The Efficacy and Safety of Different Noninvasive Therapies in the Treatment of Central Poststroke Pain (CPSP): A Network Meta-Analysis and Systematic Review.

OBJECTIVE: To evaluate the efficacy and safety of noninvasive therapies in the treatment of central poststroke pain (CPSP) by network meta-analysis and to provide an evidence-based basis for clinical practice. METHODS: PubMed, Cochrane Library, EMBASE, CNKI, Wanfang, and VIP were searched for clinical randomized controlled studies on noninvasive therapy for CPSP. The retrieval time limit was from the establishment of each database to July 2022. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included randomized controlled trials (RCTs). Stata 14.0 was used for network meta-analysis, and Review Manager 5.3 software was used for traditional meta-analysis. RESULTS: Twelve RCTs involving 8 treatment schemes and 641 patients were finally included. The results of the network meta-analysis showed the following rankings in visual analysis scale (VAS): super laser injury on stellate ganglia (SLI) > transcranial direct current stimulation (tDCS) > music therapy (MT) > repetitive transcranial magnetic stimulation (rTMS) > continuous theta burst stimulation (cTBS) > transcutaneous acupoint electrical stimulation (TAES) > common therapy (CT). The total clinical efficiency ranked as follows: psychological training of mindfulness (PT) > rTMS > CT. Clinical adverse reactions ranked as follows: rTMS > MT > CT > SLI. CONCLUSIONS: Noninvasive complementary therapy can effectively alleviate the pain of CPSP patients, and the efficacy and safety of SLI are relatively significant. However, due to the limitations of this study, the efficacy ranking cannot fully explain the advantages and disadvantages of clinical efficacy. In the future, more multicentre, large sample, double-blind clinical randomized controlled trials are needed to supplement and demonstrate the results of this study.

Comparison of Different Rehabilitation Techniques of Traditional Chinese and Western Medicine in the Treatment of Motor Dysfunction After Stroke Based on Frequency Method: A Network Meta-analysis.

OBJECTIVE: The aim of the study is to evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis. METHODS: CNKI, Wanfang, PubMed, Embase, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials of rehabilitation techniques for poststroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0. RESULTS: Seventy-four randomized controlled trials involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl-Meyer Assessment, Action Research Arm Test, and Berg Balance Scale: biofeedback therapy > mirror therapy > repetitive transcranial magnetic stimulation > acupuncture therapy > transcranial direct current stimulation > Taichi > common therapy, virtual reality > transcranial direct current stimulation > repetitive transcranial magnetic stimulation > mirror therapy > common therapy, and acupuncture therapy > virtual reality > neuromuscular electrical stimulation > mirror therapy > common therapy > transcranial direct current stimulation, respectively. CONCLUSIONS: Biofeedback therapy had the best comprehensive effect, while virtual reality was the best intervention for improving the index of action research arm test and Fugl-Meyer Assessment-lower extremity. Acupuncture therapy improved lower limb balance function.

Efficacy and safety of different antidepressants and anticonvulsants in central poststroke pain: A network meta-analysis and systematic review.

OBJECTIVE: To evaluate the efficacy and safety of different antidepressants and anticonvulsants in the treatment of central poststroke pain (CPSP) by network meta-analysis and provide an evidence-based foundation for clinical practice. METHODS: PubMed, Cochrane Library, EMBASE, CNKI, APA PsycINFO, Wanfang, VIP and other databases were searched by computer to find clinical randomized controlled studies (RCTs) on drug treatment of CPSP. The retrieval time limit was from the establishment of each database to July 2022. The quality of the included RCTs was evaluated using the bias risk assessment tool recommended by Cochrane. Stata 14.0 was used for network meta-analysis. RESULTS: A total of 13 RCTs, 1040 patients and 9 drugs were finally included. The results of the network meta-analysis showed that the effectiveness ranking as rated by the visual analog scale (VAS) was gabapentin > pregabalin > fluoxetine > lamotrigine > duloxetine > serqulin > amitriptyline > carbamazepine > vitamin B. Ranking according to the numerical rating scale (NRS) was pregabalin > gabapentin > carbamazepine. Ranking derived from the Hamilton depression scale (HAMD) was pregabalin > duloxetine > gabapentin > amitriptyline. CONCLUSION: All nine drugs can relieve the pain of CPSP patients to different degrees; among them pregabalin and gabapentin have the most significant effect, and gabapentin and pregabalin also have the most adverse reactions. In the future, more multicenter, large sample, double-blind clinical randomized controlled trials need to be carried out to supplement and demonstrate the results of this study.

Comparison of multiple acupoints combination in the treatment of post-stroke cognitive impairment: A network meta-analysis.

