Biological Mechanism of Specific Relationship between Gan (Liver) Meridian of Foot-Jueyin and Genitals / 中国结合医学杂志

From the perspective view of Chinese medicine, the Gan (Liver) meridian of Foot-Jueyin starts from the great toe, running upward along the medial side of the thigh to the perineal area, where it curves around the external genitalia and goes up to the lower abdomen. In clinical practice, acupoints in the feet of the Gan meridian of Foot-Jueyin are used to treat the genitourinary and external genitalia diseases. Studies have shown that reproductive system diseases have specific pathological reactions in the places (radial side of tibia and foot) where Gan meridian of Foot-Jueyin passes by. Why does this happen? In this article, we begin by briefly reviewing the evidences linking foot and genitalia. We then explore the potential mechanism of the relationship between genitals and the Gan meridian of Foot-Jueyin. The brain cerebral cortex is characterized by cortical interactions. Numerous studies show that different cerebral cortex function areas (especially the adjacent areas) are overlapping and interact with each other. Finally, we presume that there is a specific connection between the feet and the genitals. Physiologically in the cortical homunculus, the genital area lies adjacent or overlapped to the foot areas, the two areas may interact with each other. The functional reorganization between different areas of the cerebral cortex under pathological conditions may be the underlying mechanism of the relationship between the feet and the genitals.

Significance of affected side sensorimotor area in recovery of upper limb motor function after subcortical cerebral infarction / 中华神经科杂志

Objective:To explore the value and significance of sensorimotor cortex (SMC) in the recovery of upper limb motor function after cerebral infarction in the striatum with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI).Methods:A total of 17 patients with primary onset of striatal intracapsular infarction (SCI) with unilateral severe upper limb paralysis, who were strictly screened from the Department of Neurology, Affiliated Hospital of Yangzhou University from June 2015 to December 2017, were selected as research subjects, and 15 healthy volunteers were selected as controls. BOLD-fMRI under the passive finger extension (FE) task on the hemiplegic side was performed within one week, one month and three months after the onset of the disease. The activation of SMC was observed by SPM8 software. The activation of corresponding brain activation areas in BOLD-fMRI was observed by Xjview software and compared with the standard brain activation areas dynamically. The upper limb section of the Fugl-Meyer Scale (FM-UL) was used to track the motor function of the upper limb. The upper limb motor function of the selected patients was evaluated before functional magnetic resonance imaging (fMRI) scanning, at one month and three months after onset of the disease.Results:In the controls, fMRI showed that the main brain activation areas were located in the contralateral SMC and bilateral supplementary motor area. According to the activation time course of the affected side SMC and the comparison results with the standard brain activation area, the study patients were divided into three groups: group 1 (six patients), in which the activation intensity of SMC was stronger than that of standard brain activation area in the early stage of onset; group 2 (five patients), in which the activation intensity of SMC in the affected side was stronger than that in the standard brain activation area at one month after onset; group 3 (six patients), in which the activation intensity of SMC in the affected side increased gradually in three months, but still did not exceed the standard brain activation area. The activated voxel values of the affected side SMC in group 1 patients at the first time, one month and three months were 3 570.2±1 125.9, 1 205.8±328.2 and 1 121.5±407.5, respectively, the difference within the group being statistically significant ( F=12.8, P=0.001); the activated voxel values of the affected SMC in group 2 patients were 556.2±171.7, 648.6±177.3 and 993.2±182.9, respectively, and the differences within the group were statistically significant ( F=6.5, P=0.018); the activated SMC values of the affected SMC in group 3 patients were 520.0±375.9, 573.5±375.0 and 680.9±359.8, respectively, and there was no statistically significant difference within the group ( P>0.05). The three times FM-UL scores corresponding to group 1 patients were (10.0±3.3) points, (52.3±4.6) points and (63.7±2.9) points; the three times FM-UL scores corresponding to group 2 patients were (10.6±5.7) points, (36.6±2.4) points and (59.2±3.1) points; and the three times FM-UL scores corresponding to group 3 patients were (9.2±4.0) points, (12.5±3.0) points and (13.3±5.0) points; FM-UL scores in group 1 and group 2 patients showed statistically significant differences within the groups ( F=348.4, 183.6; P<0.001), whereas that in group 3 patients showed no statistically significant difference within the group ( P>0.05). There was no statistically significant difference in the initial FM-UL score among the groups ( P>0.05), while the differences among the groups at one month and three months were statistically significant ( F=191.7,304.5; P<0.001). Conclusions:The survival of SMC on the affected side after cerebral infarction is a prerequisite for the rehabilitation of limb motor function. Its early activation cannot predict the clinical prognosis, but the dynamic enhancement of SMC activation on the affected side is related to the rehabilitation speed of the affected limb.

