Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação / Functional independence, clinical aspects, and sociodemographic factors in patients in the acute phase of stroke: an association analysis

RESUMO Objetivo Analisar a associação da independência funcional com aspectos clínicos de comprometimento neurológico, a localização e extensão do dano neuronal e os fatores sociodemográficos em pacientes na fase aguda do AVC. Método Estudo analítico de recorte transversal, realizado com 90 pacientes adultos e idosos acometidos por AVC isquêmico, que tiveram admissão no ambiente hospitalar nas primeiras 24 horas após o evento vascular. A coleta dos dados referentes aos aspectos clínicos e fatores sociodemográficos foi realizada pelo prontuário eletrônico e/ou entrevista para descrever o perfil dos pacientes, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale e a Medida de Independência Funcional. Resultados O comprometimento neurológico, de acordo com a National Institute of Health Stroke Scale, foi associado à funcionalidade nas primeiras 24 horas após o AVC. Além disso, a presença de hipertensão arterial, idade, trabalho inativo, tabagismo e extensão do dano neuronal estiveram associados à dependência funcional, mas não permaneceram no modelo final deste estudo. Conclusão A dependência funcional está associada à hipertensão arterial, idade, trabalho inativo, tabagismo, extensão do dano neuronal e grau de comprometimento neurológico nas primeiras 24 horas após o evento vascular. Além disso, um nível mais elevado de comprometimento neurológico foi independentemente associado a níveis aumentados de dependência funcional.

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Gravedad de accidentes cerebrovasculares para determinar síntomas osteomusculares en cuidadores familiares / Stroke severity to determine musculoskeletal symptoms in family caregivers / Gravidade do AVC e determinação dos sintomas musculoesqueléticos dos cuidadores familiares

Objetivo: el objetivo de este estudio es examinar la relación entre los problemas osteomusculares sufridos por cuidadores familiares que tienen a su cargo velar por pacientes que han sufrido un accidente cerebrovascular y los niveles de salud física y discapacidad. Método: los sujetos incluidos en el estudio eran pacientes y cuidadores familiares atendidos en la clínica de servicios ambulatorios de Fisioterapia y Rehabilitación del Hospital Universitario y de Investigación Kanuni Sultan Suleyman por diagnósticos de ACV entre el 30 de mayo de 2019 y el 30 de mayo de 2021. Los cuidadores fueron evaluados mediante el Extended Nordic Musculoskeletal Questionnaire. Se emplearon escalas validadas para evaluar los niveles de salud física y discapacidad de los sobrevivientes de accidentes cerebrovasculares. Resultados: los participantes de este estudio fueron 104 sobrevivientes de accidentes cerebrovasculares y 104 cuidadores que cumplieron con nuestros criterios de inclusión. Las quejas relacionadas con la región lumbar durante el último mes se asociaron con las puntuaciones obtenidas por los pacientes en el Functional Ambulation Score (FAS), la Functional Independence Measure (FIM) y la Stroke Impact Scale (SIS), además de las puntuaciones Brunnstrom. El dolor de cuello fue la segunda queja osteomuscular, aunque no se asoció estadísticamente con factores relacionados con los pacientes. Los problemas en las extremidades superiores se asociaron con las puntuaciones obtenidas en los instrumentos FAS, FIM, SIS, Brunnstrom y Modified Ashworth Scale. Conclusión: de acuerdo con nuestros hallazgos, la región lumbar es la parte del cuerpo más afectada por quejas osteomusculares en cuidadores familiares de sobrevivientes de accidentes cerebrovasculares, demostrando una estrecha relación con los niveles de capacidad funcional y discapacidad de los pacientes. Número de registro de ensayos clínicos: NCT04901637

Objective: the objective of this study is to examine the relationship between the musculoskeletal problems experienced by the family members who care for stroke patients, physical health and disability levels. Method: the subjects included in the study were patients and family caregivers admitted to the Kanuni Sultan Suleyman Training and Research Hospital Physical Medicine and Rehabilitation outpatient clinic with a stroke diagnosis between May 30 th, 2019, and May 30 th, 2021. The caregivers were assessed using the Extended Nordic Musculoskeletal Questionnaire. Validated scales were employed to evaluate stroke patients' physical health and disability level. Results: a total of 104 stroke patients and 104 caregivers who met our inclusion criteria took part in this study. Low back complaints in the last month were associated with the patients' Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) and Brunnstrom scores. Neck pain was the second musculoskeletal complaint, but was not statistically associated with patient-related factors. Upper limb problems were associated with FAS, FIM, SIS, Brunnstrom and the Modified Ashworth Scale scores. Conclusion: according to our findings, the low back is the body area most affected by musculoskeletal complaints in family caregivers of stroke patients, closely related to the patients' functional capacity and disability levels. Clinical trials number: NCT04901637

Objetivo: o objetivo deste estudo é examinar a relação entre os problemas musculoesqueléticos vivenciados pelos familiares que cuidam de pacientes com AVC, a saúde física e o nível de deficiência do paciente. Método: foram incluídos no estudo pacientes e familiares cuidadores admitidos no hospital Kanuni Sultan Suleyman com diagnóstico de AVC entre 30 de maio de 2019 e 30 de maio de 2021. Os cuidadores foram avaliados utilizando o questionário Extended Nordic Musculoskeletal Questionnaire. Escalas validadas foram usadas para avaliar a saúde física e o grau de incapacidade dos pacientes com AVC. Resultados: um total de 104 pacientes com AVC e 104 cuidadores atenderam aos critérios de inclusão do estudo. As queixas lombares no último mês foram associadas aos escores do Functional Ambulation Score (FAS), Functional Independence Measure (FIM), Stroke Impact Scale (SIS) e teste de Brunnstrom do paciente. A dor no pescoço foi a segunda queixa musculoesquelética, mas não foi estatisticamente associada a fatores relacionados ao paciente. Os problemas nas extremidades superiores foram associados aos escores FAS, FIM, SIS, Brunnstrom e à Modified Ashworth Scale. Conclusão: e acordo com os nossos achados, a região lombar é a área do corpo mais afetada por queixas musculoesqueléticas nos cuidadores familiares de pacientes com AVC, que estão intimamente relacionadas ao nível de capacidade funcional e ao grau de incapacidade dos pacientes. Número do estudo clínico: NCT04901637.

