Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

Stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient outcomes.In recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine approaches.This abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke medicine.Recently introduced machine learning algorithms have been extensively employed in all the fields of stroke medicine.Machine learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient prognosis.Despite the tremendous potential of machine learning in stroke medicine,several challenges must be addressed.These include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and bias.In addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke care.Machine learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved prognostication.Continued research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of life.This review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic evaluation.At the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling disease.

Withania somnifera: a pre-clinical study on neuroregenerative therapy for stroke

Stroke management exerts insurmountable societal and economic burden on the patient as well as their caregivers. In the year 2010 alone, the direct and indirect costs of stroke care amounted to 36.5 billion dollars （Go et al., 2014）. Despite concentrated efforts to develop a safe, effective drug for stroke, we have not discovered one since the introduction of recombinant tissue plasminogen activator （rtPA）--the standalone FDA-approved therapy for stroke. While rtPA is highly effective, it needs to be given within 3-4.5 hours of the onset of stroke symptoms （Zivin, 2009）. This is often complicated by the delay in the commencement of treatment due to preliminary inclusion parameters that are required to be ascertained before rtPA administration.

Does a combined intervention program of repetitive transcranial magnetic stimulation and intensive occupational therapy affect cognitive function in patients with post-stroke upper limb hemiparesis?

Low-frequency repetitive transcranial magnetic stimulation（LF-r TMS） to the contralesional hemisphere and intensive occupational therapy（i OT） have been shown to contribute to a significant improvement in upper limb hemiparesis in patients with chronic stroke. However, the effect of the combined intervention program of LF-r TMS and i OT on cognitive function is unknown. We retrospectively investigated whether the combined treatment influence patient＇s Trail-Making Test part B（TMT-B） performance, which is a group of easy and inexpensive neuropsychological tests that evaluate several cognitive functions. Twenty-five patients received 11 sessions of LF-r TMS to the contralesional hemisphere and 2 sessions of i OT per day over 15 successive days. Patients with right- and left-sided hemiparesis demonstrated significant improvements in upper limb motor function following the combined intervention program. Only patients with right-sided hemiparesis exhibited improved TMT-B performance following the combined intervention program, and there was a significant negative correlation between Fugl-Meyer Assessment scale total score change and TMT-B performance. The results indicate the possibility that LF-r TMS to the contralesional hemisphere combined with i OT improves the upper limb motor function and cognitive function of patients with right-sided hemiparesis. However, further studies are necessary to elucidate the mechanism of improved cognitive function.

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

Bat-derived oligopeptide LE6 inhibits the contact-kinin pathway and harbors anti-thromboinflammation and stroke potential

Thrombosis and inflammation are primary contributors to the onset and progression of ischemic stroke.The contact-kinin pathway,initiated by plasma kallikrein(PK)and activated factor XII(FXIIa),functions bidirectionally with the coagulation and inflammation cascades,providing a novel target for therapeutic drug development in ischemic stroke.In this study,we identified a bat-derived oligopeptide from Myotis myotis(Borkhausen,1797),designated LE6(Leu-Ser-Glu-Glu-Pro-Glu,702 Da),with considerable potential in stroke therapy due to its effects on the contact kinin pathway.Notably,LE6 demonstrated significant inhibitory effects on PK and FXIIa,with inhibition constants of 43.97μmol/L and 6.37μmol/L,respectively.In vitro analyses revealed that LE6 prolonged plasma recalcification time and activated partial thromboplastin time.In murine models,LE6 effectively inhibited carrageenan-induced mouse tail thrombosis,FeCl3-induced carotid artery thrombosis,and photochemically induced intracerebral thrombosis.Furthermore,LE6 significantly decreased inflammation and stroke injury in transient middle cerebral artery occlusion models.Notably,the low toxicity,hemolytic activity,and bleeding risk of LE6,along with its synthetic simplicity,underscore its clinical applicability.In conclusion,as an inhibitor of FXIIa and PK,LE6 offers potential therapeutic benefits in stroke treatment by mitigating inflammation and preventing thrombus formation.

Occupational Therapy Evaluation for Stroke Adults in the United States

Of the 700,000 people in the United States who experience a new or recurrent stroke each year,more than 500,000 survive(American Stroke Association,2007)[1]. Occupational therapy practitioners are critical rehabilitation professionals for stroke survivors.

