Research Progress in the Treatment of Poststroke Depression with Traditional Chinese Medicine

In recent years,the incidence rate of stroke has increased year by year.Post stroke depres‐sion is one of its main complications,which seriously affects the recovery of physiological functions and quality of life of stroke patients.Traditional Chinese medicine has signifi‐cant therapeutic effects in treating this disease.This article provides a classification and review of traditional Chinese medicine treatment methods for post-stroke depression,and looks forward to the current problems.

Treatment of Post-stroke Dysphagia by VitalStim Therapy Coupled with Conventional Swallowing Training

To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia,a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups：conventional swallowing therapy group,VitalStim therapy group,and VitalStim therapy plus conventional swallowing therapy group.Prior to and after the treatment,signals of surface electromyography（sEMG） of swallowing muscles were detected,swallowing function was evaluated by using the Standardized Swallowing Assessment（SSA） and Videofluoroscopic Swallowing Study（VFSS） tests,and swallowing-related quality of life（SWAL-QOL） was evaluated using the SWAL-QOL questionnaire.There were significant differences in sEMG value,SSA,VFSS,and SWAL-QOL scores in each group between prior to and after treatment.After 4-week treatment,sEMG value,SSA,VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group,but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group.It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

Research Progress of Swallowing Therapy in Relieving Dysphagia after Stroke

This article summarizes the current rehabilitation treatment methods for dysphagia after stroke,including feeding-swallowing function treatment,acupuncture treatment,neuromuscular electrical stimulation,balloon catheter dilatation,etc.,all of which have many clinical applications,hoping to play a guiding role in future research.

Dysphagia and daily oral fluids among cerebrovascular stroke patients:an theory-based nursing intervention protocol

Objective:To evaluate the improvement of dysphagia and the daily amounts of oral fluids served among people who had recently experienced a cerebrovascular stroke(CVS)after applying a nursing intervention protocol.Methods:A quasi-experimental design was used to examine 60 stroke patients who were randomly and alternatively divided equally into a study group and a control group.Gugging Swallowing Screen(GUSS)and fluid balance chart were used.Within the first 24 h of a patient’s admission,expert nurses were trained in nursing intervention protocol to manage dysphagia and daily oral fluids.Results:Post-nursing intervention,the severity of dysphagia decreased among the study group more than in the control group.Additionally,the study group began taking greater amounts of fluids by the oral route than before the nursing intervention.Conclusions:A standardized nursing intervention protocol is needed to decrease the severity of dysphagia after CVS and increase the amount of daily oral fluids.The presence of a structured theory-based nursing intervention protocol for dysphagia management will greatly contribute to decreasing the consequences of dysphagia after CVS,and can also be expected to attenuate the effects of aspiration pneumonia,dehydration,and malnutrition;further,it also increases adherence to the protocol by both nurses and patients.

Evolving Profile and Determinants of Post-Stroke Cognitive Impairment in the 3rd Month among Kinshasa’s Survivors (Democratic Republic of the Congo)

Background: Neurocognitive impairments are common among stroke survivors. Despite their negative impact on daily life, their evolving, and determinants are not fully known in our context. To determine evolving characteristics of post-stroke cognitive impairment in the 3rd month as well as determinants among Kinshasa’s adult survivors is the aim of this study. Methods: We sought to determine neurocognitive deficits in the 3rd month in a prospective single-group cohort study in 3 hospital centers in Kinshasa. Eighty-six adult stroke survivors with a neurological and neuroimaging computerized diagnosis of stroke were assessed using MOCA (Montreal Cognitive Assessment) in the first and the third months post-stroke. Results: Neurocognitive disorders ranged from 79.1% in the first month to 54.7% in the third month after stroke (with 4.7% with severe decline). Gender female [AOR = 86.3 (CI95%: 2.8 - 2643.7);p 0.01], Chronic hypertension ([AOR = 26.8 (CI95%: 2.55 - 282.55);p 0.01]), the pathological lipid profile [AOR = 8.7 (CI95%: 1.10 - 68.82);p = 0.04] and worse MOCA score at the first month ([AOR = 41.2 (CI95%: 8.13 - 2134.81);p = 0.021]) were identified as worse predictors of cognitive impairments at the third month post-stroke. Conclusion: Post-stroke cognitive impairment is common and decreases in the 3rd month post-stroke. Chronic hypertension, gender, lipid profile, and the first month MOCA score are predictors of worse cognitive performance in Kinshasa survivors. These findings suggested the role of early management in improving cognition and the control of stroke risk factors.