Conhecimento dos profissionais da saúde de um hospital público em relação à afasia / Knowledge on aphasia held by health professionals of a public hospital / Conocimiento de los profesionales sanitarios de un hospital público sobre la afasia

Introdução: A compreensão da afasia é fundamental para os profissionais de saúde que prestam assistência a pacientes com AVC. No entanto, a informação disponível sobre a afasia ainda é limitada e insuficiente para uma abordagem eficaz. É de suma importância identificar o conhecimento dos profissionais de saúde a respeito da afasia, a fim de planejar o atendimento aos pacientes e suas famílias.Objetivo: Avaliar o nível de conhecimento dos profissionais de saúde de um hospital público em relação à afasia e analisar como eles lidam com pacientes com afasia durante o período de hospitalização. Método: Realizamos uma pesquisa com profissionais de saúde por meio de um questionário online para avaliar seu conhecimento sobre a afasia e suas estratégias de atendimento. Resultados: Os resultados indicam que profissionais de saúde com níveis de educação mais elevados tendem a possuir um entendimento mais sólido da afasia. No entanto, persistem lacunas de conhecimento em diversos aspectos da afasia. Embora a maioria dos profissionais se sinta adequadamente preparado para lidar com pacientes com afasia, eles reconhecem os desafios envolvidos e expressam o desejo de receber orientações para aprimorar suas habilidades de comunicação. Conclusão: Este estudo ressalta a necessidade de uma formação mais abrangente para os profissionais de saúde no que diz respeito à afasia e suas estratégias de comunicação. É fundamental o desenvolvimento de programas de treinamento e a elaboração de diretrizes específicas para os profissionais que atuam com esses pacientes, visando proporcionar um atendimento de alta qualidade. (AU)

Introduction: Understanding aphasia is crucial for healthcare professionals providing care to stroke patients. However, there is a need to enhance and refine the information available about aphasia for practical application. It is imperative to assess the knowledge of healthcare professionals regarding aphasia to facilitate effective care planning for patients and their families. Objective: This study aims to evaluate the level of knowledge among healthcare professionals in a public hospital concerning aphasia and their approach to patients with aphasia during their hospitalization. Method: An online questionnaire was administered to healthcare professionals to assess their understanding of aphasia and their caregiving strategies. Results: The findings indicate that healthcare professionals with higher education levels tend to have a better understanding of aphasia. Nevertheless, knowledge gaps persist in various aspects of aphasia. While most professionals feel adequately prepared to interact with patients experiencing aphasia, they acknowledge the challenges involved and express a desire for guidance to enhance their communication skills. Conclusion: This study underscores the necessity for comprehensive training of healthcare professionals in the realm of aphasia and effective communication strategies. The development of training programs and guidelines is crucial to better serve patients with aphasia, ensuring the provision of high-quality care. (AU)

Introducción: La comprensión de la afasia es importante para los profesionales de la salud que atienden a pacientes con ACV. Sin embargo, la información sobre la afasia sigue siendo limitada e insuficiente para un enfoque efectivo. Es importante identificar el conocimiento de los profesionales de la salud sobre la afasia para planificar la atención a los pacientes y sus familias. Objetivo: Evaluar el conocimiento de los profesionales de la salud de un hospital público sobre la afasia y cómo manejan a los pacientes con afasia durante el período de hospitalización. Método: Se realizó una encuesta a profesionales de la salud a través de un cuestionario en línea para evaluar su conocimiento sobre la afasia y sus tácticas de atención. Resultados: Se señala un mayor conocimiento sobre la afasia entre los profesionales de nivel superior, pero aún existen lagunas de conocimiento en varios aspectos de la afasia. La mayoría de los profesionales se sienten preparados para manejar a pacientes con afasia, pero reconocen que la atención es desafiante y les gustaría recibir orientación para mejorar sus habilidades de comunicación. Conclusión:Este estudio destaca la necesidad de una formación más amplia y completa para los profesionales de la salud sobre la afasia y su comunicación. Es fundamental desarrollar programas de capacitación y guías para atender mejor a estos pacientes y garantizar una atención de calidad. (AU)

Evolución de la afasia en adolescentes con secuela de ACV: serie de casos / Post-stroke aphasia in adolescents' progress: case series

La afasia como secuela de un accidente cerebrovascular es un trastorno del lenguaje poco estudiado en adolescentes, tanto en Latinoamérica como a nivel mundial. Independientemente del hecho de que un número significativo de afasias mejora espontáneamente, la necesidad del inicio oportuno del tratamiento es imprescindible. En esta serie de casos se describe la presentación clínica y evolución de la afasia en 3 adolescentes con secuelas de accidente cerebrovascular que ingresaron a un instituto de neurorehabilitación. Fueron dos mujeres y un varón, de entre 15 y 17 años, que recibieron rehabilitación integral intensiva desde las áreas de fisioterapia, terapia ocupacional, neuropsicología, psicopedagogía, musicoterapia y fonoaudiología. Fueron evaluados con la versión chilena de la herramienta Western Aphasia Battery (WAB). A los 3 meses todos mejoraron y evolucionaron a un tipo de afasia más leve. Este estudio expone la importancia del tratamiento precoz e intensivo en esta población de adolescentes en plena etapa de construcción social como personas, en donde la alteración del lenguaje impacta en sus vínculos, grupo de pertenencia, estado anímico y a nivel académico. Se considera fundamental la evaluación y seguimiento sistemático con el objetivo de identificar los cambios y avances alcanzados durante la rehabilitación.

