Physiotherapy after stroke: More is better?

Physiotherapy is an established component of stroke rehabilitation but uncertainties remain about the most appropriate intensity of therapy input. We conducted a systematic review of the randomised trials of physiotherapy after stroke where qualitatively similar therapy regimens were provided at different levels of intensity. A heterogeneous group of seven randomised trials (597 patients) was identified. Dichotomous outcomes (death or the combined poor outcome of death or deterioration) were analysed by use of the odds ratio and 95% confidence interval. Patients subjected to more intensive physiotherapy input showed a non-significant reduction in case fatality (odds ratio 0.60; 95% CI 033–1.09) and a significant reduction (OR 0.54; 95% CI 0.34–0.85; p<0.01) in the combined poor outcome of death or deterioration by the end of follow-up. Two statistical techniques were used to identify patterns within the continuous data. Firstly, impairment and disability scores were converted to a standardised measure of 0–100 and the weighted mean difference (WMD) between the scores in the intensive and conventional physiotherapy groups were then calculated. Modest improvements were observed in both the impairment (WMD+5; 95% CI–1–11) and disability scores (WMD+5; 95% CI 0–10) recorded at the initial review (median 3 months post-stroke), but not at the final review (median 1 year post-stroke). Secondly, Fisher's inverse chi-squared test was used to combine the p values from individual trials; this confirmed the above findings (p<0.05 at initial review; p>0.05 at final review). More intensive physiotherapy input was associated with a reduction in the combined poor outcome of death or deterioration and may enhance the rate of recovery. These observations warrant further investigation.     

补阳还五汤对缺血性脑卒后遗症大鼠神经增殖作用的影响

目的 观察补阳还五汤对缺血性脑卒后遗症大鼠神经增殖作用的影响。方法 采用机械开颅电凝法阻断大脑中动脉24h后,用随机电脉冲刺激仪每天刺激2h,连续刺激20d,造成大鼠缺血性脑卒后遗症模型。治疗组在造模结束后灌服补阳还五汤水煎液,连续给药15d。给药结束后处死大鼠,并取出大脑,处死前均腹腔注射5-溴脱氧核苷尿嘧啶（BrdU）,用免疫组织化学方法检测大鼠脑组织中BrdU的表达。结果 与模型组相比,补阳还五汤治疗组BrdU阳性细胞数量显著增多。结论补阳还五汤对缺血性脑卒后遗症大鼠神经增殖具有促进作用。     

内质网应激对缺血性脑卒中神经元凋亡与自噬的调控及中医药的干预

内质网作为细胞内的一种膜质细胞器,通过参与分泌蛋白和跨膜蛋白的合成、折叠、成熟和翻译后修饰以维持细胞内稳态,与疾病的发生发展密切相关。当内质网环境受到干扰后蛋白质将发生折叠或错误折叠,此时内质网应激被激活,可对神经元的凋亡与自噬进行调控,在缺血性脑卒中中扮演着重要角色。本文从内质网应激的信号通路入手,探讨内质网应激与神经元凋亡和自噬的关系,介绍中医药通过内质网应激途径调控缺血性脑卒中神经元凋亡与自噬的研究概况,为研究中医药在缺血性脑卒中的作用机制提供新的现代医学的理论支持和作用靶点。     

Stress hyperglycemia is associated with in‐hospital mortality in patients with diabetes and acute ischemic stroke