Analysis of Adaptation Process of Evidence-Based Interventions by Taking Post-Stroke Dysphagia Screening As an Example--Based on a Series of Empirical Studies

Background:Evidence-based interventions(EBIs)are frequently adapted or modified during the implementation process to meet the needs of the target context,public health professionals,or health practitioners.However,little is known about how the EBIs of the same clinical problem at a different time(sustainability)and a different setting(scalability)should be adapted to facilitate implementation.To address this gap,this research aims to analyze the adaptations process of EBIs by taking post-stroke dysphagia screening as an example based on a series of empirical studies.Methods:We reviewed three best practice implementation projects of post-stroke dysphagia identification and management in China's Mainland,and conducted a comparative analysis of three projects of dysphagia screening practical decision-making according to core elements of evidence-based nursing(EBN).Results:We identified the core elements of EBN that influence decision-making in each best practice implementation project.The decision-making of screening time and tool for dysphagia in the three projects varied.Project 1:Post-stroke dysphagia was screened using Water Swallow Test(WST)before the first intake of liquid or food.Project 2:A sustainability study based on project 1,post-stroke dysphagia was screened using Standardized Swallowing Assessment(SSA)before the first intake of liquid or food,within 24 hours of admission.Project 3:A community scalability study based on project 2,post-stroke dysphagia was screened using Water Swallow Test(WST)before the first intake of liquid or food,within 24 hours after referral.Conclusions:Adaption of EBIs needs to fully consider the best available external evidence from systematic research,clinical expertise,patient preferences,as well as context.

Application of Cluster Nursing Among Post-Stroke Patients with Dysphagia

Objective:To explore the effect of cluster nursing care among post-stroke patients.Methods:Post-stroke patients with dysphagia(n=72)were randomly divided into two groups:experimental(or intervention)(n=36)the control(n=36).Patients in the experimental group were given cluster care,including swallowing assessment,safe eating guide,swallowing rehabilitation,the establishment of cluster prevention strategy and health education to patients and caregivers.Patients in the control group were given conventional nursing care,and the score of swallowing function,the prevalence of aspiration pneumonia and nursing care satisfactory level in both groups were assessed before and after the intervention.Results:The swallowing function of patients in the two groups were improved after intervention,but patients in the experimental group showed significantly higher improvement than the control group(P<0.05).The incidence of aspiration pneumonia was significantly lower in the experimental group compared to the control group(P<0.05).Moreover,the satisfactory level of nursing management was higher in the experimental group than the control group(P<0.05).Conclusion:Cluster nursing(CN)practice has significantly improved the swallowing function of stroke patients with dysphagia,reduced the incidence of aspiration pneumonia and enhanced the satisfaction of nursing care.

Nutritional Support under the Neuman Systems Model for Stroke Patients

Objective: To explore nutritional support under the Neuman systems model in treating dysphagia in stroke patients. Methods: In this retrospective study, we enrolled 97 patients with dysphagia after stroke admitted to our hospital, and randomly divided them into the Neuman group (n = 51) given nursing intervention based on Neuman systems model and a control group (n = 46) given routine nursing intervention. Both groups received nutritional support for 3 months. Nutritional indexes (serum total protein, plasma albumin, serum albumin, hemoglobin and transferrin levels) and immune indexes (immunoglobulin (Ig) A, IgG, IgM and total lymphocyte count (TLC) in both groups were recorded and compared. Pulmonary function recovery, video fluoroscopic swallowing study score, water swallowing test score, complication rate, and health knowledge mastery level were also compared between the two groups. Results: After the intervention, the Neuman group showed less decrease in the nutritional and immune index scores (serum total protein, plasma albumin, hemoglobin, serum albumin;IgA, IgG, IgM, and TLC;all P Conclusion: For patients with stroke and dysphagia, comprehensive nursing intervention (e.g., nutritional support) under theNeuman systems model can promote the recovery of immune, swallowing, and pulmonary function, reduce complication incidence and facilitate comprehensive rehabilitation, ensuring adequate nutritional intake.