Aphasia as a sequela of stroke is an understudied language disorder in adolescents, both in Latin America and worldwide. Although a significant number of aphasia cases improve spontaneously, it is necessary to initiate treatment as soon as possible. This cases series describes the clinical presentation and evolution of aphasia in 3 adolescents with stroke sequelae who were admitted to a neurorehabilitation facility. Two females and one male, aged between 15 and 17 years, received intensive comprehensive rehabilitation from the areas of physiotherapy, occupational therapy, neuropsychology, psychopedagogy, music therapy and speech therapy. They were evaluated with the Chilean version of the Western Aphasia Battery (WAB). After 3 months, all of them improved and evolved to a milder type of aphasia. This study shows the importance of early, intensive treatment in adolescents who are in the height of their social development, where language alteration impacts on their bonds, their groups of belonging, their mood and their academic process. Systematicassessment and follow-up are considered essential to identify the changes and progress achieved during rehabilitation.

Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort / 中西医结合学报

OBJECTIVE@#The main aim of this study is to investigate whether acupuncture could be an effective complementary treatment for reducing the risk of macrovascular complications in diabetic patients currently taking antidiabetic medications using a nationwide population-based database.@*METHODS@#We conducted a retrospective cohort study to assess the efficacy of acupuncture on cardiovascular complications in diabetic patients using data from patients between 40 and 79 years of age, newly diagnosed with diabetes between 2003 and 2006, found in the National Health Insurance Service-National Sample Cohort (NHIS-NSC) in Korea. From the data, we identified 21,232 diabetic patients who were taking antidiabetic medication between 2003 and 2006. The selected patients were divided into two groups-those who received acupuncture at least three times and those who received no acupuncture (non-acupuncture) in the year following their diagnosis of diabetes. After 1:1 propensity score matching (PSM), each group had 3350 patients, and the observation ceased at the occurrence of a major adverse cardiovascular event (MACE), which was defined as either myocardial infarction, stroke, or death due to cardiovascular cause.@*RESULTS@#After PSM, the acupuncture group had a lower incidence of MACE (hazard ratio [HR]: 0.87; 95% confidence interval [CI]: 0.81-0.94; P = 0.0003) and all-cause mortality (HR: 0.77; 95% CI: 0.70-0.84; P < 0.0001) than the non-acupuncture group; the HRs for stroke-related mortality (HR: 0.75; 95% CI: 0.56-1.00; P = 0.0485), ischemic heart disease mortality (HR: 0.53; 95% CI: 0.34-0.84; P = 0.006) and circulatory system disease mortality (HR: 0.67; 95% CI: 0.55-0.82; P < 0.0001) were lower in the acupuncture group than in the non-acupuncture group in the secondary analysis.@*CONCLUSION@#Our results indicate that diabetic patients receiving acupuncture treatment might have a lower risk of MACE, all-cause mortality and cardiovascular mortality. This population-based retrospective study suggests beneficial effects of acupuncture in preventing macrovascular complications associated with diabetes. These findings call for further prospective cohort or experimental studies on acupuncture treatment for cardiovascular complications of diabetes. Please cite this article as: Jung H, Won T, Kim GY, Jang J, Yeo S, Lim S. Efficacy of acupuncture on cardiovascular complications in patients with diabetes mellitus in Korea: A nationwide retrospective cohort. J Integr Med. 2023; 21(2): 176-183.

Progress on Prevention and Treatment of Cerebral Small Vascular Disease Using Integrative Medicine / 中国结合医学杂志

Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.

Astragaloside IV alleviates stroke-triggered early brain injury by modulating neuroinflammation and ferroptosis via the Nrf2/HO-1 signaling pathway

Purpose: Stroke is an acute cerebrovascular disease. Astragaloside IV (AS-IV) is an active ingredient extracted from Astragalus membranaceus with an established therapeutic effect on central nervous system diseases. This study examined the neuroprotective properties and possible mechanisms of AS-IV in stroke-triggered early brain injury (EBI) in a rat transient middle cerebral artery occlusion (MCAO) model. Methods: The neurological scores and brain water content were analyzed. 2,3,5-triphenyl tetrazolium chloride (TTC) staining was utilized to determine the infarct volume, neuroinflammatory cytokine levels, and ferroptosis-related genes and proteins, and neuronal damage and molecular mechanisms were evaluated by terminal deoxynucleotidyl transferase dutp nickend labeling (TUNEL) staining, western blotting, and real-time polymerase chain reaction. Results: AS-IV administration decreased the infarct volume, brain edema, neurological deficits, and inflammatory cytokines TNF-α, interleukin-1ß (IL-1ß), IL-6, and NF-κB, increased the levels of SLC7A11 and glutathione peroxidase 4 (GPX4), decreased lipid reactive oxygen species (ROS) levels, and prevented neuronal ferroptosis. Meanwhile, AS-IV triggered the Nrf2/HO-1 signaling pathway and alleviated ferroptosis due to the induction of stroke. Conclusion: Hence, the findings of this research illustrate that AS-IV administration can improve delayed ischemic neurological deficits and decrease neuronal death by modulating nuroinflammation and ferroptosis via the Nrf2/HO-1 signaling pathway.

