Dysphagia in patients with isolated pontine infarction

Little is known about dysphagia after pontine infarction. In this study, we evaluated the incidence of dysphagia after isolated pontine infarction and identified the predictive factors for the occurrence of dysphagia. A total of 146 patients were included in this study. All patients underwent clinical testing for dysphagia within 1 day after admission and at the time of discharge. We compared the incidence of dysphagia between patients with unilateral pontine infarction and those with bilateral pontine infarction. To evaluate the functional status of patients, we investigated their initial modified Rankin Scale（mRS） score and initial National Institutes of Health Stroke Scale（NIHSS） score within 1 day of admission. Of 146 patients, 50（34.2%） had dysphagia initially within 1 day after admission. At the second evaluation at the time of discharge, dysphagia was diagnosed in 24 patients（16.4%）. Patients with bilateral pontine infarction were more likely to present with dysphagia. In addition, clinical severity（in terms of mRS and NIHSS scores） was identified as a predictor of dysphagia in patients with cerebral infarction（multiple binary logistic regression analysis, mRS： P = 0.011, NIHSS： P = 0.004）. Dysphagia frequently occurs in patients with isolated pontine infarction. Clinicians should pay particular attention to the occurrence of dysphagia, especially in patients with bilateral pontine infarction or high functional disability.

Early treadmill exercise increases macrophage migration inhibitory factor expression after cerebral ischemia/reperfusion

The neuroprotective function of macrophage migration inhibitory factor(MIF) in ischemic stroke was rarely evaluated.This study aimed to investigate the effects of early treadmill exercise on recovery from ischemic stroke and to determine whether these effects are associated with the expression levels of MIF and brain-derived neurotrophic factor(BDNF) in the ischemic area.A total of 40 male Sprague-Dawley rats were randomly assigned to the ischemia and exercise group [middle cerebral artery occlusion(MCAO)-Ex,n = 10),ischemia and sedentary group(MCAO-St,n = 10),sham-surgery and exercise group(Sham-Ex,n= 10),or sham-surgery and sedentary group(Sham-St,n = 10).The MCAO-Ex and MCAO-St groups were subjected to MCAO for 60 minutes,whereas the Sham-Ex and Sham-St groups were subjected to an identical operation without MCAO.Rats in the MCAO-Ex and Sham-Ex groups then ran on a treadmill for 30 minutes once a day for 5 consecutive days.After reperfusion,the hanging time tested by the wire hang test was longer and the relative fractional anisotropy determined by MRI was higher in the peri-infarct region of the MCAO-Ex group compared with the MCAO-St group.The expression levels of MIF and BDNF in the peri-infarct region were upregulated in the MCAO-Ex group.Increased MIF and BDNF levels were positively correlated with relative fractional anisotropy changes in the peri-infarct region.There was no significant difference in the levels of MIF and BDNF in the peri-infarct region between the Sham-Ex and Sham-St groups.Our study demonstrated that early exercise(initiated 48 hours after the MCAO) could improve motor and neuronal recovery after ischemic stroke.Furthermore,the increased levels of MIF and BDNF in the peri-infarct region(penumbra) may be one of the mechanisms of enhanced neurological function recovery.All experiments were approved by the Institutional Animal Care and Use Committee in Asan Medical Center in South Korea(2016-12-126).

Effect of docosahexaenoic acid on the recovery of motor function in rats with spinal cord injury: a meta-analysis

