[Auricular acupuncture of magnetic pellet combined with catheter balloon dilatation in treatment of post-stroke cricopharyngeus muscle dysfunction: a randomized controlled trial].

OBJECTIVE: To observe the clinical efficacy on post-stroke cricopharyngeus muscle dysfunction treated with auricular acupuncture of magnetic pellet combined with catheter balloon dilatation, and the effect on the adverse reaction during catheter balloon dilatation and the patients' quality of life. METHODS: A total of 106 patients with post-stroke cricopharyngeus muscle dysfunction were randomly divided into an observation group (53 cases, 3 cases dropped off, 1 case excluded) and a control group (53 cases, 5 cases dropped off). The catheter balloon dilatation was provided in the control group, once a day. In the observation group, on the base of the treatment as the control group, auricular acupuncture of magnetic pellet was added. Before catheter balloon dilatation, the magnetic pellet was pressed at Yanhou (TG3), Xin (CO15), Naogan (AT3,4i), etc. These auricular points were pressed 5 min, as well as in every morning and evening for another 5 min, totally 3 times a day. The auricular acupuncture of magnetic pellet was applied on the ears alternatively each time, once every 3 days. One session treatment contained 6 days and 4 sessions of treatment were required in both groups. Before and after treatment, the scores of standardized swallowing assessment (SSA), Rosenbek penetration-aspiration scale (PAS) and swallowing quality of life (SWAL-QOL) were observed in both groups. Separately, on day 1 (T1) of treatment, in 2 weeks into treatment (T2) and on the last day of treatment (T3), the score of visual analogue scale (VAS) was recorded in both groups. The incidence of nausea and vomiting and the clinical efficacy were compared between the two groups. RESULTS: After treatment, SSA and PAS scores were reduced (P<0.05) and SWAL-QOL scores were increased (P<0.05) in both groups compared with those before treatment, and the changes in the observation group were larger than those in the control group (P<0.05). At T2 and T3, VAS scores were lower than those at T1 in both groups (P<0.05), while VAS score at each time point in the observation group was lower than that of the control group (P<0.05). The incidence of nausea and vomiting in the observation group was 51.0% (25/49), lower than the control group (79.2%, 38/48, P<0.05). The total effective rate was 95.9% (47/49) in the observation group, better than the control group (87.5%, 42/48, P<0.05). CONCLUSION: Auricular acupuncture of magnetic pellet combined with catheter balloon dilatation effectively improve the swallowing function, relieve the discomforts during the dilatation and promote the quality of life in patients with post-stroke cricopharyngeus muscle dysfunction.

[Ultrasound-guided electroacupuncture at suprahyoid muscle group for pharyngeal dysphagia after stroke: a randomized controlled trial].

OBJECTIVE: To compare the effect among ultrasound-guided electroacupuncture (EA) at suprahyoid muscle group, conventional acupuncture and conventional EA at suprahyoid muscle group on pharyngeal dysphagia after stroke, and to explore its biomechanical mechanism. METHODS: A total of 120 patients with pharyngeal dysphagia after stroke were randomly divided into an observation group, a control-1 group and a control-2 group, 40 cases in each group. The patients in the observation group were treated with ultrasound-guided EA at suprahyoid muscle group; the patients in the control-1 group were treated with EA at Lianquan (CV 23), Wangu (GB 12) and Fengchi (GB 20), etc.; the patients in the control-2 group were treated with EA at suprahyoid muscle group according to anatomical location. The EA in the three groups were discontinuous wave, with frequency of 5 Hz and current intensity of 1 mA. The EA was given for 30 minutes, once a day, 6 times were taken as a course of treatment, and 4 courses of treatment were provided. The video floroscopic swallowing study (VFSS) was performed before and after treatment. The Rosenbek penetration-aspiration scale (PAS) score, the forward and upward movement distance of hyoid bone and thyroid cartilage, Ichiro Fujima ingestion-swallowing function score were recorded in the three groups, and the incidences of subcutaneous hematoma were recorded after treatment. RESULTS: Compared before treatment, the PAS scores were reduced and the Ichiro Fujima ingestion-swallowing function scores were increased after treatment in the three groups (P<0.05); the PAS scores in the observation group were lower than those in the control-1 group and the control-2 group, and the Ichiro Fujima ingestion-swallowing function scores in the observation group were higher than those in the control-1 group and the control-2 group (P<0.05). After treatment, the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group and the control-2 group was increased (P<0.05), and the forward and upward movement distance of hyoid bone was increased in the control-1 group (P<0.05); the forward and upward movement distance of hyoid bone and thyroid cartilage in the observation group was longer than that in the control-1 group and the control-2 group (P<0.05). The incidence of subcutaneous hematoma in the observation group was 0% (0/40), which was lower than 20.0% (8/40) in the control-1 group and 47.5% (19/40) in the control-2 group (P<0.05). CONCLUSION: Ultrasound-guided EA at suprahyoid muscle group could improve the swallowing function in patients with pharyngeal dysphagia after stroke by increasing the motion of hyoid laryngeal complex. Its effect and safety are better than conventional acupuncture and conventional EA at suprahyoid muscle group.

