Traditional Chinese medicine therapy reduces the risk of total knee replacement in patients with knee osteoarthritis.

Knee osteoarthritis is a degenerative disease occurring in elderly people worldwide. For severe knee osteoarthritis, total knee replacement is the final treatment option. Traditional Chinese medicine (TCM) is popular in Taiwan and has been shown to exert therapeutic effects on knee osteoarthritis. We investigated the long-term clinical effects of TCM for reducing the need for total knee replacement risk in patients with knee osteoarthritis.We used the National Health Insurance Research Database to conduct a retrospective study of patients with knee osteoarthritis between 1997 and 2003 in Taiwan. Data from the date of diagnosis of knee osteoarthritis to total knee replacement were assessed using the Cox regression proportional hazards model, and the Kaplan-Meier survival curve was used to determine the association between total knee replacement risk and TCM use.A total of 34,231 patients with knee osteoarthritis, who were diagnosed by orthopedic or rehabilitation physicians between 1997 and 2003 were included. Patients were categorized into 2 groups: 26,257 (76.7%) were TCM users and 7974 (23.3%) were TCM non-users. The mean follow-up period was 9.26 years. Multivariate regression demonstrated that using TCM may decrease the need for total knee replacement in patients with knee osteoarthritis (adjusted hazards ratio [aHR] = 0.69, 95% confidence interval [95% CI]: 0.64-0.77) compared with TCM non-users. A relationship between longer TCM use and reduced total knee replacement use was observed, especially in patients who used TCM for ≥120 days (aHR = 0.49, 95% CI: 0.42-0.56).The results of this study suggested that TCM is associated with a reduced risk of total knee replacement in patients with knee osteoarthritis, with enhanced benefits from longer durations of TCM use.

Complexity Analysis of Beat-to-Beat Skin-Surface Laser-Doppler Flowmetry Signals in Stroke Patients.

OBJECTIVES: This study performed skin-surface LDF measurements and SampEn analysis with the aims of (i) capturing the temporal complexity of cerebral hemodynamics in stroke patients and (ii) discriminating stroke patients from healthy control subjects. We also investigated the response induced by AS in beat-to-beat SampEn indexes of LDF signals. METHODS: LDF signals were obtained at bilateral TaiYang acupoints in 52 stroke patients. Each assessment involved a 20-minute baseline recording, a 20-minute AS, and a subsequent 20-minute recording. The FDT, FRT, and PW were calculated for each pulse of the LDF signals, and then their SampEn values were calculated. RESULTS: The SampEn values of FRT were significantly larger in the stroke group (1.064 ± 0.052 and p = 0.013 at the stroke side; 1.059 ± 0.055 and p = 0.017 at the controlateral side) than in the control group (0.975 ± 0.120). On the stroke side, the SampEn of value of FRT was significantly decreased following AS (1.064 ± 0.052 to 1.008 ± 0.060; p = 0.027). CONCLUSION: Larger SampEn values of FRT can be partly attributed to the local regulatory activities that are present in the stroke subjects when facing the induced abnormal vascular conditions and blood flow perfusion resistance. The present findings could aid the development of a noninvasive monitoring technique that will enable discrimination of the different microcirculatory responses in stroke patients.

Differences in the beat-to-beat parameters of skin-surface pulsatile laser-Doppler waveforms between stroke and normal subjects.

Walking can help improve the recovery after stroke. The present study used skin-surface laser-Doppler flowmetry (LDF) measurements and beat-to-beat waveform analysis with the aim of discriminating the microcirculatory blood flow (MBF) characteristics in stroke subjects subdivided into two groups according to their walking ability. Five-minute LDF measurements were performed in the following groups: Group A (cannot walk independently; n = 17), Group B (can walk independently; n = 11), and Group C (healthy controls; n = 17). The pulse width (PW) and foot delay time (FDT) and their coefficients of variation (PWCV and FDTCV, respectively) were calculated for the beat-to-beat LDF waveform. The FDT in Group A and the blood-pressure-normalized PW in Group C were significantly longer than the corresponding values in the other groups, and PWCV and FDTCV were significantly larger in Group C than in Group A. To our knowledge this is the first study demonstrating the feasibility of using a beat-to-beat LDF waveform index to discriminate between stroke subjects with different walking abilities and between stroke and normal subjects. It provides a noninvasive and real-time method for discriminating MBF characteristics, and thus could aid the development of an index for the early detection of stroke or for evaluating the recovery condition in stroke patients.

Effects of acupuncture on the harmonic components of the radial arterial blood-pressure waveform in stroke patients.

MOTIVATION: Stroke induces abnormal microcirculatory blood flow perfusion resistance in cerebral vascular beds, which may in turn alter the arterial pulse transmission. This study aimed to determine if the frequency-domain harmonic index for the blood-pressure waveform is useful in monitoring the microcirculatory blood flow perfusion response in cerebral vascular beds of stroke patients following acupuncture stimulation. METHODS: Bilateral radial arterial blood-pressure waveform and laser-Doppler flowmetry signals were obtained noninvasively before and after acupuncture in 17 stroke patients. The amplitude proportion (Cn) for all the acquired pulses and the coefficient of variance (CVn) for harmonics 1-10 were calculated to evaluate the blood-pressure harmonic variability. RESULTS: The laser-Doppler flowmetry parameters showed that the cerebral microvascular blood flow supply could be improved following acupuncture. For the blood pressure waveform harmonic index, there were significant increases in C5 and C6 and decreases in CV5 and CV7 on the stroke-affected side, but no significant changes on the contralateral side. CONCLUSION: Cn values might reflect changes in arterial pulse transmission, and the blood-pressure-harmonic-variability response might be partly attributable to cardiovascular regulatory activities caused by acupuncture-induced changes in the cerebral microvascular blood flow perfusion. The present findings of blood pressure waveform harmonic analysis may be useful to the development of a noninvasive and real-time technique for evaluating treatment efficacy in stroke patients.