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Efficacy and safety of Di-Tan Decoction for treating post-stroke neurological disorders:a systematic review and Meta-analysis of randomized clinical trials

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Chinese Journal of Natural Medicines 2021年第5期19卷 339-350页

作者： Kwon Hyuk-Ku Zhang Ting Wu Xuan Gao Qiu Jing Yi Park Sunmin Dept of Environm ental EngineeringHoseo UniversityAsanSouth Korea Dept of Food and NutritionObesity/Diabetes Research CenterHoseo UniversityAsanSouth Korea

The management of post-stroke complications plays an important role in the quality of life.Di-Tan Decoction(DTD;涤痰汤)is a widely used traditional Chinese medicine.This study incorporated systematic review and meta-analysis to evaluate the efficacy of DTD in post-stroke neurological disorders.Randomized clinical trials(RCTs)were searched from English,Chinese and Korean electronic medical databases,by including the keywords"Di-Tan Tang","Di-Tan Decoction","Scour Phlegm Decoction","stroke",and"RCT.Each RCT included control(placebo,conventional therapy,or Western medicine)and experimental(DTD treatment)groups.For patients inflicted with stroke for 1-6 weeks,the outcomes of post-stroke neurological disorders were measured by scales for post-stroke symptoms and were classified as"completely healed","markedly effective","effective"and"ineffective".Totally,11 RCTs(n=490 controls and n=502 DTD subjects)were selected from 210 articles identified in the initial search.A metaanalysis of evaluation criteria in post-stroke symptoms revealed that the overall odds ratio(ORs)for alleviating post-stroke neurological disorders were 0.30-fold lower(95%CI=0.21-0.43)in the DTD group than the control(Western medicine)group(Pstroke diagnostic scale applied(including NFA,HDS,and NIHSS),the overall post-stroke symptoms determined were less severe in the DTD group(n=219)than the control group(n=217).No adverse effects of DTD were observed in the 11 RCTs reviewed.All 11 studies used an appropriate method for randomization of subjects to evaluate the risk of bias(ROB),and 7 studies included allocation concealment as well as blinding of patients and practitioners.High-risk ROB was included in6 RCTs.No significant publication bias was derived from the funnel plot.Our results indicate that the administration of DTD alone,and DTD in combination with Western medicine,exert greater efficacy for post-stroke complication therapy,than Western medicine administered alone.More rigorous and regulated studies a

关键词： Di-Tan Decoction post-stroke Adverse effects Randomized clinical trials Risk of bias

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“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”:Commentary

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2023年第1期14卷 1-3页

作者： Jonathan Willman Brandon Lucke-Wold College of Medicine University of FloridaGainesvilleFL 32610United States Department of Neurosurgery University of FloridaGainesvilleFL 32610United States

In this commentary,we summarize some of the key points of the original paper“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”and offer support for the proposed results.Specifically,we address how early percutaneous endoscopic gastrostomy(PEG)tube placement may reduce hospital length of stay and costs.We also discuss topics related to the article including PEG weaning and post-stroke nutritional formulation.However,we note that concerns purported by previous studies that early PEG placement may worsen outcomes are not fully addressed,and further research is needed.

关键词： Percutaneous endoscopic gastrostomy tube post-stroke Nutritional management Rehabilitation Dysphagia

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Mechanism of the acupoints of the governor vessel in treatment of post-stroke depression on the base of the specificity of meridian points

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World Journal of Acupuncture-Moxibustion 2019年第3期29卷 244-248页

作者：钱林霞江玥婷林法财南京中医药大学第二临床医学院

Focusing on the effect specificity of meridian points along the running course of meridian,by taking the treatment of post-stroke depression(PSD)with the acupoints of the governor vessel as an example,the correlation between meridian points and disease was explored.The specific regulatory effect of governor vessel,Baihui(百会GV20)and Shenting(神庭GV24)in physiology and pathology in PSD and the material basis of the specificity effect were analyzed.Finally,the specific relationship between the acupoints of the governor vessel and PSD was explained.

关键词： Specificity of meridian points post-stroke depression Governor vessel Baihui(百会GV20) Shenting(神庭GV24)

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Research progress on the prediction of post-stroke epilepsy

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Acta Epileptologica 2020年第1期2卷 200-207页

作者： Shangnan Zou Yangmei Chen Chongqing Medical University Chongqing 400016China. The Second Affiliated Hospital of Chongqing Medical University Chongqing 400000China.

