Individualized predictions of early isolated distal deep vein thrombosis in patients with acute ischemic stroke: a retrospective study.

BACKGROUND: Although isolated distal deep vein thrombosis (IDDVT) is a clinical complication for acute ischemic stroke (AIS) patients, very few clinicians value it and few methods can predict early IDDVT. This study aimed to establish and validate an individualized predictive nomogram for the risk of early IDDVT in AIS patients. METHODS: This study enrolled 647 consecutive AIS patients who were randomly divided into a training cohort (n = 431) and a validation cohort (n = 216). Based on logistic analyses in training cohort, a nomogram was constructed to predict early IDDVT. The nomogram was then validated using area under the receiver operating characteristic curve (AUROC) and calibration plots. RESULTS: The multivariate logistic regression analysis revealed that age, gender, lower limb paralysis, current pneumonia, atrial fibrillation and malignant tumor were independent risk factors of early IDDVT; these variables were integrated to construct the nomogram. Calibration plots revealed acceptable agreement between the predicted and actual IDDVT probabilities in both the training and validation cohorts. The nomogram had AUROC values of 0.767 (95% CI: 0.742-0.806) and 0.820 (95% CI: 0.762-0.869) in the training and validation cohorts, respectively. Additionally, in the validation cohort, the AUROC of the nomogram was higher than those of the other scores for predicting IDDVT. CONCLUSIONS: The present nomogram provides clinicians with a novel and easy-to-use tool for the prediction of the individualized risk of IDDVT in the early stages of AIS, which would be helpful to initiate imaging examination and interventions timely.

Diagnostic and Categorization Criteria for Palpitations Below the Heart in Traditional Chinese Medicine: A Delphi Consensus Study.

OBJECTIVES: To explore and establish the diagnosis, syndrome classification and syndrome differentiation criteria of palpitations below the heart in traditional Chinese medicine (TCM) in order to lay a foundation for the clinical diagnosis, treatment and research of palpitations below the heart. METHODS: In the early stage of this study, we searched the literature related to palpitations below the heart in TCM in domestic and foreign databases, analyzed the results and developed an expert consultation questionnaire. Using the Delphi method, a survey was conducted by 19 expert TCM practitioners. The survey results were statistically analyzed, aggregated and categorized to create the next round of questionnaires, and the process was repeated was repeated for a total of 4 rounds of expert opinions and until a consensus was achieved. Finally, the questionnaire items were classified into the main diagnosis (primary disease) and secondary diagnosis (secondary disease) for each syndrome. RESULTS: This study was completed ahead of schedule after 2 rounds of expert questionnaire surveys. A total of 19 exceptional TCM experts from all over China reached a consensus on 1 diagnostic standard and 4 syndrome types. The main diagnoses of palpitations below the heart included "conscious sub cardiac epigastric beating," "throbbing at the lower part of the heart" and "palpitation rhythm consistent with the pulse and obvious pulsation in the heart area," while the secondary diagnosis was "palpitation obvious after nervous tension, fatigue, drinking water or changing body position." Based on the balance of TCM Yin (negative, dark, feminine) and Yang (positive, bright, masculine) energy, TCM syndrome differentiation (Bian Zheng - the comprehensive analysis of clinical information obtained from the 4 main diagnostic TCM procedures: observation, listening, questioning, and pulse analysis, that is used to guide the choice of treatment by acupuncture and/or TCM) of palpitations below the heart are differentiated as heart yang deficiency syndrome, middle yang deficiency syndrome, kidney yang deficiency syndrome and phlegm drink syndrome, and the main and secondary syndromes of each are established. In the consultation process, the expert opinions were highly correlated, questionnaire reliability was strong and the results were credible. CONCLUSIONS: The criteria proposed in this study do not claim to be the best or the most accurate, but they do provide some guidelines for practitioners, a basis for clinical differentiation and treatment with TCM and a basis for further randomized controlled trials in the future. Further research is needed in order to reach a consensus regarding TCM treatment of palpitations below the heart.

An NMR-Based Metabolomic Approach to Unravel the Preventive Effect of Water-Soluble Extract from Dendrobium officinale Kimura & Migo on Streptozotocin-Induced Diabetes in Mice.