Alterações de linguagem em pacientes pós lesão encefálica adquirida na fase aguda / Language changes in patients after brain injury acquired in the acute phase

Caracterizar as alterações de linguagem encontradas em pacientes com lesão encefálica adquirida em fase aguda Métodos: Trata-se de uma pesquisa observacional, descritiva do tipo transversal. A avaliação foi realizada nas enfermarias de um hospital de urgências, com pacientes de idade superior a 18 anos, diagnóstico de lesão encefálica adquirida e tempo de internação de até 60 dias. O protocolo utilizado incluiu avaliação das praxias orais, expressão, compreensão da linguagem oral e leitura. Ao final, foi possível apresentar as hipóteses diagnósticas de afasias fluentes e não fluentes, disartria e sem alteração de linguagem. A análise dos dados foi realizada por meio de estatística descritiva através da distribuição de frequência absoluta e frequência relativa Resultados: A amostra foi composta por 24 pacientes sendo a maioria do gênero masculino, com média de idade de 51 anos. O diagnóstico de maior frequência foi Acidente Vascular Cerebral. Dos pacientes avaliados, 79% tiveram alterações de fala/linguagem. As hipóteses diagnósticas fonoaudiológicas encontradas foram: afasia global, afasia de broca, afasia transcortical mista, afasia de condução, afasia transcortical motora, afasia transcortical sensorial e disartria. Conclusão: A afasia global foi o transtorno de linguagem de maior ocorrência entre os indivíduos, bem como o gênero masculino e o acidente vascular cerebral. A avaliação da linguagem de pacientes com lesões encefálicas adquiridas na fase aguda é pertinente, pois promove o levantamento de alterações desde as perceptíveis até as mais discretas

To characterize the language disorders found in patients with brain injury acquired in the acute phase Methods: This is an observational, descriptive cross-sectional study. The evaluation was carried out in the wards of an emergency hospital, with patients aged over 18 years, diagnosed with acquired brain injury and hospitalization time of up to 60 days. The protocol used included assessment of oral praxis, expression, comprehension of oral language and reading. In the end, it was possible to present the diagnostic hypotheses of fluent and non-fluent aphasias, dysarthria and without language alteration. Data analysis was performed using descriptive statistics through the distribution of absolute frequency and relative frequency. Results: The sample consisted of 24 patients, most of whom were male, with a mean age of 51 years. The most frequent diagnosis was Cerebral Vascular Accident. Of the evaluated patients, 79% had speech/language disorders. The speech-language diagnostic hypotheses found were: global aphasia, drill aphasia, mixed transcortical aphasia, conduction aphasia, motor transcortical aphasia, sensory transcortical aphasia and dysarthria. Conclusion: Global aphasia was the most frequent language disorder among individuals, as well as males and stroke. The evaluation of the language of patients with brain injuries acquired in the acute phase is relevant, as it promotes the survey of changes from the perceptible to the most discreet

Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.@*METHODS@#Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.@*RESULTS@#A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13-2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16-1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25-2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15-2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04-1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.@*CONCLUSIONS@#In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.

Post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy on post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation.@*METHODS@#Sixty patients with post-stroke dysphagia were randomly divided into an observation group and a control group, with 30 cases in each group. The neuromuscular electrical stimulation was adopted in the control group. Besides the treatment as the control group, in the observation group, the four-step acupuncture therapy for opening orifices and benefiting throat was supplemented. Step 1: the three areas of scalp acupuncture on the affected side were stimulated. Step 2: pricking method was operated on the posterior pharyngeal wall. Step 3: bleeding technique was operated at Jinjin (EX-HN 12) and Yuye (EX-HN 13). Step 4: deep insertion of needle was operated at three-pharynx points. The needles were retained for 30 min at the three areas of scalp acupuncture and the three-pharynx points. The intervention of each group was delivered once daily, 6 times a week, at the interval of 1 day. One course of treatment was 1 week and 4 successive courses were required. The rating of Kubota water swallow test, the score of standardized swallowing assessment (SSA) and the rating of Rosenbek penetration- aspiration scale (PAS) were observed before and after treatment in patients of the two groups. The incidence of clinical complications and clinical efficacy were compared between the two groups.@*RESULTS@#Compared with those before treatment, the rating of Kubota water swallow test, the scores of SSA and the rating of PAS of patients in the two groups were decreased after treatment (P<0.01), and the values of the observation group were lower than those of the control group after treatment (P<0.05). The incidence of clinical complications in the observation group was 13.3% (4/30), lower than 36.7% (11/30) in the control group (P<0.05). The total effective rate in the observation group was 93.3% (28/30), which was better than 70.0% (21/30) in the control group (P<0.05).@*CONCLUSION@#The four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation can improve the swallowing function of patients with post-stroke dysphagia and reduce the incidence of clinical complications.

Effects of electroacupuncture at "Siguan" points on the expression of colonic 5-hydroxytryptamine and fecal short-chain fatty acids in rats with post-stroke depression / 中国针灸

OBJECTIVE@#To observe the effects of electroacupuncture at "Siguan" points on behavior, colonic 5-hydroxytryptamine (5-HT) and fecal short-chain fatty acids (SCFAs) in rats with post-stroke depression (PSD), and explore the effect mechanism of electroacupuncture at Siguan points on PSD.@*METHODS@#Fifty SD rats were randomly divided into a sham-operation group, a stroke group, a PSD group, a drug group and an electroacupuncture group, with 10 rats in each one. The stroke model was established by middle cerebral artery occlusion (MCAO) method in the stroke group; except for the sham-operation group, the rats in the other groups were intervened with MCAO combined with solitary and chronic unpredictable mild stress (CUMS) to establish PSD model. In the electroacupuncture group, electroacupuncture was delivered at "Hegu" (LI 4) and "Taichong" (LR 3), with disperse-dense wave, 2 Hz/10 Hz in frequency, for 30 min in each intervention, once daily, for consecutive 21 days. Simultaneously, distilled water (0.01 L•kg-1•d-1) was administrated intragastrically. Fluoxetine solution (2.33 mg•kg-1•d-1) was given by gavage , once a day and for 21 days in the drug group. The same procedure of fixation and gavage with distilled water were adopted in the sham-operation group, the stroke group and the PSD group. Separately, before stroke modeling, after PSD modeling and after 21-day intervention, the consumption of sugar water and the scores of horizontal movement and vertical movement in open-field test were observed. After 21-day intervention, the content of colonic 5-HT was detected by immunohistochemical method, and that of fecal SCFAs was determined by gas chromatography mass spectrometry.@*RESULTS@#After PSD modeling, compared with the stroke group, the sugar water consumption, the horizontal movement scores and vertical movement scores of the open-field test were all reduced in the PSD group, the drug group and the electroacupuncture group (P<0.05). After 21-day intervention, the sugar water consumption and the scores of horizontal movement and vertical movement of the open-field test were increased in the drug group and the electroacupuncture group (P<0.05) when compared with the PSD group; and the horizontal movement score in the electroacupuncture group was lower than that of the drug group (P<0.05). Compared with the sham-operation group, the contents of total fecal SCFAs and acetic acid were lower in the stroke group (P<0.05), and the contents of colonic 5-HT and total fecal SCFAs, acetic acid, propionic acid and butyric acid were reduced in the PSD group (P<0.05). In comparison with the PSD group, the contents of colonic 5-HT and total fecal SCFAs, acetic acid and propionic acid were increased in the drug group and the electroacupuncture group (P<0.05); and the content of colonic 5-HT in the electroacupuncture group was lower than that of the drug group (P<0.05). The level of colonic 5-HT was positively correlated with the contents of total fecal SCFAs and propionic acid (r=0.424, P=0.005; r=0.427, P=0.004).@*CONCLUSION@#Electroacupuncture at "Siguan" points can relieve the depression-like behavior of PSD rats, and its underlying mechanism may be related to the regulation of fecal SCFAs, which affects the release of colonic 5-HT.

Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet for post-stoke depression: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Tiaoshen Jieyu acupuncture (acupuncture for regulating mind and relieving depression) combined with sertraline hydrochloride tablet and simple sertraline hydrochloride tablet for post-stroke depression (PSD).@*METHODS@#A total of 76 patients with PSD were randomized into an observation group (38 cases, 6 cases dropped off) and a control group (38 cases, 4 cases dropped off). Both groups were treated with conventional treatment i.e. controlling blood pressure and anti-inflammation. Sertraline hydrochloride tablet was given orally in the control group, 20 mg a time, once a day. On the basis of the treatment in the control group, Tiaoshen Jieyu acupuncture was applied at Baihui (GV 20), Yintang (GV 24+), Neiguan (PC 6), Taichong (LR 3), etc. in the observation group, Baihui (GV 20) and Yintang (GV 24+) were connected to electroacupuncture, with disperse-dense wave, 2 Hz/100 Hz in frequency, 30 min a time, once a day, 6 times a week. Treatment of 8 weeks was required in both groups. Before and after treatment, the scores of Hamilton depression scale (HAMD), National Institutes of Health stroke scale (NIHSS), Barthel index (BI) and Pittsburgh sleep quality index (PSQI) were observed respectively, the therapeutic efficacy and rate of adverse reactions were evaluated in the two groups.@*RESULTS@#After treatment, the scores of HAMD, NIHSS and PSQI were lower while BI scores were higher than those before treatment in both groups (P<0.05); the scores of HAMD, NIHSS and PSQI in the observation group were lower while BI score was higher than those in the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, which was higher than 70.6% (24/34) in the control group (P<0.05). The rate of adverse reactions was 9.4% (3/32) in the observation group, which was lower than 32.4% (11/34) in the control group (P<0.05).@*CONCLUSION@#Tiaoshen Jieyu acupuncture combined with sertraline hydrochloride tablet can improve the depression degree, neurological function, activity of daily living and sleep quality in patients with post-stroke depression, the clinical efficacy is superior to simple sertraline hydrochloride, and can alleviate the adverse reactions caused by medication.

Comparação de desfechos clínicos e correlação entre funcionalidade e tempo de ventilação mecânica de pacientes em uti / Comparison of clinical outcomes and correlation between functionality and time of mechanical ventilation in icu patients / Comparación de los resultados clínicos y correlación entre la funcionalidad y el tiempo de ventilación mecánica de los pacientes en uti

O objetivo deste estudo foi comparar os desfechos clínicos dos pacientes em suporte ventilatório invasivo por período curto e prolongado e correlacionar funcionalidade e tempo de ventilação mecânica (VM). Estudo documental retrospectivo, realizado na UTI neurocirúrgica de um hospital escola. Dos prontuários clínicos foram coletados: idade, sexo, hipótese diagnóstica de internação, tempo de internação e de VM em dias, o desfecho sucesso ou falha da extubação e o nível de funcionalidade. Os prontuários foram divididos em grupo um (GI): pacientes em VM por até três dias e grupo dois (GII): pacientes em VM por mais de três dias. Foram analisados 210 prontuários, 73% dos pacientes permaneceram menos de três dias em VM. A idade média de GI foi 51,8±15,5 anos e GII 48,7±16,3 anos (p=0,20), prevalência do sexo masculino em GI (59%) e GII (68%). O acidente vascular cerebral foi o diagnóstico mais prevalente no GI (18%) e o tumor cerebral no GII (21%) e hipertensão arterial, a comorbidade mais prevalente em GI (28%) e GII (25%). O GII permaneceu maior tempo (p<0,0001) em VM e internação na UTI que o GI e percentual de sucesso no desmame/extubação menor (p=0,01) que o GI. Não houve correlação significativa entre funcionalidade e tempo de VM em GI e GII (p>0,05). Os pacientes em suporte ventilatório invasivo por período prolongado evoluíram com maior permanência em VM, maior tempo de internação na UTI e menor taxa de sucesso no desmame/extubação. O tempo de permanência em suporte ventilatório invasivo não interferiu na funcionalidade desses pacientes.

The aim of this study was to compare the clinical outcomes of patients on short- and long-term invasive ventilatory support and to correlate functionality and duration of mechanical ventilation (MV). Retrospective documental study, carried out in the neurosurgical ICU of a teaching hospital. The following were collected from the clinical records: age, gender, diagnostic hypothesis of hospitalization, length of hospital stay and MV in days, the outcome of success or failure of extubation and the level of functionality. The medical records were divided into group one (GI): patients on MV for up to three days and group two (GII): patients on MV for more than three days. A total of 210 medical records were analyzed, 73% of the patients remained on MV for less than three days. The mean age of GI was 51.8±15.5 years and GII 48.7±16.3 years (p=0.20), male prevalence in GI (59%) and GII (68%). Stroke was the most prevalent diagnosis in GI (18%) and brain tumor in GII (21%) and hypertension was the most prevalent comorbidity in GI (28%) and GII (25%). GII remained longer (p<0.0001) in MV and ICU admission than GI and the percentage of success in weaning/extubation was lower (p=0.01) than GI. There was no significant correlation between functionality and time on MV in GI and GII (p>0.05). Patients on invasive ventilatory support for a long period evolved with longer MV stays, longer ICU stays and lower weaning/extubation success rates. The length of stay on invasive ventilatory support did not interfere with the functionality of these patients.