Epilepsy is a common neurological disease that not only causes difficulties in the work and life activities of patients,but also brings complex social problems.Cerebrovascular disease is currently the main cause of epilepsy in the elderly.With the increased survival rate of patients after stroke,the incidence of epilepsy after stroke has also increased.Effective prediction of epilepsy after stroke is extremely crucial for the prognosis of patients,the initiation of antiepileptic therapy and the reduction of epileptic seizures.In this review,we summarize and compare the current models for the prediction of epilepsy after stroke,including the SeLECT prediction model,post-stroke Epilepsy Risk Scale(PoSERS),CAVE score,electroencephalogram(EEG)prediction model,and Scandinavian stroke Scale(SSS)score,in order to provide reference for clinical practice and future research.Prediction models can be selected based on the clinical classification of cerebrovascular events.The SeLECT score prognostic model is a better choice for ischemic stroke,especially for the exclusive prediction of mild post stroke epilepsy.The CAVE score model is suitable for intra-cerebral hemorrhage patients.It is simple and offers high correlation between the risk factors and epilepsy.The PoSERS score simultaneously predicts ischemic and hemorrhagic stroke,and is superior to other methods in specificity as well as positive and negative prediction rate.The SSS score,which only measures stroke severity,is not strictly considered as a mature predictor,but it can be used as a first step screening tool.A growing number of large studies are under the way to identify risk factors of poststroke epilepsy(PSE)and to improve the inclusion of predictive indicators.New and advanced findings by EEG recordings may further improve the prediction of PSE.

关键词： post-stroke Epilepsy SeLECT PoSERS CAVE Scandinavian stroke scale score Electroencephalogram

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Ruyi Zhenbao Pills for Patients with Motor and Sensory Dysfunction after stroke: A Double-Blinded, Randomized Placebo-Controlled Clinical Trial

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Chinese Journal of Integrative Medicine 2022年第10期28卷 872-878页

作者： LING Shan-shan PAN Rui-huan ZHAN Le-chang LI Mei YANG Zhi-jing YANG Hao-dong CHEN Hong-xia Department of Rehabilitation The Second Afﬁliated HospitalGuangzhou University of Chinese MedicineGuangzhou(510120)China The Second Institute of Clinical Medicine Guangzhou University of Chinese MedicineGuangzhou(510120)China

Objective: To evaluate the efficacy and safety of Tibetan medicine Ruyi Zhenbao Pills(RZPs) in the treatment of patients with motor and sensory dysfunction after stroke. Methods: A total of 120 convalescent stroke patients hospitalized in the Rehabilitation Department of Guangdong Provincial Hospital of Chinese Medicine from June 2017 to December 2019 were enrolled in this trial. Patients were assigned to control(60 cases) and research(60 cases) groups by computer random assignment. All patients received internal treatment and modern rehabilitation training. On this basis, the research group was given oral RZPs for 4 weeks, while the control group was given oral placebo. The primary outcome was motor function of the affected side evaluated by simplified FuglMeyer Motion Assessment Scale(FMA-M). The secondary outcomes included sensory function, activity of daily living(ADL), quality of life, balance function, and pain, which were assessed by Fugl-Meyer Sensory Assessment Scale(FMA-S), Modified Barthel Index(MBI), Special Scale of the Quality of Life(SS-QOL), Berg Balance Scale(BBS), and Visual Analogue Scale(VAS), respectively. All of the assessments were performed before treatment, and 4 and 8 weeks after treatment. Vital signs, liver and kidney functions, routine blood test, blood coagulation profile, and routine urinalysis of patients were monitored. Results: After 4-week treatment, the FMA-M, BBS and FMA-S scores in the research group significantly increased compared with the control group(P0.05). Moreover, after treatment, there was no significant difference in vital signs, liver and kidney functions, blood coagulation function, blood routine and urinalysis between the 2 groups(P>0.05). Conclusion: RZPs improved limb motor, balance, and sensory functions of stroke patients during recovery p

关键词： Ruyi Zhenbao Pills post-stroke motor dysfunction sensory dysfunction Tibetan medicine randomized controlled trial

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Cyclo (MQCNS) has the potential to treat ischemic stroke

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Neural Regeneration Research 2023年第11期18卷 2429-2435页

作者： Zhibing Song Xinyu Li Mengting Lv Yuchen Guo Shanshan Deng Yuefan Zhang Tiejun Li School of Medicine Shanghai UniversityShanghaiChina College of Biological and Medical Engineering Donghua UniversityShanghaiChina College of Pharmacology Anhui University of Chinese MedicineHefeiAnhui ProvinceChina