Dendrobium officinale Kimura & Migo (D. officinale) is a precious herbal medicine. In this study, we investigated metabolic mechanism underlying the effect of D. officinale water extract (DOWE) on diabetes prevention in mice after streptozotocin (STZ) exposure using NMR-based metabolomics. Interestingly, we found a decrease in blood glucose and an increase in liver glycogen in mice pretreated with DOWE after STZ exposure. The DOWE pretreatment significantly increased citrate and glutamine in the serum as well as creatine, alanine, leucine, isoleucine, valine, glutamine, glutathione and taurine in the liver of STZ-treated mice. Furthermore, serum glucose was significantly negatively correlated with citrate, pyruvate, alanine, isoleucine, histidine and glutamine in the serum as well as alanine and taurine in the liver. These findings suggest that the effect of DOWE on diabetes prevention may be linked to increases in liver glycogen and taurine as well as the up-regulation of energy and amino acid metabolism.

Trends of burning mouth syndrome: a bibliometric study.

Objectives: This study utilizes bibliometric analysis to map the current research landscape and forecast emerging trends within the domain of Burning Mouth Syndrome (BMS). Materials and methods: A comprehensive review of literature related to BMS was conducted, drawing from the Web of Science Core Collection (WoSCC) from 2008 to 2023. The analysis included both publication types "Article" and "Review Article." Advanced quantitative techniques and visual analytics tools, including CiteSpace, VOSviewer, Tableau, and the Map Equation online platform were utilized to analyze the academic publications within this domain. Results: Our analysis incorporated 497 articles on BMS. The data exhibit a progressive increase in the annual volume of publications from 2008 to 2023. In terms of geographic and institutional contributions, the United States of America (with 80 publications) and Nihon University (with 26 publications) emerged as leading entities in BMS research, while the Netherlands and England were identified as central to international collaboration efforts. Prominent researchers in this field include Adamo Daniela (18 publications) and Sun Andy (16 publications). Furthermore, the most cited works were authored by Jääskeläinen SK. An examination of the journals in which these articles were published showed a dominance of dental journals, highlighting significant interest and research efforts in BMS within the dental research community. Conclusion: The steady growth in BMS research signifies the formation of a robust core of researchers and demonstrates the maturation of the field. Despite this progress, the findings highlight a notable deficiency in cross-institutional and cross-regional collaborative efforts. Keyword cluster analysis has revealed "management" as a persistently relevant theme, with "pain modulation" emerging as the current focal interest. Additionally, "blood profile," "pernicious anemia," and "folate" have been identified as prospective areas of growing interest, suggesting important directions for future investigations. Clinical relevance: This bibliometric analysis reveals the research landscape of BMS, aiming to highlight potential collaborative opportunities and define future research directions. These insights are invaluable for guiding subsequent investigations and carving new paths in the exploration of BMS.

A bibliometric analysis of international publication trends in brain atrophy research (2008-2023).

Background: Brain atrophy is a type of neurological and psychiatric disorder characterized by a decrease in brain tissue volume and weight for various reasons and can have a serious impact on the quality of life of patients. Although there are many studies on brain atrophy, there is a lack of relevant bibliometric studies. Therefore, this study aims to provide a visual analysis of global trends in brain atrophy research over the past 16 years. Methods: CiteSpace and VOSviewer were used to visually analyze publication output, scientific collaborations, cocitations, publishing journals, and keywords to determine the current status and future trends of brain atrophy research. Materials published from 2008 to 2023 were collected from the Web of Science Core Collection (WoSCC) database. This study placed no restrictions on the types of literature and focused on English language publications. Results: A total of 3,371 publications were included in the analysis. From 2008 to 2023, the number of publications increased annually. In terms of national and academic institutions, universities in the United States and University College London rank first in publication out. Barkhof Frederik and Zivadinov Robert are the most prolific researchers in this field. The publication with the highest cocitation strength is "Deep gray matter volume loss drives disability worsening in multiple sclerosis." Keyword clustering analysis showed that "Alzheimer's disease" and "multiple sclerosis" are current popular topics. The analysis of emergent words indicates that "cerebral small vessel disease," "neurodegeneration," and "cortex/gray matter volume" may become hot research topics in the coming years. Conclusion: This study analyses papers on brain atrophy from the past 16 years, providing a new perspective for research in this field. In the past 16 years, research on brain atrophy has received increasing attention. The quality of articles in this field is generally high. Extensive national cooperation already exists. The statistical results indicate that a stable core author group in the field of brain atrophy has almost formed.