Physiopathology of ischemic stroke and its modulation using memantine:evidence from preclinical stroke

Ischemic stroke is the most common type of cerebrovascular disease and is caused by an interruption of blood flow in the brain.In this disease,two different damage areas are identifying:the lesion core,in which cells quickly die;and the penumbra(surrounding the lesion core),in which cells are functionally weakened but may recover and restore their functions.The currently approved treatments for ischemic stroke are the recombinant tissue plasminogen activator and endovascular thrombectomy,but they have a short therapeutic window(4.5 and 6 hours after stroke onset,respectively)and a low percentage of stroke patients actually receive these treatments.Memantine is an approved drug for the treatment of Alzheimer's disease.Memantine is a noncompetitive,low affinity and use-dependent antagonist of N-methyl-D-aspartate glutamate receptor.Memantine has several advantages over developing a new drug to treat focal ischemic stroke,but the most important is that it has sufficient safe probes in preclinical models and humans,and if the preclinical studies provide more evidence about pharmacological actions in tissue protection and repair,this could help to increase the number of clinical trials.The present review summarizes the physiopathology of isquemic stroke and the pharmacological actions in neuroprotection and neuroplasticity of memantine in the post stroke stage of preclinical stroke models,to illustrate their potential to improve functional recovery in human patients.

Neuroimmunomodulatory effects of transcranial laser therapy combined with intravenous tPA administration for acute cerebral ischemic injury

At present, the only FDA approved treatment for ischemic strokes is intravenous administration of tissue plasminogen activator within 4.5 hours of stroke onset. Owing to this brief window only a small percentage of patients receive tissue plasminogen activator. Transcranial laser therapy has been shown to be effective in animal models of acute ischemic stroke, resulting in significant improvement in neurological score and function. NEST-1 and NEST-2 clinical trials in human patients have demonstrated the safety and positive trends in efficacy of transcranial laser therapy for the treatment of ischemic stroke when initiated close to the time of stroke onset. Combining intravenous tissue plasminogen activator treatment with transcranial laser therapy may provide better functional outcomes. Statins given within 4 weeks of stroke onset improve stroke outcomes at 90 days compared to patients not given statins, and giving statins following transcranial laser therapy may provide an effective treatment for patients not able to be given tissue plasminogen activator due to time constraints.

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.

OBSERVATION ON THE THERAPEUTIC EFFECT OF ACU-MOXIBUSTION OF DIFFERENT ACUPOINT GROUPS IN STROKE PATIENTS IN CONVALESCENCE STAGE

Objective: To observe and compare clinical therapeutic effect of acupuncture and moxibustion at different acupoint groups in stroke patients in the convalescence stage. Methods: Sixty stroke patients were evenly randomized into yin-meridian group and yang-meridian group. On the basis of the treatment with Chinese and Western medicines, these stroke patients of two groups were treated mainly by acupuncture of acupoints of yin meridians such as Jiquan (极泉HT 1), Tongli (通里HT 5), Neiguan (内关PC 6), etc., and those of yang meridians as Jianyu (NFDA1 LI 15), Quchi (曲池 LI 11), Shousanli (手三里LI 10), etc. respectively. After 30 days’ treatment, the therapeutic effect was evaluated by using American National Institutes of Health Stroke Scale (NIHSS), Hamilton Depression (HAMD) Rating Scale, Mini-Mental State Examination (MMSE), Barthel Index and Activities of Daily Living (ADL) Scale. Results: Following treatment, the therapeutic effect of yin-meridian group was significantly superior to that of yang-meridian group in improving stroke patients’ neurological deficits [Level B: 50% (15/30) vs 20% (6/30)] and ADL [Level Ⅱ: 40% (12/30) vs 13.3% (4/30)]. No significant difference was found between two groups in the neurological impairment domains. Conclusion: Acu-moxibustion of acupoints of yin meridians is superior to acupoints of yang meridians in improving stroke patients’ neurological impairment and daily living activities.

Magnetic resonance imaging and cell-based neurorestorative therapy after brain injury

Restorative cell-based therapies for experimental brain injury, such as stroke and traumatic brain injury,substantially improve functional outcome. We discuss and review state of the art magnetic resonance imaging methodologies and their applications related to cell-based treatment after brain injury. We focus on the potential of magnetic resonance imaging technique and its associated challenges to obtain useful new information related to cell migration, distribution, and quantitation, as well as vascular and neuronal remodeling in response to cell-based therapy after brain injury. The noninvasive nature of imaging might more readily help with translation of cell-based therapy from the laboratory to the clinic.