Effect of Repeated Transcranial Magnetic Stimulation on Reorganization of Aphasia after Stroke: A Study Based on Functional Magnetic Resonance Imaging / 中国康复理论与实践

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the brain functional reorga-nization of aphasia after stroke, with functional magnetic resonance imaging (fMRI). Methods From January, 2017 to February, 2018, six eligible stroke patients with aphasia were recruited in experimental group, and nine age-gender matched healthy adults were recruited in healthy control group. Subjects in both groups received task-fMRI, and the experimental group was assessed with Chinese version of Western Aphasia Battery (WAB) examination before and after rTMS treatment. Four patients underwent rTMS at the right inferior frontal gyri pars triangularis marked by neuro-navigation-guided system, 1 Hz, five times per week for two weeks. The fMRI data were processed by SPM 12. The differences of brain activation and voxel changes be-tween two groups were compared. The fMRI data including the differences in brain activation, voxel volume and activation voxel indices (AVI) and WAB scores were analyzed before and after rTMS. Results The cerebral hemisphere activation in the experimental group was higher than that of the healthy control group, including the regions of interest (ROI) such as bilateral supplementary motor area and middle frontal gyrus, and the non-ROI (n-ROI) such as left praecuneus, left postcentral gyrus, right hippocampus, right paracingulate cor-tex, etc., while the activation reduced in the areas of left pars triangularis and n-ROI such as left calcarine fissure cortex, left gyrus lingualis, the right anterior cingulate and the paracingulate cortex. Cases 1 and 2 had shorter course of disease, smaller lesion volume, and activation increased in bilateral cerebral hemispheres before treat-ment. AVI showed that their hemispheric dominance was right, and activation reduced in bilateral cerebral hemi-sphere after treatment, but the high-efficiency language function area of ROI, such as the left pars triangularis, turned from inactive to active, and the hemispheric dominance lateralized from right to left, with the improve-ment of language function. For the case 3 and case 4, the disease courses were longer, the lesions sizes were larg-er, and both cerebral hemisphere activations were reduced before treatment. AVI showed that the hemispheric dominance of case 3 was right and was left in case 4. After treatment, bilateral cerebral hemispheres were activat-ed more than before, and the hemispheric dominance of language function was in the right hemisphere; the left middle frontal gyrus and right middle temporal gyrus were activated from no activation before treatment in case 3. The activation of the supplemental motor area on the right side was increased. In case 4, there was no activa-tion in ROI before treatment. After treatment, the bilateral supplementary motor area, right pars opercularis, and the right middle temporal gyrus were activated. Conclusion Low-frequency rTMS could improve the language function by optimizing bilateral cerebral hemisphere brain areas related with language function in patients with aphasia after stroke.

Functional and Structural Changes of Lower Motor Neuron Distal to the Site of Rats with Spinal Cord Transection at T10 / 中国康复理论与实践

Objective To investigate the structural and functional changes of lower motor neuron distal to the site of spinal cord injury in rats. Methods Seventies Sprague-Dawley rats were divided randomly into 6 groups: sham-operation group (controls, n=10) and 3 day group (n=10), 1 week group (n=10), 2 week group (n=10), 4 week group (n=15) and 8 week group (n=15) after spinal cord transaction at T10. Neuronal apoptosis and acetylcholinesterase (AChE) activity of spinal cord at L4-6 were observed by using the terminal deoxynucleotidal transferase-mediated DUTP-biotin nick end labeling (TUNEL) method and the semiquantitative enzyme cytochemistry, respectively. Re-sults The assessment of apoptosis by TUNEL labeling showed that fluorescent markers were observed occasionally in anterior horn distal to the site of injury. The optical density (OD) value of AchE positive motor neurons (area>300μm2) initially decreased about 3 days after transaction and then overshot 1 week or so. However, after that, the OD value decreased again, the lowest about 4 weeks. Then the OD value increased again, though at 8 weeks was still lower than that of controls (P<0.05). Conclusion The findings on indistinctive apoptosis provid-ed the proof of no significant changes of lower motor neuron distal to the site of transection. Semiquantitative histochemical results about AChE reflected marked metabolic changes of motoneurons caudal to the transaction, which represented as part of functional reorganization.