Proposing an intelligent technique based on radial basis function neural network to forecast the energy spectrum of diagnostic X-ray imaging systems.

In digital subtraction angiography (digital subtraction total cerebral angiography), cardiac and macrovascular cardiography, anorectal radiology, fluoroscopy, and computed tomography (CT), a prior knowledge to X-ray energy spectrum is crucial for assessing the image quality and also calculating patient X-ray dosage. The present investigation's main objective is to propose an intelligent technique for faster calculating X-ray energy spectrum of medical imaging systems with different exposure settings of tube voltage, filter material, and thickness based on limited specific spectra. In this study, Monte Carlo N Particle (MCNP) simulation code was initially used to generate some limited X-ray spectra for tube voltages of 20, 30, 40, 50, 80, 100, 130, and 150 kV for two different filters of beryllium and aluminum with thicknesses of 0. 4, 0.8, 1.2, 1.6 and 2 mm. Tube voltage, type, and thickness of filter were used as the 3 inputs of 150 Radial Basis Function Neural Network (RBFNN) to forecast point by point of the X-ray spectrum. After training, the RBFNNs could forecast most of the X-ray spectra for tube voltages in the range of 20-150 kV and two various filters of aluminum and beryllium with thicknesses in the range of 0-2 mm.

Caveolin-1 regulates nitric oxide-mediated matrix metalloproteinases activity and blood-brain barrier permeability in focal cerebral ischemia and reperfusion injury.

The roles of caveolin-1 (cav-1) in regulating blood-brain barrier (BBB) permeability are unclear yet. We previously reported that cav-1 was down-regulated and the production of nitric oxide (NO) induced the loss of cav-1 in focal cerebral ischemia and reperfusion injury. The present study aims to address whether the loss of cav-1 impacts on BBB permeability and matrix metalloproteinases (MMPs) activity during cerebral ischemia-reperfusion injury. We found that focal cerebral ischemia-reperfusion down-regulated the expression of cav-1 in isolated cortex microvessels, hippocampus, and cortex of ischemic brain. The down-regulation of cav-1 was correlated with the increased MMP-2 and -9 activities, decreased tight junction (TJ) protein zonula occludens (ZO)-1 expression and enhanced BBB permeability. Treatment of N(G) -nitro-L-arginine methyl ester [L-NAME, a non-selective nitric oxide synthase (NOS) inhibitor] reserved the expression of cav-1, inhibited MMPs activity, and reduced BBB permeability. To elucidate the roles of cav-1 in regulating MMPs and BBB permeability, we used two approaches including cav-1 knockdown in cultured brain microvascular endothelial cells (BMECs) in vitro and cav-1 knockout (KO) mice in vivo. Cav-1 knockdown remarkably increased MMPs activity in BMECs. Meanwhile, with focal cerebral ischemia-reperfusion, cav-1 deficiency mice displayed higher MMPs activities and BBB permeability than wild-type mice. Interestingly, the effects of L-NAME on MMPs activity and BBB permeability was partly reversed in cav-1 deficiency mice. These results, when taken together, suggest that cav-1 plays important roles in regulating MMPs activity and BBB permeability in focal cerebral ischemia and reperfusion injury. The effects of L-NAME on MMPs activity and BBB permeability are partly mediated by preservation of cav-1.