Usefulness of radial extracorporeal shock wave therapy for the spasticity of the subscapularis in patients with stroke： a pilot study

Background There are not many studies about treatment of shoulder spasticity. Although botulinum toxin injection has been reported to be effective for shoulder spasticity, the effectiveness was judged by pain and limited motion change, but not the spasticity itself. Shoulder spasticity is considered to play an important role in hemiplegic frozen shoulder. However, the subscapularis muscle, unlike the pectoralis major muscle, is located deep beneath scapula, where conventional injection is difficult to perform. As extracorporeal shock wave therapy （ESWT） has been reported to be effective for spasticity relief, and we thought spasticity of subscapularis muscle located deep beneath the scapula would be a good candidate for ESWT treatment. This study was to evaluate the beneficial effects of radial ESWT （rESWT） on spastic subscapularis muscle in stroke patients. Methods This is an uncontrolled, prospective, unicenter, clinical pilot study. Stroke patients （n=57; mean age 55.4 years） with spastic shoulders were recruited between June 2011 and February 2012 at the University Rehabilitation Hospital. rESWT was administered to each patient every two or three days for two weeks （five total treatments）. Evaluation consisted of 11 measurements for each patient; at the start of each of the five treatments and once per week during the following six weeks. Spasticity was measured at external rotator muscles of the shoulder using the modified Ashworth scale （MAS）, and passive range of motion （ROM） of the shoulder in external rotation was recorded. Pain was measured using a visual analogue scale （VAS） during passive ROM of the shoulder in external rotation, and was additionally recorded for patients who preserved cognitive and communicative ability （Pain group）. Results Reduction in MAS and VAS and improvement of ROM during and after rESWT treatments were prominent compared to baseline. The reduction in MAS and VAS and improvement of ROM continued four weeks after the last treatment and the effects of the treatment decreased afterward. Conclusion rESWT will be able to provide stroke patients with an effective and safe procedure for the reduction of spasticity and pain as well as for the improvement of ROM of spastic shoulders.

Effect of music therapy derived from the five elements in Traditional Chinese Medicine on post-stroke depression

OBJECTIVE: To evaluate the clinical efficacy and safety of five phase music therapy in patients with depression after ischemic stroke.METHODS: A total of 92 patients with post-stroke depression were randomly divided into the control group(32 cases), treatment group A(30 cases), and treatment group B(30 cases). All groups were given basic therapies for cerebral infarction. In addition,the control group was administerd 50 mg of oral sertraline hydrochloride daily, while treatment groups A and B received needling at Baihui(GV 20)plus acupoint injection at Yanglingquan(GB 34) daily; treatment group B also received music therapy derived from the five phases in Traditional ChineseMedicine theory twice daily. All treatments were administered for 5 d per treatment cycle for three cycles, with a 1 d interval between cycles. In all three groups, Hamilton's depression scale(HAMD-17)score and the activities of daily life(ADL) score were measured before and after treatment, and side effects were assessed with the treatment emergent symptom scale.RESULTS: The HAMD-17 score significantly decreased after treatment in all three groups, and the post-treatment reduction in HAMD-17 score was markedly greater in treatment group B than in treatment group A(P < 0.01). The ADL score significantly increased after treatment in all three groups,and the post-treatment increase in ADL score was significantly greater in treatment group B than in treatment group A(P < 0.01). The treatment emergent symptom scale score was highest in the control group, and lowest in group B, and significantly differed between the three groups(P < 0.01).CONCLUSION: Five phase music therapy plus acupoint needling and acupoint injection can improve the symptoms in patients with post-stroke depression.

New Stroke-healing Gel Helped Regrow Neurons and Blood Vessels in Mice with Stroke-damaged Brains, Hinting at What May Someday Be a New Therapy for Stroke in People

In a first-of-its-kind finding,a new stroke-healing gel helped regrow neurons and blood vessels in mice with stroke-damaged brains.The results suggest that such an approach may someday be a new therapy for stroke in people.The study tested this in laboratory mice to determine if it would repair the brain in a model

Herbal Medicine in Ischemic Stroke:Challenges and Prospective

Herbal medicines, mainly of plant source, are invaluable source for the discovery of new therapeutic agents for all sorts of human ailments. The complex pathogenesis of stroke and multifactorial effect of herbal medicine and their active constituents may suggest the promising future of natural medicine for stroke treatment. Anti-oxidant, anti-inflammatory, anti-apoptotic, neuroprotective and vascular protective effect of herbal medicines are believed to be efficacious in stroke treatment. Herbs typically have fewer reported side effects than allopathic medicine, and may be safer to use over longer period of time. Herbal medicines are believed to be more effective for the longstanding health complaints, such as stroke. Several medicinal plants and their active constituents show the promising results in laboratory research. However failure in transformation of laboratory animal research to the clinical trials has created huge challenge for the use of herbal medicine in stroke. Until and unless scientifically comprehensive evidence of the efficacy and safety of herbal medicine in ischemic stroke patients is available, efforts should be made to continue implementing treatment strategies of proven effectiveness. More consideration should be paid to natural compounds that can have extensive therapeutic time windows, perfect pharmacological targets with few side effects. Herbal medicine has excellent prospective for the treatment of ischemic stroke, but a lot of effort should be invested to transform the success of animal research to human use.