[Effect of electrical stimulation with bilateral scalp acupuncture on time parameters in video fluoroscopic swallowing study and cortical excitability in patients with dysphagia after cortical stroke].

OBJECTIVE: To investigate the effect of electrical stimulation with bilateral scalp acupuncture on time parameters in video fluoroscopic swallowing study and cortical excitability in patients with dysphagia after cortical stroke, as well as its possible mechanism of action. METHODS: A total of 84 patients with dysphagia after cortical stroke were randomly divided into control group with 41 patients and observation group with 43 patients. The patients in the control group were given acupuncture based on acupoint selection for pseudobulbar palsy, and in addition to the treatment in the control group, the patients in the observation group were given electrical stimulation of bilateral scalp acupuncture, with acupuncture and pulse acupuncture at the lower 2/5 of the bilateral anterior oblique parietotemporal lines[on the line connecting Qianshencong (EX-HN1) to Xuanli (GB6)] and the lower 2/5 of the bilateral posterior oblique parietotemporal lines [on the line connecting Baihui (GV20)and Qubin (GB7)], with a needle retaining time of 30 minutes, once a day and 6 times a week for 3 weeks. Before treatment and after 3 weeks of treatment, oral delay time (ODT), oral transit time (OTT), pharyngeal delay time (PDT), and pharyngeal transit time (PTT) were compared between the two group; the Rosenbek Penetration-Aspiration Scale was used to evaluate penetration-aspiration and appro-ximate entropy (ApEn) of EEG nonlinear index. RESULTS: After treatment, both groups had significant reductions in ODT, OTT, PDT, PTT, and Rosenbek Penetration-Aspiration score and a significant increase in ApEn (P<0.05). Compared with the control group after treatment, the observation group had significant reductions in ODT and OTT (P<0.05) and significant increases in the ApEn values of bilateral central, parietal, and posterior temporal regions (P<0.05), while there were no significant differences in PDT, PTT, and Rosenbek Penetration-Aspiration score between the two groups (P>0.05). CONCLUSION: In addition to body acupuncture, electrical stimulation with bilateral scalp acupuncture can improve ODT and OTT in the treatment of patients with dysphagia after cortical stroke, which may be associated with the increased excitability of the swallowing cortex.

Effect of electroacupuncture on the expression of Nav1.1 in rat after acute cerebral ischemia.

OBJECTIVE: To observe the expression of Nav1.1 and the effect of electroacupuncture therapy (ET) on it after acute cerebral ischemia. METHODS: Focal acute cerebral ischemic model was established by occluding right middle cerebral artery. One hundred and forty-five male adult Sprague-Dawley rats were randomly divided into four groups: sham operation group, middle cerebral artery occlusion (MCAO) group, ET group and riluzole group. Double immunofluorescence and real-time PCR were used to observe Nav1.1 expression, and TTC staining was used to detect infarct volume at 6 hours, 1 day, 2 days, 3 days and 7 days after ischemia. RESULTS: The expression of Nav1.1 in sham operation group had no change. After ischemia, the expression of Nav1.1 was up-regulated evidently at 6 hours compared with sham operation group, down-regulated at 1 day and up-regulated again from 2 to 7 days after ischemia; the expression at 7 days was lower than that at 6 hours. In ET group and riluzole group, Nav1.1 expression were down-regulated compared with that in MCAO group after ischemia, the infarct volume was smaller than that in MCAO group at the same time point, and the difference is significant (p<0.05); however, the difference between ET group and riluzole group is not significant (p>0.05). CONCLUSION: ET and riluzole could regulate the expression of Nav1.1 after ischemia, decrease the infarction volume and reduce cerebral ischemic injury. One of the important mechanisms for ET's cerebral protective function may be that it could regulate the expression of Nav1.1 after ischemia.