Impact of Strokes: The Burden of Care, Post-CVA Fatigue & Caregiver Role Strain

Strokes and cerebral vascular accidents (CVAs) and related disease events are an unfortunate circumstance that inflicts individuals around the world and impacts people every day as individuals and their caregivers. The consequences of these strokes or CVA events are life-changing for all those involved. As a result of long-term disability related to strokes, the caregiver may undergo many emotional, psychological, and physical factors that impact their daily lives. There is a relatively short period of time to react to the necessary change and as a result there may be differences in coping associated with these unexpected health circumstances. Many stoke victims experience motor, cognitive, emotional, and psycho-social deficits and their caregivers may not be prepared for these abrupt life altering effects. The impact for caregivers, factors impacting strokes, and solutions for care will be addressed in the paper. Evidence suggests that post fatigue stroke (PFS) may be triggered by a dysfunction of the stress system. Family caregivers with a low level of social engagement may be more likely to perceived stress, and increased risk for caregiver role strain.

Tongguan Liqiao acupuncture therapy improves dysphagia after brainstem stroke

Tongguan Liqiao acupuncture therapy has been shown to effectively treat dysphagia after stroke-based pseudobulbar paralysis. We presumed that this therapy would be effective for dysphagia after bulbar paralysis in patients with brainstem infarction. Sixty-four patients with dysphagia following brainstem infarction were recruited and divided into a medulla oblongata infarction group（n = 22）, a midbrain and pons infarction group（n = 16）, and a multiple cerebral infarction group（n = 26） according to their magnetic resonance imaging results. All patients received Tongguan Liqiao acupuncture for 28 days. The main acupoints were Neiguan（PC6）, Renzhong（DU26）, Sanyinjiao（SP6）, Fengchi（GB20）, Wangu（GB12）, and Yifeng（SJ17）. Furthermore, the posterior pharyngeal wall was pricked. Before and after treatment, patient swallowing functions were evaluated with the Kubota Water Test, Fujishima Ichiro Rating Scale, and the Standard Swallowing Assessment. The Barthel Index was also used to evaluate their quality of life. Results showed that after 28 days of treatment, scores on the Kubota Water Test and Standard Swallowing Assessment had decreased, but scores on the Fujishima Ichiro Rating Scale and Barthel Index had increased in each group. The total efficacy rate was 92.2% after treatment, and was most obvious in patients with medulla oblongata infarction（95.9%）. These findings suggest that Tongguan Liqiao acupuncture therapy can repair the connection of upper motor neurons to the medulla oblongata motor nucleus, promote the recovery of brainstem infarction, and improve patient＇s swallowing ability and quality of life.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing,China

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospi- tals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50-69 years of age. Of 106 patients, there were 60 cases （56.6%） of adhesive capsulitis, 19 （17.9%） of shoulder subluxation, 14 （13.2%） of complex regional pain syndrome, and 13 （12.6%） of central pain. The main symptoms were shoulder pain （100%）, limit of shoulder mobility （98.1%）, and adhesion of the scapula （56.6%）. MRI of the shoulder showed tendon and ligament lesions （57.1%） and rotator cuff tear （38.1%）. 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In par- ticular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder subluxa- tion and complex regional pain syndrome. Multiple linear regression results showed a negative re- lationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis.

Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction： a diffusion tensor tractography imaging study

Many studies using diffusion tensor tractography（DTT） have demonstrated that injury of the spinothalamic tract（STT） is the pathogenetic mechanism of central post-stroke pain（CPSP） in intracerebral hemorrhage; however, there is no DTT study reporting the pathogenetic mechanism of CPSP in cerebral infarction. In this study, we investigated injury of the STT in patients with CPSP following cerebral infarction, using DTT. Five patients with CPSP following cerebral infarction and eight age-and sex-matched healthy control subjects were recruited for this study. STT was examined using DTT. Among DTT parameters of the affected STT, fractional anisotropy and tract volume were decreased by more than two standard deviations in two patients（patients 1 and 2） and three patients（patients 3, 4, and 5）, respectively, compared with those of the control subjects, while mean diffusivity value was increased by more than two standard deviations in one patient（patient 2）. Regarding DTT configuration, all affected STTs passed through adjacent part of the infarct and three STTs showed narrowing. These findings suggest that injury of the STT might be a pathogenetic etiology of CPSP in patients with cerebral infarction.

The effects of Xingnao Jieyu capsules on post-stroke depression are similar to those of fluoxetine

The Xingnao Jieyu capsule has been shown to effectively relieve neurologic impairments and les- sen depression. It remains poorly understood whether this capsule can be used to treat post-stroke depression. Thus, in the present study, we established a rat model of post-stroke depression using left middle cerebral artery occlusions in combination of chronic unpredictable stress and solitary housing during development. Experimental rats received intragastric perfusion with 0.82, 0.41, and 0.20 g/kg Xingnao Jieyu capsules separately dissolved in 2 mL distilled water. Fluoxetine served as a positive control. The treatment was conducted over 28 days. Sugar water consumption test, open-field test, real-time fluorescent quantitative PCR and immunohistochemical staining results demonstrated that intragastric perfusion with various doses of Xingnao Jieyu capsules increased sugar water consumption, voluntary behaviors and synaptotagmin mRNA and protein expression in rats with post-stroke depression. These therapeutic effects were similar to those of fluoxetine. These results indicate that Xingnao Jieyu capsules upregulate synaptotagmin expression in hip pocampi of rats with post-stroke depression, and exert antidepressant effects.

miR-137, a new target for post-stroke depression?

Expression of miR-137 is downregulated in brain tissue from patients with depression and suicidal behavior, and is also downregulated in peripheral blood from stroke patients. However, it is not yet known if miR-137 acts as a bridge between stroke and depression. To test this, we used middle cerebral artery occlusion and chronic mild stress to establish a post-stroke depression model in rats. Compared with controls, we found significantly lower miR-137 levels in the brain and peripheral blood from post-stroke depression rats. Injection of a miR-137 antagonist into the brain ventricles upregulated miR-137 levels, and improved behavioral changes in post-stroke depression rats. Luciferase assays showed miR-137 bound to the 3＇UTR of Grin2A, regulating Grin2A expression in a neuronal cell line. Grin2A gene overexpression in the brain of post-stroke depression rats, no- ticeably suppressed the inhibitory effect of miR-137 on post-stroke depression. Overall, our results show that miR-137 suppresses Grin2A protein expression through binding to Grin2A mRNA, thereby exerting an inhibitory effect on post-stroke depression. Our results offer a new therapeutic direction for post-stroke depression.

Electroacupuncture at the Wangu (GB 12) acupoint suppresses expression of inflammatory factors in the hippocampus and frontal lobe of rats with post-stroke depression

Electroacupuncture was performed at the Wangu （GB 12） acupoint, whose position is similar to the cerebellar fastigial nucleus in rats with post-stroke depression. Results showed that the expression of nuclear factor-κB and the levels of tumor necrosis factor-α and interleukin-1β decreased. Simultaneously, the extent of edema in the hippocampus and frontal lobe decreased, and the morphology of the nerve cells recovered to near normal. In addition, fluoxetine treatment displayed a similar effect on post-stroke depression as electroacupuncture at GB 12 acupoint. The results indicate that electroacupuncture at GB 12 acupoint can reduce the levels of cytokines in the hippocampus and frontal lobe of rats with post-stroke depression, and thus provide a neuroprotective effect on post-stroke depression.