Functional and Structural Changes of Lower Motor Neuron Distal to the Site of Rats with Spinal Cord Transection at T10 / 中国康复理论与实践

@#Objective To investigate the structural and functional changes of lower motor neuron distal to the site of spinal cord injury in rats. Methods Seventies Sprague-Dawley rats were divided randomly into 6 groups: sham-operation group (controls, n=10) and 3 day group (n=10), 1 week group (n=10), 2 week group (n=10), 4 week group (n=15) and 8 week group (n=15) after spinal cord transaction at T10. Neuronal apoptosis and acetylcholinesterase (AChE) activity of spinal cord at L4- 6 were observed by using the terminal deoxynucleotidal transferase- mediated DUTP-biotin nick end labeling (TUNEL) method and the semiquantitative enzyme cytochemistry, respectively. Results The assessment of apoptosis by TUNEL labeling showed that fluorescent markers were observed occasionally in anterior horn distal to the site of injury. The optical density (OD) value of AchE positive motor neurons (area > 300 μm2) initially decreased about 3 days after transaction and then overshot 1 week or so. However, after that, the OD value decreased again, the lowest about 4 weeks. Then the OD value increased again, though at 8 weeks was still lower than that of controls (P<0.05). Conclusion The findings on indistinctive apoptosis provided the proof of no significant changes of lower motor neuron distal to the site of transection. Semiquantitative histochemical results about AChE reflected marked metabolic changes of motoneurons caudal to the transaction, which represented as part of functional reorganization.

Functional and Structural Changes of Lower Motor Neuron Distal to the Site of Rats with Spinal Cord Transection at T10 / 中国康复理论与实践

@#Objective To investigate the structural and functional changes of lower motor neuron distal to the site of spinal cord injury in rats. Methods Seventies Sprague-Dawley rats were divided randomly into 6 groups: sham-operation group (controls, n=10) and 3 day group (n=10), 1 week group (n=10), 2 week group (n=10), 4 week group (n=15) and 8 week group (n=15) after spinal cord transaction at T10. Neuronal apoptosis and acetylcholinesterase (AChE) activity of spinal cord at L4- 6 were observed by using the terminal deoxynucleotidal transferase- mediated DUTP-biotin nick end labeling (TUNEL) method and the semiquantitative enzyme cytochemistry, respectively. Results The assessment of apoptosis by TUNEL labeling showed that fluorescent markers were observed occasionally in anterior horn distal to the site of injury. The optical density (OD) value of AchE positive motor neurons (area > 300 μm2) initially decreased about 3 days after transaction and then overshot 1 week or so. However, after that, the OD value decreased again, the lowest about 4 weeks. Then the OD value increased again, though at 8 weeks was still lower than that of controls (P<0.05). Conclusion The findings on indistinctive apoptosis provided the proof of no significant changes of lower motor neuron distal to the site of transection. Semiquantitative histochemical results about AChE reflected marked metabolic changes of motoneurons caudal to the transaction, which represented as part of functional reorganization.

A functional magnetic resonance imaging study of brain functional reorganization in patients with cerebral infarction / 中华物理医学与康复杂志

Objective To investigate activation patterns in the motor cortex of patients with cerebral infarction by blood oxygen level dependent-functional magnetic resonance imaging ( BOLD-fMRI) , and to explore the brain's functional reorganization mechanism. Methods Sixteen patients ( 12 men and 4 women, age 37 to 80, mean 61.0±11.3) who had suffered a subcortical infarction within the previous 3 months were studied. All the patients received fMRI scanning during passive flexion-extension movement of both the affected and unaffected wrist separately.Brain functional mapping was acquired with SPM2 software. Activation patterns in the brain were compared between the affected and unaffected hands. Results The volume and intensity of the activated areas were diverse, but showed some order. When the affected hand moved, the fMRI map showed general hyperactivation. When the unaffected hand moved, the contralateral M1 and S1 were activated. Conclusions After cerebral infarction, the brain cortex showed compensatory changes. As the main motor cortex (M1) was deactivated, the subsidiary motor areas such as the PMC, SMA, CMA, IPL, PFC and CRB were activated. The activated motor areas could shift to the area around the lesion, and the non-motor area was activated also.