Metabolomics-based study of the potential interventional effects of Xiao-Xu-Ming Decoction on cerebral ischemia/reperfusion rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Xiao-Xu-Ming Decoction (XXMD) is a classical Chinese medicinal compound for the treatment of ischemic stroke, which has good efficacy in clinical studies and also plays a neuroprotective role in pharmacological studies. AIM OF THE STUDY: The purpose of this study is to investigate the potential and integral interventional effects of XXMD on cerebral ischemia/reperfusion rat model. MATERIALS AND METHODS: In this study, 1H NMR metabolomics was used, combined with neurological functional assessments, cerebral infarct area measurements, and pathological staining including Nissl staining, immunofluorescence staining of NeuN and TUNEL, and immunohistochemical staining of MCT2, to analyze the metabolic effects of XXMD in the treatment of an ischemia/reperfusion rat model. RESULTS: It's observed that XXMD treatment could improve the neurological deficit scores and reduce the cerebral infarct areas on cerebral ischemia/reperfusion rat model. The pathological staining results performed that XXMD treatment could improve the decrease of Nissl bodies and the expression of NeuN and MCT2, reduce the high expression of TUNEL. In 1H NMR study, it revealed that the metabolic patterns among three experimental groups were different, the level of lactate, acetate, NAA, glutamate, and GABA were improved to varying degrees in different brain area. CONCLUSION: Our findings indicated that XXMD has positive effect on neuroprotection and improvement of metabolism targeting cerebral ischemic injury in rats, which showed great potential for ischemic stroke.

Correlation between Palpitations below the Heart in Traditional Chinese Medicine and Autonomic Nerve Function Based on Heart Rate Variability: A Case-Control Study.

OBJECTIVE: To explore the autonomic nerve rhythm and the correlation between palpitations below the heart (PBTH) and autonomic nerve function in patients with PBTH based on heart rate variability (HRV). METHODS: The outpatients or ward patients of Wenzhou Hospital of Traditional Chinese Medicine were collected and divided into two groups: the PBTH group and the normal group. The HRV of each group was detected. Single-factor statistical methods, Spearman correlation analysis, and logistic regression were used to describe and analyze the rhythm and characteristics of autonomic nerves in patients with PBTH and the correlation between PBTH and autonomic nerve function. RESULTS: (1) In the comparison of HRV in different time periods in the same group, the SDNN, RMSSD, pNN50, TP, and HF in the PBTH group at night were significantly higher than those in the daytime (P < 0.01), while the LF/HF ratio was significantly lower than that in the daytime (P < 0.01). (2) In the comparison of HRV between the two groups in the same time period, the RMSSD and pNN50 of the PBTH group during the daytime period were significantly higher than those of the normal control group (P < 0.05), and the LF/HF was significantly lower than that of the normal group (P < 0.05). (3) In the Spearman correlation analysis, PBTH was significantly correlated with RMSSD, pNN50, and LF/HF ratio in the daytime period, with correlation coefficients of 0.424, 0.462, and -0.524, respectively (P < 0.05). (4) Logistic regression analysis showed that the decrease of LF/HF ratio during the daytime period was an independent risk factor for PBTH in TCM (OR = 0.474, 95% CI: 0.230-0.977, P < 0.05). CONCLUSIONS: The changes in parasympathetic nerve function in patients with PBTH have a circadian rhythm, which is characterized by increased activity during the nighttime. At the same time, the autonomic nerve activity of people with PBTH during the daytime is unbalanced, and the decrease of LF/HF ratio during the day is an independent high risk factor for PBTH.

Neuroprotective Effect of Astragaloside IV on Cerebral Ischemia/Reperfusion Injury Rats Through Sirt1/Mapt Pathway.