Background and ObjectiveStress hyperglycemia may occur in diabetic patients with acute severe cerebrovascular disease, but the results regarding its association with stroke outcomes are conflicting. This study aimed to examine the association between stress‐induced hyperglycemia and the occurrence of in‐hospital death in patients with diabetes and acute ischemic stroke.Research Design and MethodsAll data were from the Chinese Stroke Center Alliance (CSCA) database and were collected between 2016 and 2018 from >300 centers across China. Patients’ demographics, clinical presentation, and laboratory data were extracted from the database. The primary endpoint was in‐hospital death. The ratio of fasting blood glucose (FBG) to HbA1c was calculated, that is, the stress‐induced hyperglycemia ratio (SHR), to determine stress hyperglycemia following acute ischemic stroke.ResultsA total of 168,381 patients were included. The mean age was 66.2 ± 10.7, and 77,688 (43.0%) patients were female. The patients were divided into two groups: survivors (n = 167,499) and non‐survivors (n = 882), as well as into four groups according to their SHR quartiles (n = 42,090–42,099/quartile). There were 109 (0.26%), 142 (0.34%), 196 (0.47%), and 435 (1.03%) patients who died in the Q1, Q2, Q3, and Q4 quartiles, respectively. Compared with Q1 patients, the death risk was higher in Q4 patients (odds ratio (OR) = 4.02) (adjusted OR = 1.80, 95% confidence interval [CI] = 1.10–2.92, p = 0.018 after adjustment for traditional cardiovascular risk factors). The ROC analyses showed that SHR (AUC = 0.667, 95% CI: 0.647–0.686) had a better predictive value for mortality than that of fasting blood glucose (AUC = 0.633, 95% CI: 0.613–0.652) and HbA1c (AUC = 0.523, 95% CI: 0.504–0.543).ConclusionsThe SHR may serve as an accessory parameter for the prognosis of patients with diabetes after acute ischemic stroke. Hyperglycemia in stroke patients with diabetes mellitus is associated with a higher risk of in‐hospital death.     

从瘀论治中风后失眠

中风后失眠是脑血管意外恢复期出现睡眠障碍的病症,主要是以睡眠障碍伴有偏瘫、吞咽障碍、肢体功能障碍等。导师认为瘀是本病的主要病理因素,本虚标实是本病着手点,自拟益气调血安神汤治疗中风后失眠临床效果颇佳。     

Simple Nutrient-Based Rules vs. a Nutritionally Rich Plant-Centered Diet in Prediction of Future Coronary Heart Disease and Stroke: Prospective Observational Study in the US

To better understand nutrition paradigm shift from nutrients to foods and dietary patterns, we compared associations of a nutrient-based blood cholesterol-lowering diet vs. a food-based plant-centered diet with risk of coronary heart disease (CHD) and stroke. Participants were 4701 adults aged 18–30 years and free of cardiovascular disease at baseline, followed for clinical events from 1985 and 86 to 2018. A plant-centered diet was represented by higher A Priori Diet Quality Score (APDQS). A blood cholesterol-lowering diet was represented by lower Keys Score. Proportional hazards regression was used to calculate hazard ratios (HR). Higher APDQS showed a nutrient-dense composition that is low in saturated fat but high in fiber, vitamins and minerals. Keys Score and APDQS changes were each inversely associated with concurrent plasma low-density lipoprotein cholesterol (LDL-C) change. Over follow-up, 116 CHD and 80 stroke events occurred. LDL-C predicted CHD, but not stroke. APDQS, but not Keys Score, predicted lower risk of CHD and of stroke. Adjusted HRs (95% CIs) for each 1-SD higher APDQS were 0.73 (0.55–0.96) for CHD and 0.70 (0.50–0.99) for stroke. Neither low dietary fat nor low dietary carbohydrate predicted these events. Our findings support the ongoing shift in diet messages for cardiovascular prevention.     