A fMRI Study of Cortical Reorganization in Chronic Stroke Hemiplegia Treated with Constraint-induced Movement Therapy / 中国康复理论与实践

@#Objective To investigate the evidence of cortical reorganization in stroke hemiplegia treated with constraint-induced movement therapy(CIMT)by fMRI.Methods Five patients with chronic stroke were evaluated with the Action Research Arm Test(ARAT).The functional MRI(fMRI)was performed on a 3.0-T MRI with echo-planar imaging.The subjects were required to finish the finger-tapping task and undergo fMRI before and after CIMT.A block design was used for the inspection.Results After CIMT,the function of upper limb(sick side)of patients improved significantly assessed by ARAT(P<0.001),and cortical reorganization was found on fMRI.Conclusion CIMT can improve motor function of upper limb of chronic stroke patients with hemiplegia and induce cortical reorganization as measured by fMRI.

Advance in the Mechanisms of Functional Recovery after Brain Injury (review) / 中国康复理论与实践

@#With the increasing morbidity of brain injury suffered from different causes,a large number of researchers focus on the recovery of the post-brain-injury.Based on the brain plasticity theory,this paper reviewed some possible recovery mechanisms of the post-brain-injury,including changes in neural cells,functional reorganization,functional compensation,changes in the excitability of cortex,and specific skills learning.

Dynamically Functional Reorganization in Somatosensory Cortex Induced by The Contralateral Peripheral Nerve Transfer to an Injured Arm / 生物化学与生物物理进展

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexus root avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after the operation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked the process in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in the somatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown in SEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to the contralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensory representation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after the operation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensory cortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different in responding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can cause dynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain function induced by an alteration of sensory input between two sides of the body in adult rats.

Dynamically Functional Reorganization inSomatosensory Cortex Induced byThe Contralateral Peripheral NerveTransfer to an Injured Arm / 生物化学与生物物理进展

Peripheral nerve injury of a limb usually causes functional reorganization of the contralateral somatosensory cortex.However, the patients with an operation of the contralateral seventh cervical nerve (C7) transfer to an injured arm with brachial plexusroot avulsions usually have the sole tactile sensibility of the healthy hand when the injured hand is touched at the early stage after theoperation. Then, at later stage they gradually get normal sense from the injured and the normal hands independently. Mimicked theprocess in a rat model based on the above operation, representations of the injured forepaw and the healthy forepaw in thesomatosensory cortex were studied by means of somatosensory evoked potential (SEP) recording. Somatosensory function shown inSEP response amplitude and peak latency of the injured forepaw gradually recovered with time after the operation due to thecontralateral C7 regeneration toward the injured limb, accompanied with the recovery process of limb movement. The somatosensoryrepresentation of the injured forepaw was observed exclusively in the ipsilateral somatosensory cortex since the 5th month after theoperation. Accordingly, the overlapped representation of the injured and healthy forepaws emerged in the ipsilateral somatosensorycortex of 13 rats studied except one with separated representation though the SEP latency and response amplitude were different inresponding to stimuli on the two forepaws. It is concluded that the contralateral peripheral nerve transfer to the injured arm can causedynamically functional reorganization in the ipsilateral somatosensory cortex suggesting a remarkable plasticity of the brain functioninduced by an alteration of sensory input between two sides of the body in adult rats.

中枢神经系统（CNS）损伤后功能恢复的理论（三） / 中国康复理论与实践

@#This section will introduce the free radicals damages following brain injury and their pre-vention.In addition,certain factors which contribute to recovery of function from brain injury in the acutestage are discussed

Theories of Functional Recovery after CNS Injuries / 中国康复理论与实践

@#In previous section,the theories and promoting factors for functional recovery of the CNSfollowing injury,as well as the development and concept of the brain plasticity theory are intreduced.This section will discuss the anatomy and physiology underlying the brain plasticity theory and thepositive evidence for the theory in both animal and human studies. Internal and external factors which af-fect the brain plasticity will be illustrated as well,based on the Luria’s functional reorgnization theory.