El objetivo de este estudio fue comparar los resultados clínicos de los pacientes con soporte ventilatorio invasivo a corto y largo plazo y correlacionar la funcionalidad y el tiempo de ventilación mecánica (VM). Se trata de un estudio documental retrospectivo, realizado en la UCI neuroquirúrgica de un hospital universitario. Se recogieron los siguientes datos de las historias clínicas: edad, sexo, hipótesis diagnóstica, duración de la estancia y tiempo de VM en días, el resultado éxito o fracaso de la extubación y el nivel de funcionalidad. Las historias clínicas se dividieron en el grupo uno (GI): pacientes bajo VM hasta tres días y el grupo dos (GII): pacientes bajo VM durante más de tres días. Se analizaron 210 historias clínicas, el 73% de los pacientes permanecieron menos de tres días con VM. La edad media de GI fue de 51,8±15,5 años y la de GII de 48,7±16,3 años (p=0,20), con prevalencia masculina en GI (59%) y GII (68%). El ictus fue el diagnóstico más prevalente en GI (18%) y el tumor cerebral en GII (21%) y la hipertensión, la comorbilidad más prevalente en GI (28%) y GII (25%). El GII permaneció más tiempo (p<0,0001) en la VM y la estancia en la UCI que el GI y el porcentaje de éxito en el destete/extubación fue menor (p=0,01) que el GI. No hubo correlación significativa entre la funcionalidad y el tiempo de VM en GI y GII (p>0,05). Los pacientes con soporte ventilatorio invasivo a largo plazo evolucionaron con una mayor estancia en la VM, una mayor estancia en la UCI y una menor tasa de éxito de destete/extubación. La duración de la estancia con soporte ventilatorio invasivo no interfirió en la funcionalidad de estos pacientes.

Autopercepção da paralisia facial e condições sociodemográficas clínicas de pacientes pós-AVC agudo: uma análise de associação / Self-perception of facial paralysis and sociodemographic-clinical conditions of postacute stroke patients: association analysis / Autopercepción de pacientes agudos faciales y condiciones sociodemográficas-clínicas posteriores post-accidente cerebrovascular en la fase aguda un análisis de asociación de pacientes

Introdução: A Paralisia Facial é uma das sequelas mais comuns em pacientes pós- Acidente Vascular Cerebral, podendo ocasionar uma série de consequências negativas para autopercepção. Objetivos: Avaliar autopercepção dos pacientes quanto à paralisia facial pós-Acidente Vascular Cerebral na fase aguda e verificar se está relacionada às condições sociodemográficas e clínicas. Método: Trata-se de estudo descritivo observacional com 86 pacientes com paralisia facial pós-Acidente Vascular Cerebral. Os critérios de inclusão foram idade acima de 18 anos, escala de Glasgow maior que 13 e compreensão preservada. Dados sócio-demográficos e clínicos foram extraídos do prontuário. A mímica facial foi avaliada com protocolo House & Brackmann (1985) e a autopercepção quanto aos incômodos físicos e psicossociais pelo questionário de auto-avaliação da condição facial. Foram realizadas análises descritiva e de associação com significância estatística de 5%. Resultados: O grau de comprometimento da paralisia facial variou entre moderado a paralisia total. A maioria dos pacientes avaliou a face em repouso como boa, movimento da face como péssima e ruim, sendo os lábios com pior classificação. Os pacientes relataram muito prejuízo nas atividades sociais, muita insatisfação com a face e médio prejuízo da alimentação. A análise de associação revelou que a autopercepção da face em repouso está associada ao sexo e ao comprometimento neurológico. Conclusão: Os pacientes na fase aguda do Acidente Vascular Cerebral possuem autopercepção de que a paralisia facial impacta no movimento dos lábios e atividades psicossociais, sendo pior para as mulheres e naqueles com o nível de comprometimento neurológico moderado e grave.

Introduction: Facial palsy is one of the most common sequelae in post-stroke patients, bringing a series of negative consequences for self-perception. Objective: To evaluate patients' self-perception regarding facial palsy after acute stroke and verify if it is related to sociodemographic and clinical conditions. Method: This is a descriptive observational study with 86 patients with facial paralysis after acute stroke admitted to a public hospital. The inclusion criteria were age over 18 years, Glasgow scale above 13 and preserved understanding. Socio-demographic and clinical data were extracted from the medical records. Facial mimicry was assessed using the House & Brackmann protocol (1985) and self-perception of physical and psychosocial discomfort using the facial condition self-assessment questionnaire. Descriptive and association analyses were performed with statistical significance of 5%. Results: The degree of impairment of facial paralysis varied from moderate to total paralysis. Most patients rated the resting face as good, face movement as very bad and bad, with the lips being the worst rated. The patients reported a lot of damage in social activities, a lot of dissatisfaction with the face and medium impairment on eating. The association analysis revealed that self-perception of the face at rest is associated with sex and neurological impairment. Conclusion: Patients in the acute phase of stroke have a self-perception that facial paralysis impacts on lip movement and psychosocial activities, being worse for women and those with moderate and severe neurological impairment.