Objective:Studies have shown that docosahexaenoic acid(DHA)has a beneficial effect in the treatment of spinal cord injury.A meta-analysis was used to study the effect of DHA on the neurological recovery in the rat spinal cord injury model,and the relationship between the recovery of motor function after spinal cord injury and the time and method of administration and the dose of DHA.Data source:Published studies on the effect of DHA on spinal cord injury animal models from seven databases were searched from their inception to January 2019,including PubMed,MEDLINE,EMBASE,the China National Knowledge Infrastructure,Wanfang,VIP,and SinoMed databases.The search terms included“spinal cord injury”“docosahexaenoic acid”,and“rats”.Data selection:Studies that evaluated the influence of DHA in rat models of spinal cord injury for locomotor functional recovery were included.The intervention group included any form of DHA treatment and the control group included treatment with normal saline,vehicle solution or no treatment.The Systematic Review Centre for Laboratory animal Experimentation’s risk of bias assessment tool was used for the quality assessment of the included studies.Literature inclusion,quality evaluation and data extraction were performed by two researchers.Meta-analysis was then conducted on all studies that met the inclusion criteria.Statistical analysis was performed on the data using RevMan 5.1.2.software.Outcome measures:The primary outcome measure was the score on the Basso,Beattie,and Bresnahan scale.Secondary outcome measures were the sloping plate test,balance beam test,stair test and grid exploration test.Results:A total of 12 related studies were included,3 of which were of higher quality and the remaining 9 were of lower quality.The highest mean Basso,Beattie,and Bresnahan scale score occurred at 42 days after DHA treatment in spinal cord injury rats.At 21 days after treatment,the mean difference in Basso,Beattie,Bresnahan scores between the DHA group and the control group was the most significant(pooled MD=4.14;95%CI=3.58–4.70;P<0.00001).In the subgroup analysis,improvement in the Basso,Beattie,and Bresnahan scale score was more significant in rats administered DHA intravenously(pooled MD=2.74;95%CI=1.41–4.07;P<0.0001)and subcutaneously(pooled MD=2.99;95%CI=2.29–3.69;P<0.00001)than in the groups administered DHA orally(pooled MD=3.04;95%CI=–1.01 to 7.09;P=0.14).Intravenous injection of DHA at 250 nmol/kg(pooled MD=2.94;95%CI=2.47–3.41;P<0.00001]and 1000 nmol/kg[pooled MD=3.60;95%CI=2.66–4.54;P<0.00001)significantly improved the Basso,Beattie,and Bresnahan scale score in rats and promoted the recovery of motor function.Conclusion:DHA can promote motor functional recovery after spinal cord injury in rats.The administration of DHA by intravenous or subcutaneous injection is more effective than oral administration of DHA.Intravenous injection of DHA at doses of 250 nmol/kg or 1000 nmol/kg is beneficial.Because of the small number and the low quality of the included studies,more high-quality research is needed in future to substantiate the results.

Essentials of thoracic outlet syndrome:A narrative review

Thoracic outlet syndrome(TOS)is a group of diverse disorders involving compression of the nerves and/or blood vessels in the thoracic outlet region.TOS results in pain,numbness,paresthesia,and motor weakness in the affected upper limb.We reviewed the pathophysiology,clinical evaluation,differential diagnoses,and treatment of TOS.TOS is usually classified into three types,neurogenic,venous,and arterial,according to the primarily affected structure.Both true neurogenic and disputed TOS are considered neurogenic TOS.Since identifying the causative lesions is complex,detailed history taking and thorough clinical investigation are needed.Electrodiagnostic and imaging studies are helpful for excluding other possible disorders and confirming the diagnosis of true neurogenic TOS.The existence of a disputed TOS remains controversial.Neuromuscular physicians tend to be skeptical about the existence of disputed TOS,but thoracic surgeons argue that disputed TOS is under-diagnosed.Clinicians who encounter patients with TOS need to understand its key features to avoid misdiagnosis and provide appropriate treatment.

Relationship between treatment types and blood–brain barrier disruption in patients with acute ischemic stroke:Two case reports

BACKGROUND Blood-brain barrier(BBB)disruption plays an important role in the development of neurological dysfunction in ischemic stroke.However,diagnostic modalities that can clearly diagnose the degree of BBB disruption in ischemic stroke are limited.Here,we describe two cases in which the usefulness of dynamic contrastenhanced magnetic resonance imaging(DCE-MRI)in detecting BBB disruption was evaluated after treatment of acute ischemic stroke using two different methods.CASE SUMMARY The two patients of similar age and relatively similar cerebral infarction locations were treated conservatively or with thrombectomy,although their sex was different.As a result of analysis by performing DCE-MRI,it was confirmed that BBB disruption was significantly less severe in the patient who underwent thrombectomy(P=3.3×10^(-7)),whereas the average Ktrans of the contralateral hemisphere in both patients was similar(2.4×10^(-5)min^(-1) and 2.0×10^(-5)min^(-1)).If reperfusion is achieved through thrombectomy,it may indicate that the penumbra can be saved and BBB recovery can be promoted.CONCLUSION Our cases suggest that BBB disruption could be important if BBB permeability is used to guide clinical treatment.

The neuroprotective effects of human growth hormone as a potential treatment for amyotrophic lateral sclerosis

Human growth hormone（GH）is a single-chain polypeptide of 191 amino acids that is involved in the regulation of various physiological processes,such as growth and metabolism.GH is synthesized and secreted by somatotropic cells in the anterior pituitary gland.Its secretion is primarily regulated by a balance between growth hormone-releasing hormone and growth hormone-inhibiting hormone,

Effect of modified fasting therapy on body weight, fat and muscle mass, and blood chemistry in patients with obesity

