RÉSUMÉ
Stroke flaccid paralysis is stroke patients with abnormal physical movement function and muscle tone decline as the main performance and is a kind of common pathological state after apoplectic stroke. The longer the flaccid paralysis is, the worse the prognosis. The theory of TCM holds that stroke is mainly due to "deficiency, wind, fire, phlegm, stasis, qi", and when the pathogenic factor accumulate and block the meridians, which would cause blood stagnation, muscle and tendon damage and flaccidity, resulting in stroke paralysis. Therefore, it is necessary to set up the "Tongjing Roujin" (stimulating the muscle and nourishing the tendon) as its main treatment. Fire-needling has the effect of stimulating muscle, warming yang, nourishing tendon, and relieving pain in the treatment of stroke flaccid paralysis. It can warm yang and dissipate cold, replenish and nourish meridian qi, release muscle nodules, promote the circulation of qi and blood, and nourish all limbs and bones. Fire-needling therapy can promote the recovery of neural pathway, strengthen local metabolism, improve local muscle tension, and thus restore limb function. The high-quality clinical research, acupoint selection rules, and standardized operating techniques of fire-needling treatment for stroke flaccid paralysis need to be further deepened.
RÉSUMÉ
Objective:To use the resting state functional network connectivity (FNC) method based on independent component analysis (ICA) to analyze the characteristics of FNC changes in patients with basal ganglia aphasia (BGA) after stroke, and to explore its occurrence and recovery mechanism under the intervention of acupuncture combined with language rehabilitation training.Methods:Using a prospective observational research method, 16 right-handed BGA patients who were treated at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University from July 2021 to December 2022, as well as 14 healthy subjects matched in age, gender, education level, and handedness, were included. The resting state functional magnetic resonance imaging, demographic information, and Western Aphasia Examination data of healthy subjects and BGA patients before and after intervention were collected. The GIFT toolbox based on MATLAB platform was applied for ICA and resting state brain network FNC analysis. The FNC differences between BGA patients and healthy subjects were compared horizontally, and the FNC changes in BGA patients before and after intervention were compared vertically.Results:Compared with healthy subjects, post-stroke BGA patients showed decreased connectivity between the basal ganglia network, default network, and visual network before intervention, while increased connectivity between the auditory network, right frontoparietal network, and anterior cuneiform network; After the intervention of acupuncture combined with language rehabilitation training, the connectivity between the basal ganglia network, visual network, and anterior cuneiform network decreased, while the connectivity between the anterior convex network and bilateral frontoparietal network decreased, while the connectivity between the default network, auditory network, right frontoparietal network, and visual network increased. The BGA patient group showed enhanced connectivity between the basal ganglia network and the left frontoparietal network before and after intervention.Conclusions:The FNC changes between the basal ganglia network and other brain networks are key to reflecting the mechanism of BGA occurrence and language function recovery. Acupuncture combined with language rehabilitation training may improve language function by enhancing the connectivity between the basal ganglia network and the left frontoparietal network, and the redistribution of attention resources may also be one of the reasons for promoting language function recovery in BGA patients.
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Objective To evaluate the value of glycosylated hemoglobin (HbAlc) level in glucose monitoring,insulin therapy and neonatal birth weight prognosis in gestational diabetes mellitus (GDM) patients.Methods Data of 1074 women who were diagnosed as GDM and delivered at Peking University First Hospital between January 1,2005 and August 31,2011 were collected and retrospective analysis was conducted.The relationship of HbAlc level with plasma glucose level of oral glucose tolerance test (OGTT),insulin administration and neonatal birth weight were investigated with Pearson correlation analysis,Logistic regression analysis or receiver operating characteristic (ROC) curve.Results OGTT was done on 1074 women with (31.8± 4.0) years old during the second and third trimester and diagnosed GDM at (27.6 ± 3.4) weeks of gestational age.Among them,glucose level of fasting and 1 and 2 hours after OGTT were (5.2 ± 0.7),(10.9± 1.4) and (9.4±1.5) mmol/L.The levels of HbAlcwere (5.57±0.48)％ at the fist time of HbAlc testing at (31.8±4.3) weeks of gestational age.(1)The average value of HbAlc in 726 women determined at one month after OGTT was (5.54±0.47)％,and increased from (5.34±0.41)％ in women with one abnormal item in OGTT to (5.47±0.41)％ and (5.71±0.46)％ in women with two or three abnormal items inOGTT (t=3.025 and 6.399,all P＜0.01).(2) HbAlc level in women received insulin therapy was higher than those who did not [(5.78±0.58) ％ vs (5.42±0.37) ％,t=9.431,P＜0.01].The sensitivity and specificity were 57.8％ and 75.5％ respectively in predicting insulin requirement in women with GDM at the cut-off value of 5.67％ for HbAlc (Logistics analysis:OR＝6.847,95％CI:4.588-10.218,P＜0.01).(3) Maternal HbAlc levelat the third trimester was higher in large for gestational age(LGA) group than that in non-LGA group [(5.75±0.52)％ vs (5.54±0.42)％,t=6.845,P＜0.01].The sensitivity and specificity were 44.8％ and 73.8％ respectively in predicting LGA at the cut-off value of 5.75％ for HbAlc (Logistics analysis:OR=2.187,95％CI:2.097-3.783,P＜0.01).(4) Maternal HbAlc level at the third trimester was higher in macrosomia group than that in non-macrosomia group [(5.88±0.53)％ vs (5.57±0.45)％,t=5.990,P＜0.01].The sensitivity and specificity were 50.4％ and 79.8％ respectively in predicting macrosomia at the cut-off value of 5.85％ for HbAlc (Logistics analysis:OR=3.299,95％CI:2.237-4.865,P＜0.01).Conclusions HbAlc level at the time of GDM diagnosis could imply the severity of disease and might predict insulin requirement.While maternal HbAlc level at the third trimester may predict the occurrence of LGA and macrosomia.
RÉSUMÉ
Acupuncture treatment of insomnia has been reported for many years,but its validity remains controversial up to now.In the present review,the authors took "Acupuncture","Insomnia" as the key words to do a literature search from databases in both Chinese and English via computer retrieval system and also conducted a hand-made retrieval from journals of Chinese medicine as Chinese Acu-moxibustion,and collections of theses of the related academic conferences.Then,they made a systemic evaluation on the original articles from methodology,diagnosis,criteria for the enlisted and excluded patients,intervention methods of acupuncture and control groups,standards for assessing the curative efficacy,follow-up visit,etc.Of the retrieved 80 clinical articles,20 are RCT(randomized controlled trails) composed of 1907 cases,including 4 high-quality trails and 16 lower-quality trails.Regarding the assessment of the therapeutic effect,measuring scales are often adopted in overseas studies,while in domestic researches,self-drawn standards are frequently used.In conclusion,there have had no high-quality clinical trails about acupuncture treatment of primary insomnia in China at the present,and the related evaluating methods could not definitely confirm the efficacy of acupuncture in relieving insomnia.Therefore,a strict and scientific clinical trail scheme being in line with evidence-based medicine is urgently needed in the coming studies on acupuncture treatment of primary insomnia.