Introducción: La parálisis facial es una de las secuelas más comunes en pacientes post-accidente cerebrovascular, que puede causar una serie de consecuencias negativas para la auto-percepción. Objetivos: Evaluar la auto-percepción de los pacientes con respecto a la parálisis facial después del accidente cerebrovascular en la fase aguda y verificar si está relacionada con condiciones sociodemográficas y clínicas. Método: Este es un estudio descriptivo observacional con 86 pacientes con parálisis facial después del accidente cerebrovascular. Los criterios de inclusión tenían una edad superior a los 18 años, glasgow escalaba más de 13 y se conservaba la comprensión. Los datos sociodemográficos y clínicos se extrajeron de los registros médicos. El mimetismo facial fue evaluado usando el protocolo house &brackmann (1985) y la auto-percepción de las molestias físicas y psicosociales explora la autoevaluación de la condición facial. Se realizaron análisis descriptivos y asociativos con una significación estadística del 5%. Resultados: El grado de afectación de la parálisis facial osciló entre la parálisis moderada y total. La mayoría de los pacientes calificaron la cara en reposo como buena, el movimiento facial como malo y malo, siendo los labios los peor valorados. Los pacientes reportaron mucho deterioro en las actividades sociales, mucha insatisfacción con el deterioro facial y medio de los alimentos. El análisis de la asociación reveló que la autopercepción de la cara en reposo se asocia con el sexo y el deterioro neurológico. Conclusión: Los pacientes en la fase aguda del accidente cerebrovascular tienen la autopercepción de que la parálisis facial afecta el movimiento de los labios y las actividades psicosociales, siendo peor para las mujeres y aquellos con el nivel de deterioro neurológico moderado y grave.

Formal language assessment in low-educated persons with aphasia: can the lesion effect be distinguished from the education effect? / Avaliação da linguagem em pacientes afásicos com baixa escolaridade: o impacto da lesão neurológica pode ser discriminado da baixa escolaridade?

ABSTRACT Background: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge. Objective: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia. Methods: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects. Results: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed. Conclusions: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.

RESUMO Antecedentes: Os testes de linguagem são importantes para a avaliação e o acompanhamento de pacientes afásicos. Apesar disso, a avaliação de linguagem em indivíduos com baixa escolaridade ainda é um desafio. Objetivo: Investigar se a avaliação formal da afasia é capaz de diferenciar o efeito da lesão neurológica versus o efeito da baixa escolaridade em pacientes afásicos, acometidos por acidente vascular cerebral (AVC). Métodos: A amostra foi composta de um grupo de 30 sujeitos afásicos (AG) e um grupo controle (CG) de 36 indivíduos, todos com um a quatro anos de escolaridade. A Bateria Montreal-Toulouse de Avaliação da Linguagem foi administrada a todos os participantes. Resultados: Das 20 tarefas analisadas, 19 apresentaram diferenças significativas entre os grupos. Conclusões: Os resultados sugerem que procedimentos formais de avaliação são capazes de identificar as alterações linguísticas ocasionadas por um AVC, também em pacientes com baixa escolaridade.

The association between sleep disturbances and tooth loss among post-stroke patients / Prevalência de edentulismo e distúrbios de sono após acidente vascular cerebral

ABSTRACT Background: Loss of teeth has been associated with neurological and sleep disorders. It is considered to be a predictor of stroke and leads to modifications of airway patency and predisposition to obstructive sleep apnea. Objective: To investigate sleep quality, risk of obstructive sleep apnea and excessive sleepiness among post-stroke patients with tooth loss attending the Neurovascular Clinic of the Federal University of São Paulo. Methods: The prevalence rates of different types of stroke were assessed among 130 patients with different degrees of tooth loss, along with the presence of sleep disturbances, risk of obstructive sleep apnea and excessive daytime sleepiness. Results: The prevalence of ischemic stroke was 94.6%, with either no significant disability or slight disability. Our sample had poor sleep quality, and a high risk of obstructive sleep apnea, but without excessive daytime sleepiness. Half of our sample had lost between 9 and 31 teeth, and more than 25% had edentulism. The majority used full removable dental prostheses, and more than half of these individuals slept without removing the prosthesis. Conclusions: We found high prevalence of poor sleep quality and high risk of obstructive sleep apnea among post-stroke patients with tooth loss. This indicates the need for further studies on treating and preventing sleep disturbances in stroke patients with tooth loss.

RESUMO Antecedentes: A perda de dentes tem sido associada a distúrbios neurológicos e do sono. É considerada um preditor de acidente vascular cerebral (AVC), com modificações na permeabilidade das vias aéreas e predisposição à apneia obstrutiva do sono. Objetivo: Investigar a qualidade do sono, o risco de apneia obstrutiva do sono e a sonolência excessiva em pacientes pós-AVC com perda dentária, atendidos na Clínica Neurovascular da Universidade Federal de São Paulo. Métodos: O estudo avaliou a prevalência de diferentes tipos de AVC em 130 pacientes com diferentes graus de perda dentária e a presença de distúrbios do sono, risco de apneia obstrutiva do sono e sonolência excessiva. Resultados: A prevalência de AVC isquêmico foi de 94,6%, sem deficiência significativa ou deficiência leve. Nossa amostra tinha má qualidade de sono e alto risco de apneia obstrutiva do sono, sem sonolência diurna excessiva. Metade de nossa amostra perdeu entre nove e 31 dentes, e mais de 25% tiveram edentulismo. A maioria usava próteses dentárias totalmente removíveis e, desses pacientes, mais da metade dormia com elas. Conclusões: Encontramos alta prevalência de má qualidade do sono e alto risco de apneia obstrutiva do sono em pacientes pós-AVC com perda dentária. Isso indica a necessidade de mais estudos sobre o tratamento e a prevenção de distúrbios do sono em pacientes com AVC e perda dentária.