We previously found that monocyte locomotion inhibitory factor has a neuroprotective effect on ischemic brain injury during the acute phase of stro ke.Therefore,we modified the structure of an anti-inflammato ry monocyte locomotion inhibitory factor peptide to construct an active cyclic peptide—Cyclo(MQCNS)(LZ-3)—and investigated its effects on ischemic stroke.In this study,we established a rat model of ischemic stroke by occluding the middle cerebral artery and then administered LZ-3(2 or 4 mg/kg) via the tail vein for 7 consecutive days.Our res ults showed that LZ-3(2 or 4 mg/kg) substantially decreased infarct volu m e,reduced co rtical ne rve cell death,improved neurological function,reduced cortical and hippocampal injury,and decreased the levels of inflammatory factors in the blood and brain tissues.In a well-diffe rentiated,oxygen-glucose deprivation/reoxygenation-induced BV2 cell model of poststroke,LZ-3(100 μM) inhibited the JAK1-STAT6 signaling pathway.LZ-3 regulated microglia/macrophage polarization from the M1 to the M2 type and inhibited microglia/macrophage phagocytosis and migration via the JAK1/STAT6 signaling pathway.To conclude,LZ-3 regulates microglial activation by inhibiting the JAK1/STAT6 sign aling pathway and improves functional recovery post-stroke.

关键词： cortex functional recovery JAK1 LZ-3 macrophage microglia monocyte locomotion inhibitory factor phagocytosis polarization post-stroke STAT6

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Clinical Study on Tongyan Spray(通咽喷雾剂) for post-stroke Dysphagia Patients:A Randomized Controlled Trial

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Chinese Journal of Integrative Medicine 2012年第5期18卷 345-349页

作者：冯学功郝文杰丁舟隋强郭欢符健 Neurology Department of Beijng Hospital of Traditional Chinese and Western Medicine

Objective： To observe the effectiveness and safety of Tongyan Spray （通咽喷雾剂） composed of Chinese medicine for post-stroke dysphagia patients. Method： One hundred and twenty-two post-stroke dysphagia patients were randomly assigned to the treatment group （61 cases） and the control group （61 cases）. Basic treatment was given to both groups, with Tongyan Spray additionally used in oropharynx for the treatment group, and the placebo used for the control group. After 28-day treatment, the clinical effect and safety were evaluated according to the standard swallowing assessment （SSA） scale. Results： One patient dropped out in each group, and 120 patients reached the final analysis of the study. The total effective rate for the treatment group was 71.7% （43/60）, higher than 46.7% （28/60） in the control group （P〈0.05）, and the improvement on SSA scores of the two groups were significantly different after treatment （P〈0.05）. For grade 1 dysphagia patients （completely depending on nasogastric tube）, the effective rate of the treatment group was 40.9% （9/22）, and 12.5% （2/16） of the control group, without significant difference （P〉0.05）, while the improvement of SSA score was significantly different between the two groups after treatment （P〈0.05）. For grade 2-3 dysphagia patients （oral and nasogastric tube feeding）, the total effective rate of the treatment group was 89.5% （34/38）, higher than 59.1% （26/44） in the control group （P〈0.05）, and also the improvement on SSA scores was significantly different between the two groups after treatment （P〈0.05）. Conclusion： Tongyan Spray was an effective and safe method for post-stroke dysphagia patients.

关键词： post-stroke dysphagia Tongyan Spray

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Effects of Aerobic Conditioning on Individuals post-stroke: What Is the Evidence?

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International Journal of Clinical Medicine 2016年第3期7卷 245-260页

作者： Roberta Lins Gonçalves Ingrid de Fátima Aquino Suzuki Fernanda Figueiroa Sanchez Elisa Brosina De Leon Peterson Marco de Oliveira Andrade Physiology and Pharmacology Federal University of Amazonas UFAM Amazonas Brazil Campus Universitário Senador Arthur Virgílio Filho Faculdade de Educa&ccedil&atildeo Física e Fisioterapia—FEFF UFAM Amazonas Brazil UFAM Amazonas Brazil UFJF Minas Gerais Brazil