Metabolic changes of prefrontal cerebral lobe,white matter and cerebellum in patients with post-stroke depression A proton magnetic resonance spectroscopy study

BACKGROUND： Proton magnetic resonance spectroscopy （IH-MRS） non-invasively detects changes in chemical substances in the brain, which reflects the pathological metabolism.OBJECTIVE： To investigate changes in N-acetyl-aspartate （NAA）, choline （Cho）, creatine （Cr）, and myoinositol （MI） in the gray and white matter of cerebral prefrontal lobe and cerebellum of patients with differential degrees of post-stroke depression （PSD） using ^1H-MRS. DESIGN： A case control study. SETTING： The First Affiliated Hospital of the Dalian Medical University. PARTICIPANTS： A total of 38 patients with stroke （28 male and l0 female patients, aged 40 to 79 years） were selected from the Department of Neurology, 1st Affiliated Hospital, Dalian Medical University, from February to October in 2004. All subjects met the DSM-IV criteria for cerebrovascular disease and depression. The degree of depression was defined according to Hamilton criteria. 38 patients with PSD were divided into two groups according to the time after ischemia, 20 patients in the acute group with less than 10 days after ischemic attack （mild： 16 patients, moderate/severe： 4 patients） and 18 patients in the chronic group with more than l l days after ischemic attack （mild： 15 patients, moderate/severe： 3 patients）. Seventeen healthy volunteers with matching age from 41 to 80 years were examined as a control group. The study was approved by the Medical Ethics Committee of the University Medical Center Utrecht, and each participant signed an informed consent form. METHODS： Spectra were acquired by multi-voxel point-resolved spectroscopy （PRESS） sequence with GE signal.5T MR/i, localized in prefrontal cerebral lobe and cerebellum. Values of NAA, Cho, MI, and Cr ere compared between different graded PSD patients and control subjects with one-way analysis of variance in software SPSS 11.5. MAIN OUTCOME MEASURES： Metabolite concentration in different brain regions of interest. Difference in metabolites between distinctly graded PSD patients and control subjects. Exclusion of age-effects on metabolites. RESULTS： Metabolite concentrations of different brain regions： A significant rise in the Cho/Cr ratio was detected in the acute and chronic group compared to the control group. The ratio change was more significant in the acute group （P 〈 0.05）. There was no significant difference between these three groups for other metabolites detected by IH-MRS in the right frontal white matter, bilateral frontal grey matter, and cerebellum （P 〉 0.05）. Comparison of metabolite levels among differently graded PSD patients and control subjects： a significant increase in the Cho/Cr ratio was detected in the left frontal white matter compared to the control group （P 〈 0.05）. There was no significant difference in age between patients in the stroke groups and the control group （P 〉 0.05）, and similarly, there was no significant correlation between age and absolute or relative values in the control group （P 〉 0.05）. CONCLUSION： Abnormalities of frontal lobe in PSD were located in the white matter. There was early abnormality of metabolic substance in PSD.

Apolipoprotein E polymorphisms increase the risk of post-stroke depression

Recent reports have shown that apolipoprotein E （APOE） polymorphisms are involved in neurodegenerative disease. However, it is unclear whether APOE affects post-stroke depression. Accordingly, we hypothesized that APOE polymorphisms modify the risk of post-stroke depression. Here, we performed a hospital-based case-control study （including 76 cerebral infarction cases with post-stroke depression, 88 cerebral infarction cases without post-stroke depression, and 109 controls without any evidence of post-stroke depression or cerebral infarction） to determine possible association between APOE rs429358 and rs7412 polymorphisms and risk of post-stroke depression. Our findings show no difference among the groups with regards genotype distribution of the rs7412 polymorphism. In contrast, APOE genotypes with rs429358-C alleles increased the risk of post-stroke depression. Further, the rs429358 polymorphism was associated with significantly decreased regional cerebral blood flow values in the left temporal lobe of post-stroke depression cases. Additionally, the rs429358 polymorphism was not only associated with depression severity, but with increasing serum levels of total cholesterol. These resuits suggest that the APOE rs429358 polymorphism is associated with increased risk of developing post-stroke depression, and that APOE rs429358-C allele genotypes may be detrimental to recovery of nerve function after stoke. Indeed, these findings provide clinical data for future post-stroke depression gene interventions.