Background: Ischemic stroke is a common disease with poor prognosis, which has become one of the leading causes of morbidity and mortality worldwide. Astragaloside IV (AS-IV) is the main bioactive ingredient of Astragali Radix (which has been used for ischemic stroke for thousands of years) and has been found to have multiple bioactivities in the nervous system. In the present study, we aimed to explore the neuroprotective effects of AS-IV in rats with cerebral ischemia/reperfusion (CIR) injury targeting the Sirt1/Mapt pathway. Methods: Sprague-Dawley rats (male, 250-280 g) were randomly divided into the Sham group, middle cerebral artery occlusion/reperfusion (MCAO/R) group, AS-IV group, MCAO/R + EX527 (SIRT1-specific inhibitor) group, and AS-IV + EX527 group. Each group was further assigned into several subgroups according to ischemic time (6 h, 1 d, 3 d, and 7 days). The CIR injury was induced in MCAO/R group, AS-IV group, MCAO/R + EX527 group, and AS-IV + EX527 group by MCAO surgery in accordance with the modified Zea Longa criteria. Modified Neurological Severity Scores (mNSS) were used to evaluate the neurological deficits; TTC (2,3,5-triphenyltetrazolium chloride) staining was used to detect cerebral infarction area; Western Blot was used to assess the protein levels of SIRT1, acetylated MAPT (ac-MAPT), phosphorylated MAPT (p-MAPT), and total MAPT (t-MAPT); Real-time Quantitative Polymerase Chain Reaction (qRT-PCR) was used in the detection of Sirt1 and Mapt transcriptions. Results: Compared with the MCAO/R group, AS-IV can significantly improve the neurological dysfunction (p < 0.05), reduce the infarction area (p < 0.05), raise the expression of SIRT1 (p < 0.05), and alleviate the abnormal hyperacetylation and hyperphosphorylation of MAPT (p < 0.05). While compared with the AS-IV group, AS-IV + EX527 group showed higher mNSS scores (p < 0.05), more severe cerebral infarction (p < 0.05), lower SIRT1 expression (p < 0.01), and higher ac-MAPT and p-MAPT levels (p < 0.05). Conclusion: AS-IV can improve the neurological deficit after CIR injury in rats and reduce the cerebral infarction area, which exerts neuroprotective effects probably through the Sirt1/Mapt pathway.

Efficacy of Getong Tongluo Capsule () for Convalescent-Phase of Ischemic Stroke and Primary Hypertension: A Multicenter, Randomized, Double-Blind, Controlled Trial.

OBJECTIVE: To evaluate whether the efficacy of Getong Tongluo Capsule (, GTC, consisted of total flavone of Radix Puerariae) on improving patients' quality of life and lowering blood pressure are superior to the extract of Ginkgo biloba (EGB) for patients with convalescent-phase ischemic stroke and primary hypertension. METHODS: This randomized, positive-drug- and placebo-controlled, double-blind trial was conducted from September 2015 to October 2017. Totally 477 eligible patients from 18 hospitals in China were randomly assigned in a 2:1:1 ratio to the following interventions, twice a day for 12 weeks: (1) GTC 250 mg plus EGB-matching placebo 40 mg (237 cases, GTC group), (2) EGB 40 mg plus GTC-matching placebo 250 mg (120 cases, EGB group) or (3) GTC-matching placebo 250 mg plus EGB-matching placebo 40 mg (120 cases, placebo group). Moreover, all patients were orally administered aspirin enteric-coated tablets 100 mg, once a day for 12 weeks. The primary outcome was the Barthel Index (BI). The secondary outcomes included the control rate of blood pressure and National Institutes of Health Stroke Scale (NIHSS) scores. The incidence and severity of adverse events (AEs) were calculated and assessed. RESULTS: The BI relative independence rates, the clinical recovery rates of NIHSS, and the total effective rates of NIHSS in the GTC and EGB groups were significantly higher than the placebo group at 12 weeks after treatment (P<0.05), and no statistical significance was found between the GTC and EGB groups (P>0.05). The control rate of blood pressure in the GTC group was significantly higher than the EGB and placebo groups at 12, 18 and 24 weeks after treatment (P<0.01). There were no statistically significant differences in the incidences of AEs, adverse drug reactions, or serious AEs among the 3 groups (P>0.05). CONCLUSION: GTC exhibited significant efficacy in improving patients' quality of life as well as neurological function and controlling hypertension. (Registration No. ChiCTR1800016667).

Mechanism of action of Panax notoginoside against lung cancer in mice based on response to CTSB gene.