补阳还五汤对大鼠缺血性脑中风损伤后轴突再生的影响

目的:探索补阳还五汤促进缺血性脑中风大鼠轴突再生和神经康复的作用。方法:SD大鼠共180只,建立大脑中动脉梗死(MCAO)模型,选取造模成功的大鼠随机分成模型组、补阳还五汤组(12 g·kg~(-1))和尼莫地平组(20 mg·kg~(-1)),另设假手术组,每组28只。连续灌胃给药7 d后,断头取脑,通过TTC染色检测脑梗死率,测定脑含水量检测脑水肿程度,改良银染法观察轴突变性,免疫荧光染色观察神经微丝蛋白-200(NF-200)的表达,实时荧光定量PCR(Real-time PCR)检测排斥性导向分子a(RGMa),Ras同源酶(Rho),Rho激酶(ROCK)和脑衰反应调节蛋白2(CRMP2)的mRNA表达,并通过改良神经功能评分观察神经功能恢复情况。结果:与假手术组比较,模型组的脑梗死体积和脑含水量显著上升(P0.01),神经功能显著下降(P0.01),轴突变性和神经纤维损伤严重,轴突生长相关蛋白的mRNA表达异常(P0.01);与模型组比较,补阳还五汤组和尼莫地平组的脑损伤程度明显降低,表现为脑梗死率和脑含水量显著降低(P0.01),轴突变性减少;NF-200阳性染色增多;RGMa,Rho和ROCK的mRNA表达明显降低(P0.05),CRMP2的mRNA表达显著升高(P0.01),神经功能明显提高(P0.05)。结论:补阳还五汤可通过调节轴突生长相关蛋白的mRNA表达促进缺血性脑中风损伤后轴突再生,从而改善神经功能。     

基于蛋白质组学大黄异病同治急性中风大鼠脑物质的基础及相关机制

目的:基于定量蛋白质组学和生物信息学分析,探索大黄异病同治急性中风的物质基础及机制。方法:采用线栓法制备缺血再灌注的缺血性中风(IS)大鼠模型和胶原酶来诱导的出血性中风(ICH)模型。将60只SD大鼠随机分为缺血性中风假手术组(Sham1),缺血性中风组(IS),出血性中风+大黄治疗组(DH1),出血性中风假手术组(Sham2),出血性中风(ICH)组和出血性中风+大黄治疗组(DH2),每组10只。IS,Sham1和DH1组在24 h后,ICH,Sham2和DH2组在48 h后,生理盐水灌注后取脑组织行定量蛋白质组学分析,鉴定差异表达蛋白(DEPs)。对共性DEPs进行生物信息学分析,并对相关的DEPs进行蛋白免疫印迹验证。结果:大黄调节急性中风疾病相关共性DEPs 21个(上调12个,下调9个)。京都基因和基因组百科全书(KEGG)分析显示,富集了肌萎缩侧索硬化症(ALS)通路,通路中包含神经丝蛋白轻链多肽(Nefl),神经丝蛋白中链多肽(Nefm),神经丝蛋白重链多肽(Nefh)。大黄异病同治急性中风共性机制主要包括能量代谢、离子稳态、突触相关蛋白的调节、细胞周期及神经形成。共性DEPs验证,大黄治疗后,GTP结合蛋白REM2(Rem2),酪氨酸3-单加氧酶(Th),Nefl和神经调制蛋白(Gap43)表达量与相应模型组比较差异均有统计学意义(P0.05)。其中,治疗后Nefl表达为下调,而Rem2,Th和Gap43表达为上调,此结果与蛋白质组学检测结果一致。结论:该研究建立了大黄-异病同治-差异蛋白质表达谱,能量代谢、离子稳态、突触相关蛋白调节、细胞周期及神经形成是其共性机制。     

针刺联合重复经颅磁刺激治疗脑卒中后吞咽功能障碍的临床观察

目的评估针刺联合重复经颅磁刺激治疗脑卒中后吞咽功能障碍的临床效果。方法选取2017年8月—2018年10月,在大连市中心医院康复科病房收治的60例,病程在30~90 d的脑卒中后存在吞咽功能障碍的患者,随机分为重复经颅磁刺激组30人;综合组(针刺联合重复经颅磁刺激组)30人。2组均给予吞咽功能训练。重复经颅磁刺激组予重复经颅刺激治疗,综合组予重复经颅磁刺激(rTMS)及针刺治疗。治疗周期为4周,治疗前、后采用Frowen吞咽功能量表进行评定。结果经过4周的治疗后,2组患者治疗后Frowen吞咽功能量表评分显著低于同一组治疗前评分,差异有统计学意义(P<0.05);2组患者治疗后Frowen吞咽功能量表评分比较,综合组明显低于重复经颅磁刺激组,差异有统计学意义(P<0.01)。结论针刺联合重复经颅磁刺激治疗可显著改善脑卒中后吞咽功能障碍。