Background: stroke has been considered the major cause of chronic disability in the world and ranks among the leading causes of death. Despite the fact that new vascular events often happen and risk factors are the same that Cardiovascular Diseases, secondary prevention through non-pharmacological measures, are not part of the routine physical rehabilitation after stroke. Objective: The aim is to answer the following clinical question: Should aerobic fitness be part of the physical rehabilitation of individuals post-stroke? Methodological Design: The methodology used in the study was an integrative literature review. Inclusion Criteria: Articles in English are published in secondary databases: systematic reviews with or without meta-analysis, which address the question PICO: patient (post-stroke), intervention (aerobic exercise), comparison (with or without aerobic conditioning) the outcome (volume of oxygen consumed peak (VO2peak), quality of life (QoL), morbidity and mortality). Outcomes: VO2peak, QoL, complications and mortality. Analysis of Studies: The methodological quality of included studies is assessed using the tools: PRISMA and R-AMSTAR. Results: There was “good” evidence for the inclusion of aerobic exercise on physical rehabilitation of post-stroke individuals to improve their physical capacity (VO2peak), facilitating the completion of activities of daily living and gait. There was weak evidence on the association of aerobic fitness with positive results on QoL in stroke victims and insufficient results to evaluate the effect of aerobic fitness on the risk of stroke recurrence and mortality. Conclusion: The aerobic conditioning should be included in the rehabilitation of stroke victims.

关键词： post-stroke Aerobic Conditioning Aerobic Exercise Quality of Life Oxygen Consumption

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Role of Transcranial Direct Current Stimulation in the Management of post-stroke Depression

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Neuroscience & Medicine 2020年第1期11卷 1-11页

作者： T. Alloush E. Fayez I. Abd-Allah Al-Azab M. Bouls M. Hamdy Neurology and Psychiatry Department Faculty of Medicine Ain Shams University Cairo Egypt Physical Therapy Department for Neuromuscular Disorder and Its Surgery Faculty of Physical Therapy Cairo University Cairo Egypt

Study Objectives: stroke is a major neurological disease significantly threatening the human health and life with a high morbidity, disability, and mortality. post-stroke depression (PSD) is one of the common complications of stroke. PSD has been a major factor hindering the recovery of neurological functions and daily activities in stroke patients and is closely related to the social avoidance and increased mortality of stroke patients. Although antidepressant drug treatment has improved during the last decades, symptoms in about 20% of the patients are not in remission two years after initiation of pharmacological intervention. Nowadays, non-invasive brain stimulation;techniques;transcranial direct current stimulation (tCDS) has gained an important interest in the treatment of many neuropsychiatric disorders which might be of some help in treatment of PSD. The goal of the current study is to evaluate the beneficial short term role of tDCS on post-stroke depression. Study Design: This was a randomized double blind placebo-controlled clinical trial included forty hemiparetic patients with post-stroke depression from outpatient clinic of Faculty of Physical Therapy, Cairo University, in the period between June 2018 to June 2019. All patients diagnosed as having a PSD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Depression was evaluated by Hamilton Depression Rating Scale (HAM-D) pre and post treatment and quality of life was evaluated by the stroke Specific Quality Of Life scale (SS-QOL). Patients were assigned randomly into two groups: the study group A and the control group B. Both groups received antidepressant medication in addition to physical therapy program. Group A received tCDS for 30 minutes, three times per week for one month, while the group B received sham transcranial direct current stimulation. Results: Active tDCS was significantly superior to sham with significant improvement in depression and stroke Specific Quality Of Life in treated group in comparison to grou

关键词： post-stroke Depression Transcranial Direct Current Stimulation Diagnostic and Statistical Manual of Mental Disorders

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Latest Advances in the Treatment of post-stroke Limb Spasm with Botulinum Neurotoxin

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Journal of Advances in Medicine Science 2018年第4期1卷 133-139页

作者： Shuhua Chen Lingjing Jin Department of Neurology Yangpu hosptial Tongji University School of Medicine Shanghai 200090 China Department of General Medicine Tongji University School of Medicine 200093 China Department of Neurology Tongji Hospital Affiliated to Tongji University (Tongji Hospital of Shanghai) Shanghai 200065 China

Objective: To describe the latest progress in the use of botulinum neurotoxin for post-stroke limb spasm. Methods: This paper looks up the relevant research literatures in recent years in PubMed, Web of Science, Springer, Ovid, CNKI, WanFang databases and summarizes them. Results: The latest progress in the use of botulinum neurotoxin for post-stroke limb spasm was studied from the following aspects: the action mechanism of botulinum neurotoxin;efficacy evaluation;injection dose;target muscle selection;guiding technology;combination therapy. Conclusion: Botulinum neurotoxin is the first-line treatment for post-stroke limb spasm. We need to make continuous improvement and progress from the treatment period, injection dose, target muscle selection, guiding technology and efficacy evaluation to improve the quality of life of the majority of post-stroke survivors in China.

关键词： Botulinum neurotoxin post-stroke limb spasm Guiding technology Combination therapy Efficacy evaluation

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