Research Progress of Traditional Chinese Medicine in Treating Dysphagia After Stroke

Dysphagia is a common complication after stroke,which does not only affect the quality of life of patients,but also increase the risk of death.Traditional Chinese medicine(TCM)treatment has always played an important role in the clinical treatment of dysphagia after stroke,but its mechanism has not been fully elucidated.Literatures on the use of TCM for the disease in the recent 5 years have been reviewed,and the problems existing in the development and treatment of the disease are discussed in this article,in an attempt to provide new ideas for the treatment of the disease.This paper presents a summary of traditional Chinese medicine treatment for the disease in the past five years,including traditional Chinese medicine compound and acupuncture.

Post-Stroke Sexual Disorders and Its Real-Life Experience within Couples in Brazzaville

Background: Post-stroke sequelae can have repercussions on the sexual life and relational life of patients and their partners. Objectives: To determine the frequencies of sexual disorders after a first stroke event;to identify the factors associated with sexual disorders;to explore the real-life experience of sexual disorders within couples. Methods: It was an analytical cross-sectional study, conducted on patients followed up for a first stroke and their partners. It was carried out at public and private hospitals in Brazzaville, Congo, during the period of patient follow-up, from May to September 2019 (5 months). The Female Sexual Function Index, International Index of Erectile Function 5 and interviews were used to describe sexual aspects. The real-life experience of couples was explored using standardized and pre-established questionnaires. Results: Of the 36 patients who had taken up again sexual intercourse after stroke, 29 (80.6%) were men. Among the post-stroke sexual disorders, erectile dysfunction (53.2%) and ejaculatory dysfunction (40.4%) were the most frequent in men. Decrease of sexual desire was predominant in women (100%). Factors associated with erectile dysfunction were sleep disorder (p = 0.007) and mean sleep duration per night (p = 0.01). Lack of verbal and non-verbal communication of sexual problems and psychological effects was noted in 77.8% of patients and 60% of their partners. The most frequent psychological effects were: in patients, frustration (52.8%), attitude of person decreased (50%) and sadness (41.7%);in partners, attitude of carer (86.7%). Conclusion: Post-stroke sexual disorders are frequent in our context. Sleep disorders and mean sleep duration per night, psychological factors seem to have a negative impact on the sexual life and relational life of stroke patients and their partners. It is important to improve the sex management of couples.

CLINICAL STUDY ON ACUPUNCTURE IN THE TREATMENT OF POST-STROKE DEPRESSION WITH THE METHOD OF ACTIVATING THE DU MERIDIAN AND CLEARING THE MIND

Objective: To observe the therapeutic effect of acupuncture in the treatment of post-stroke depression (PSD) with the method of activating the Du Meridian and clearing the mind. Methods: Two hundred and thirty one cases of PSD were randomly divided into two groups, acupuncture and control groups. In acupuncture group, Baihui (百会 GV 20), Dazhui (大椎 GV 14), Neiguan (内关 PC 6), Taichong (太冲 LR 3) and Shenmen (神门 HT 7) were selected as the main points to invigorate flow of qi in the Du Meridian and clear the mind. Patients in the control group received Fluoxetine orally, 20 mg once per-day. In addition, the same routine treatments were given to both groups, strengthened with rehabilitation exercises as early as possible; 8 weeks constituted one therapeutic course. HAMD and severity of neuro-functional defect of each case were evaluated before and 8-week after the treatment. Results: The total effective rate of acupuncture group was 92.37%, the control group, 72.88%. According to χ2 test, the difference between the two groups was remarkably significant (P<0.05). Conclusion: Acupuncture therapy of activating the Du Meridian and clearing the mind in the treatment of PSD was safe and effective.