower the oxidative stress level and improve limb function in treating limb dysfunction in the remission stage of stroke;body acupuncture plus FANG’s scalp acupuncture can produce better results.

Clinical observation of the effect of acupuncture on constipation after stroke

Objective： To observe the differences in therapeutic effects of acupuncture and lactulose oral solution on constipation after stroke. Method： Sixty patients with constipation after stroke were divided into an acupuncture group and a western medicine group by a random number method, with 30 cases in each group. Based on the the conventional treatment and rehabilitation for function recovery, the acupuncture group was treated at the selected the bilateral acupoints： Daheng （SP15）, Fujie （SP14）, Zhigou （TE6）, Zhaohai （KI6）, Yingxiang （LI20）, and Shaoshang （LU11） while the western medicine group was treated with 30 ml of lactulose oral solution. The clinical symptoms score and clinical efficacy of the treatment provided for constipation in both groups were recorded pre-treatment, at one week of treatment, after treatment for two weeks, and one month after discharge respectively. Results： The clinical symptom scores of constipation in the two groups after one week of treatment, two weeks of treatment, and one month of treatment were significantly lower than those before treatment （P 〈 0.001）. The treatment efficacy in the acupuncture group showed significant improvement when compared with the western medicine group, at one week, two weeks and one month （1.03 ± 1.19 vs 1.43 ± 1.19, P 〉 0.05 ; 0.73 ± 1.01 vs 1.33 ± 1.18, P 〈 0.05; 0.53 ± 0.82 vs 1.27 ± 1.14, P 〈 0.05, respectively）. The efficacy rate was statistically significant at two weeks after treatment and one month after follow-up （86.67% vs 70%,P 〈 0.05; 93.33% vs 73.33%, P 〈 0.05, respectively）. Conclusion： The short-term and long-term efficacy of acupuncture on constipation after stroke is better thanthat of treatment with lactulose oral solution. This method is safe, free of side effects, durable, has high feasibility, and is suitable for clinical application.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.

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.