Scanning of paroxysmal atrial fibrillation as an etiological risk factor in patients with acute ischemic stroke: prospective study

Abstract BACKGROUND: Prevention of recurrence of stroke depends on recognition of the underlying mechanism of ischemia. OBJECTIVE: To screen patients who were hospitalized with diagnosis of acute ischemic stroke in terms of atrial fibrillation (AF) with repeated Holter electrocardiography recordings. DESIGN AND SETTING: Prospective study conducted at Konya Education and Research Hospital, Turkey. METHODS: Patients with a diagnosis of acute ischemic stroke, without atrial fibrillation on electrocardiography (ECG), were evaluated. Their age, gender, histories of previous ischemic attack, occurrences of paroxysmal atrial fibrillation (PAF) and other risks were assessed during the first week after acute ischemic stroke and one month thereafter. ECG recordings were obtained from 130 patients through 24-hour ambulatory Holter. Patients without PAF attack during the first Holter were re-evaluated. RESULTS: PAF was detected through the first Holter in 33 (25.4%) out of 130 acute ischemic stroke patients. A second Holter was planned for 97 patients: 53 (54.6%) of them could not attend due to COVID-19 pandemic; while 44 (45.3%) patients had the second Holter and, among these, 4 (9.1%) had PAF. The only parameter associated with PAF was older age. Four (10.8%) of the 37 patients with PAF had also symptomatic carotid stenosis. CONCLUSIONS: Detecting the presence of PAF by screening patients with no AF in the ECG through Holter ECG examinations is valuable in terms of changing the course of the treatment. It should be kept in mind that the possibility of accompanying PAF cannot be ruled out in the presence of other factors that pose a risk of stroke.

An overview of dysphagia rehabilitation for stroke patients / Uma revisão das terapias de reabilitação para disfagia em pacientes com acidente vascular cerebral

ABSTRACT Background: Dysphagia is characterized by difficulty in the swallowing pattern at any stage of this neuromuscular process. It is a frequent symptom after stroke. Objective: This study aimed to investigate the most commonly used phonoaudiological interventions as therapy for the treatment of swallowing disorders in patients with dysphagia after stroke. Methods: We performed a review of studies indexed in MEDLINE-PubMed, LILACS, Cochrane, and Clinical trials.gov focusing on speech-language interventions for adult dysphagic patients after stroke between January 2008 and January 2021. Results: Thirty-six articles of clinical trials were selected. Eleven different types of therapies have been studied. Studies on the efficacy of therapeutic interventions for the rehabilitation of adult patients with dysphagia after stroke are still scarce. Most techniques are combined with conventional therapy, so the effectiveness of the other techniques alone cannot be assessed. Conclusions: Therapeutic interventions should be selected in accordance with the possibilities and limitations of the patients, and especially with the findings of the clinical evaluation and with its objective.

RESUMO Antecedentes: A disfagia é caracterizada como uma dificuldade no padrão de deglutição em qualquer fase desse processo neuromuscular. É um sintoma frequente após o Acidente Vascular Cerebral. Objetivos: O objetivo deste estudo foi investigar as intervenções fonoaudiológicas mais utilizadas como terapia para o tratamento dos distúrbios da deglutição em pacientes com disfagia pós AVC. Métodos: Realizamos uma revisão dos estudos indexados no MEDLINE-PubMed, LILACS, Cochrane e Clinical trials.gov com foco nas intervenções fonoaudiológicas em pacientes adultos e disfágicos após AVC entre janeiro de 2008 e janeiro de 2021. Resultados: Foram selecionados trinta e seis artigos de ensaios clínicos e estudados onze tipos de terapia. Os estudos sobre a eficácia de intervenções terapêuticas para a reabilitação destes pacientes adultos ainda são restritos. A maioria das técnicas é aplicada em combinação com a terapia convencional, tornando inconclusiva a medição da eficácia de outras técnicas isoladamente. Conclusões: As intervenções terapêuticas devem ser escolhidas de acordo com as possibilidades e limitações dos pacientes e, principalmente, com os achados da avaliação clínica e seu objetivo.

Cardiovascular and Cerebrovascular Diseases Induced by Air Pollution / 中国医学科学院学报

Air pollution has severe detrimental effects on public health.A substantial number of studies have demonstrated that air pollution exposure is a risk factor for the occurrence of cardiovascular and cerebrovascular diseases and a cause of non-communicable diseases.Both long-term and short-term exposure to air pollution are associated with respiratory diseases,stroke,coronary artery disease,and diabetes.Aiming to better understand the association,we reviewed the latest studies about the association of air pollution with cardiovascular and cerebrovascular diseases,especially stroke,coronary heart disease,arrhythmia,hypertension,and heart failure,and summarized the underlying mechanisms of the health damage caused by long-term and short-term exposure to air pollution.

Effect of acupuncture for dysphagia after stroke based on fiberoptic endoscopic swallowing function evaluation / 中国针灸

OBJECTIVE@#To observe the effect of acupuncture combined with regular treatment and swallowing function training on pharyngeal motor, sensory function and penetration-aspiration function in patients with dysphagia after stroke.@*METHODS@#A total of 60 patients with dysphagia after stroke were randomly divided into a control group and an observation group, 30 patients in each group. Both groups were treated with conventional treatment and swallowing function training; in addition, the observation group was treated with acupuncture at Lianquan (CV 23), Fengfu (GV 16), Yifeng (TE 17). All the treatments were given once a day, 5 days a week, for totally 4 weeks. In the two groups, the pharyngeal motor and sensory function, penetration-aspiration scores were evaluated by fiberoptic endoscopic evaluation of swallowing (FEES), and the Kubota water swallowing test scores were assessed before and after treatment, and the clinical effects were compared.@*RESULTS@#After treatment, the pharyngeal motor and sensory function in the two groups were all higher than those before treatment (P<0.05), and those in the observation group were better than the control group (P<0.05). After treatment, the penetration-aspiration scores and Kubota water swallowing test scores in the two groups were all lower than those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). The total effective rate was 93.3% (28/30) in the observation group, which was better than 73.3% (22/30) in the control group (P<0.05).@*CONCLUSION@#Acupuncture combined with regular treatment and swallowing training could improve the pharyngeal motor and sensory function, and penetration-aspiration scores in patients with dysphagia after stroke.