Hydrogel-mediated drug delivery for treating stroke

Stroke is a common disease and is the major cause of death and disability.It occurs and generates devastating neurological deficits when cerebral blood vessel is blocked(ischemic stroke,IS)or ruptured(hemorrhagic stroke,HS).Hydrogel,being biodegradable and biocompatible,have shown attractive advantages in stroke therapy as a new biomaterial with desirable mechanical properties and tunability of structure,owing to special ability to load different cargoes for multiple treatment strategies,such as pharmacotherapy based on drug-delivery systems and cell therapy including mesenchymal stem cells(MSCs)and neural progenitor cells(NPCs)for improving functional outcomes.However,a comprehensive review of the functional hydrogel for treatment of stroke is still lacking.Therefore,in this work,the main pathological mechanisms of stroke including IS and HS are comprehensively described.The benefits of hydrogel for stroke treatment are also summarized regarding the natural advantages and the delivery advantages.Simultaneously,the application development of hydrogel for treatment of stroke is highlighted.Finally,the unique considerations and challenges in the design and application of hydrogel is discussed for treatment of stroke and clinical application in the future.

Effectiveness of bee venom acupuncture in alleviating post-stroke shoulder pain: a systematic review and meta-analysis

BACKGROUND：Shoulder pain is a common complication of stroke.Bee venom acupuncture（BVA）is increasingly used in the treatment of post-stroke shoulder pain.OBJECTIVE：To summarize and evaluate evidence on the effectiveness of BVA in relieving shoulder pain after stroke.SEARCH STRATEGY：Nine databases,namely MEDLINE,EMBASE,the Cochrane Library,the China National Knowledge Infrastructure（CNKI）,the Japan Science and Technology Information Aggregator,Electronic（J-STAGE）,and four Korean medical databases,namely,the National Assembly Library,the Research Information Service System,the National Discovery for Science Leaders,and OASIS,were searched from their inception through August 2014 without language restrictions.INCLUSION CRITERIA：Randomized controlled trials（RCTs）were included if BVA was used at acupoints as the sole treatment,or as an adjunct to other treatments,for shoulder pain after stroke.DATA EXTRACTION AND ANALYSIS：Two review authors independently selected trials for inclusion,assessed methodological quality and extracted data.RESULTS：A total of 138 potentially relevant articles were identifi ed,4 of which were RCTs that met our inclusion criteria.The quality of studies included was generally low,and a preponderance of positive results was demonstrated.All four trials reported favorable effects of BVA on shoulder pain after stroke.Two RCTs assessing the effects of BVA on post-stroke shoulder pain,as opposed to saline injections,were included in the meta-analysis.Pain was signifi cantly lower for BVA than for saline injections（standardized mean difference on 10-cm visual analog scale：1.46 cm,95%CI=0.30–2.62,P=0.02,n=86）CONCLUSION：This review provided evidence suggesting that BVA is effective in relieving shoulder pain after stroke.However,further studies are needed to confi rm the role of BVA in alleviating post-stroke shoulder pain.Future studies should be conducted with large samples and rigorous study designs.

Acupuncture plus Chinese Medicinal Fumigation and Washing for Edema of the Stroke-affected Limb

Objective: To evaluate the therapeutic efficacy of acupuncture plus Chinese medicinal fumigation and washing in treating edema of the affected limb in post-stroke hemiplegia. Methods: Two hundred patients with edema of the stroke-affected limb from our hospital were randomized into two groups according to their visiting sequence. In the observation group, 100 subjects were intervened by acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics, while the other 100 subjects in the control group were only given diuretics. The therapeutic efficacy was evaluated after successive 2-week treatments. Results: The total effective rate was 90.0% in the observation group, significantly higher than 66.0% in the control group, indicating that there was a significant difference in comparing the overall therapeutic effect(P<0.01). Conclusion: Acupuncture plus Chinese medicinal fumigation and washing in addition to oral administration of diuretics is effective in treating edema of the affected limb in post-stroke hemiplegia.

Reinforcing and Reducing Manipulation by Breathing on Yin and Yang Meridian Points for Motor Function of Knee Joints in Patients with Ischemic Stroke

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke. Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively. Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment(all P>0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved(P<0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment(P < 0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment(P<0.05). Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.