OBJECTIVE: The aim of this study was to investigate the effects and safety of modified fasting therapy using fermented medicinal herbs and exercise on body weight, fat and muscle mass, and blood chemistry in obese subjects.METHODS: Twenty-six patients participated in a14-day fast, during which they ingested a supplement made from fermented medicinal herbs and carbohydrates(intake: 400-600 kcal/d). The schedule included 7 prefasting relief days and 14 days of stepwise reintroduction of food. The patients also took part in an exercise program that incorporated Qigong, weight training, and walking exercises. The efficacy of treatments was observed by assessing body fat mass and muscle mass, and alanine aminotransferase(ALT), aspartate aminotransferase(AST),cholesterol, and triglycerides in each study period.Specific symptoms or side effects were reported.RESULTS: Body weight and body fat mass both decreased significantly by(5.16 ± 0.95) and(3.89 ±0.79) kg(both P < 0.05), while muscle mass decreased by an average of(0.26 ± 0.22) kg, without statistical significance. ALT levels were significantly decreased(P < 0.05), while AST levels decreased without statistical significance(P = 0.052). The levels of total cholesterol and triglycerides were also significantly decreased(both P < 0.05). There were few adverse events except for mild dizziness, which did not affect everyday living.CONCLUSION: These results suggest that modified fasting therapy using fermented medicinal herbs and exercise could be effective and safe on obese patients.

Effect of Qingxue Dan on obesity and metabolic biomarker: a double-blind randomized-controlled pilot study

OBJECTIVE: To investigate the clinical effect of Qingxue Dan(QXD) on obesity and metabolic biomarker related to obesity.METHODS: A randomized, double blinded, placebo-controlled trial with a paralleled study design was conducted. Twenty-six obese volunteers aged between 30 and 60 with obesity and more than 2 metabolic risk factors were recruited at the department of oriental rehabilitation medicine, Kyunghee university oriental medical hospital, Seoul, Korea. Subjects were randomly assigned to an intervention(QXD) group or a placebo group, and treated with 900 mg/d of QXD or placebo medicine for 8 weeks. Primary endpoint was the change of body mass index(BMI) at 8 week from baseline. Secondary outcomes included the change of body composition, abdominal fat mass measured with Dual energy X-ray absorptiometry(DXA), blood pressure,lipid profiles and the homeostasis model assessment for insulin resistance(HOMA-IR).RESULTS: BMI was decreased in the QXD group sig-nificantly. Total body fat, abdominal fat mass measured with DXA Region of Interest and waist circumference(WC) showed a trend toward decreasing in the QXD group, but fat free mass was decreased in all groups. Triglyceride(TG) was decreased in QXD group significantly, but WC, total cholesterol and high-density lipoprotein cholesterol were increased in both group. BP didn't change during the study period. HOMA-IR is decreased in both groups without group effect.CONCLUSION: 8-weeks of oral administrations of QXD(900 mg/d) reduces BMI, with a tendency of lose of total body fat mass, especially abdominal fat. It also significantly reduced serum TG level.These results suggest QXD could be used to treat obesity and metabolic risk factors. Further study is needed to confirm our pilot findings.

Review on the characteristics of liver-pacifying medicinal in relation to the treatment of stroke: from scientific evidence to traditional medical theory

OBJECTIVE: To analyze the characteristics of liver pacifying medicinal in the treatment of brain disease to provide scientific evidence in clinical usage on stroke.METHODS: MEDLINE/Pub Med, Google Scholar,and China National Knowledge Infrastructure Database were used as the literature sources. The Scientific name, Latin pharmaceutical name,Chinese name of 7 kinds of liver pacifying medicinal including Gouteng(Ramulus Uncariae Rhynchophyllae cum Uncis), Tianma(Rhizoma Gastrodiae), Juemingzi(Semen Cassiae Obtusifoliae),Quanxie(Scorpio), Wugong(Scolopendra), Jiangcan(Bombyx Batryticatus), and Dilong(Pheretima Aspergillum) were used as the keywords to search the databases for relevant publications up to July2016. Their major compounds were also used as the keywords. The papers were selected based on the pharmacological activities and mechanisms of action related to brain diseases and subsequently,were analyzed and reviewed. We first described the origin, efficacy, and clinical indications of selected medicines, then brain disease specific activities focusing on stroke after the description of the general pharmacological activities.RESULTS: On the basis of the literature of scientific studies and clinical use in traditional medicine, we found and discussed the characteristics of liver pacifying medicinal in stroke treatment. First, liver-pacifying medicinal,or their components, might pass through the blood-brain barrier and act directly on neurons or on the neural network to provide protective effects against brain disease. Second, although it could be used throughout the disease duration,treatment of stroke might be more effective from the subacute up to the convalescent phase than the acute phase.CONCLUSION: We can suggest that live pacifying medicinal has beneficial pharmacological activities directly or indirectly on neurons in brain disease and is useful for the treatment of stroke from subacute to convalescent phase.