BACKGROUND: To evaluate the efficacy of multiple acupoint combinations for the treatment of post-stroke cognitive impairment (PSCI) using a network meta-analysis method. METHODS: Searches for clinical randomized controlled trials (RCTs) of various types of acupuncture treatments for post-stroke cognitive dysfunction were conducted, data were extracted from studies selected according to the inclusion criteria, and the RCTs included in the analysis were assessed separately for risk of literature bias. Network meta-analysis was performed using Stata 14.0. RESULTS: Sixteen RCTs involving 1257 patients were included, which involved 9 groups of acupoint treatment plans. The best treatment plan for improving the mini-mental state examination score of PSCI was a cephalic plexus spur (99.7%). The best treatment option for improving the montreal cognitive assessment score for PSCI was Zishen Yisui acupuncture therapy (ZSYSA) (77.3%). The best option for improving the barthel index score of PSCI was ZSYSA (99.2%). In terms of improving the overall clinical outcomes of PSCI, the best treatment option for improving the overall clinical effectiveness of PSCI is ZSYSA Therapy (92.2%). CONCLUSION: The analysis of all results shows that ZSYSA can significantly improve PSCI compared to other acupuncture therapies. STRENGTHS AND LIMITATIONS OF THIS STUDY: This is the 1st study on the treatment of PSCI with different acupoint combinations based on a network meta-analysis method, which provides a reference for clinical rehabilitation workers; all included studies were randomized controlled trials, which increased the reliability of this study. Limitations; The number of relevant clinical studies retrieved was too small, and all included clinical trials were located in China; therefore, there is a great possibility of publication bias; Most of the included studies did not clearly explain the random distribution mode, follow-up, distribution concealment, or other experimental conditions. Therefore, selection and reporting biases cannot be excluded, suggesting that the quality of the literature is not high; Because of the strict inclusion criteria, the number of studies was limited, and subgroup analysis could not be performed according to the time of onset and the length of the disease course.

[Research Progress on the Application of Artificial Intelligence in Rehabilitation Medicine in China].

The development of science and technology and the increasing demand of rehabilitation have driven the integration between artificial intelligence and rehabilitation medicine.In this study,statistical methods,document visualization tools,and other analysis methods were used in the Citespace software to analyze China's research status of artificial intelligence in the field of rehabilitation medicine with the key words of co-occurrence,emergence,and clustering.The relevant research hot spots were then classified and expounded.The results demonstrated that the current hot spots of artificial intelligence related to rehabilitation medicine included robots,brain-computer interfaces,human-computer interaction,and motor imagery.According to the clustering of key words and literature analysis,the five themes of artificial intelligence in rehabilitation medicine were determined as robot,brain-computer interface,intelligent rehabilitation training system,human-computer interaction,and assisted diagnosis and remote rehabilitation.Robotics and human-computer interaction would still be the research hot spots in the long future,and brain-computer interfaces,motor imagery,and remote rehabilitation would be new ones.This study analyzed the current hot spots,predicted the development trends,discussed the limitations,and proposed suggestions,aiming to provide reference for other scholars focusing on the application of artificial intelligence in rehabilitation medicine.

The inhibitory effect of Gynostemma pentaphyllum on MCP-1 and type I procollagen expression in rat hepatic stellate cells.

AIM OF THE STUDY: Gynostemma pentaphyllum is a popular folk medicine that has been used for treatment of hepatitis in Asia. Our previous study demonstrates that Gynostemma pentaphyllum n-butanol extract inhibits the onset and improves the recovery of CCl(4)-induced liver fibrogenesis in rats and inhibits PDGF-induced rat hepatic stellate cells (HSCs) proliferation. In this study, the effect of Gynostemma pentaphyllum extract on cytokines and type I procollagen expression was analyzed. MATERIALS AND METHODS: Rat HSCs were treated with PDGF, Gynostemma pentaphyllum n-butanol extract, RP-18-Gyp fraction, rapamycin or vehicle. Rat cytokine antibody array chip or ELISA kit was used for cytokines detection. Intracellular protein expression was detected by Western blotting, mRNA expression was analyzed by RT-PCR. RESULTS: RP-18-Gyp fraction is the more purified gypenosides fraction from Gynostemma pentaphyllum n-butanol extract. In cell proliferation, the inhibitory effect of 200 microg/ml RP-18-Gyp fraction is similar to 500 microg/ml Gynostemma pentaphyllum n-butanol extract. Furthermore, both of them have the ability of decreasing monocyte chemoattractant protein-1 (MCP-1) mRNA expression and protein release and inhibiting type I procollagen protein expression. CONCLUSIONS: Both of Gynostemma pentaphyllum n-butanol extract and its more purified RP-18-Gyp fraction have the biological activities in the inhibition of cell proliferation, MCP-1 release and type I procollagen expression in rat HSCs. These data could provide the evidence to support for the traditional use of Gynostemma pentaphyllum in hepatitis.