BACKGROUND: This study aimed to investigate the mechanism of action of Panax notoginoside (PNS) against lung cancer and inhibition of lung cancer cell proliferation by the drug at different concentrations in a mouse model, considering the cathepsin B (CTSB) gene as a target. METHODS: The mice were randomly assigned into the following five groups: normal control, tumor-bearing, low-dose Panax notoginoside (TSPN), medium-dose TSPN, and high-dose TSPN. All mice were treated with physiological saline or TSPN at different concentrations for 28 days consecutively by gavage. The tumor size was measured, the tumor growth was observed, and the survival curve was drawn. At different time points, the expression of the CTSB gene was detected using quantitative fluorescent polymerase chain reaction, Western blot analysis, and indirect immunofluorescence. The serum indices, such as carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and Soluble fragment of cytokeratin 19 (CYFRA21), were detected by enzyme-linked immunosorbent assay. RESULTS: In vivo, PNS could directly inhibit the expression of the CTSB gene in tumors of mice, limit tumor growth, and alter tumor-related indices, such as CEA, NSE, and CYFRA21 levels, in the serum to different extents simultaneously. CONCLUSION: CTSB gene was closely related to the pathogenesis of lung cancer. PNS could act on the CTSB gene, downregulate the expression of CTSB in lung cancer cells, inhibit the proliferation and invasion of tumors, and prolong the survival period.

Assessment of effect of Zhu-tan Tong-luo decoction on CYP450 isoforms activity of rats.

In order to investigate the effects of Zhu-tan Tong-luo decoction on the metabolic capacity of cytochrome P450 (CYP) enzymes, a cocktail method was employed to evaluate the activities of CYP2B6, CYP2C19, CYP1A2, CYP3A4, CYP2C9, CYP2D6. The rats were randomly divided into acute Zhu-Tan Tong-Luo decoction group (Low, High), chronic Zhu-Tan Tong-Luo decoction group (Low, High) and control group. The acute group rats were given 0.6, 1.2 g/kg (Low, High) Zhu-tan Tong-luo decoction by intragastric administration for 1 day, and the chronic group for 14 days. Six probe drugs bupropion, omeprazole, phenacetin, testosterone, tolbutamide, and metroprolol were given to rats through intragastric administration, and the plasma concentrations were determined by UPLC-MS/MS. There statistical pharmacokinetics differences for omeprazole, phenacetin, testosterone, tolbutamide, and metroprolol in rats were observed by comparing acute Zhu-tan Tong-luo decoction group with control group; and statistical pharmacokinetics differences for bupropion, omeprazole, phenacetin, testosterone, tolbutamide, and metroprolol were observed by comparing chronic Zhu-Tan Tong-Luo decoction group with control group. After intragastric administration of Zhu-Tan Tong-Luo decoction may slightly induce the activities of CYP2B6, CYP2C19, CYP1A2, CYP3A4, CYP2C9, CYP2D6 of rats. Induction of drug metabolizing enzyme by Zhu-Tan Tong-Luo decoction would reduce the efficacy of other drug. Additional, there no statistical difference for biochemical results after 1 or 14 intragastric administration of Zhu-Tan Tong-Luo decoction.

Clinical efficacy and sEMG analysis of a new traditional Chinese medicine therapy in the treatment of spasticity following apoplectic hemiparalysis.

To investigate the clinical effect and surface electromyography (sEMG) of rehabilitation exercise therapy in combination with total glucosides form Shaoyao Gancao decoction in treating spasticity after apoplectic hemiparalysis. Composite spasticity scale (CSS), Fugl-Meyer assessment (FMA) and modified Barthel index were compared between the exercise only group and the combined therapy group before and 1 month after the treatment to scale muscular tension, function and activities of daily living. Meanwhile, integrate EMG and root mean square (RMS) were used to detect the tension of upper limbs (biceps brachii) and ankles (tibialis anterior muscle and gastrocnemius) after the 1-month treatment. In the combined therapy group, the Ashworth and CSS scales were significantly improved compared to before the treatment (P < 0.05) and compared to the patients in the control group (P < 0.05). After the 1-month treatment, the combined therapy group showed significantly higher FMA and BI scores (P < 0.05) compared to the control group. For the combined therapy group, the sEMG was significantly improved at 1 month after the treatment (P < 0.05), while the control group only showed relatively slight improvement in the RMS of the tibialis anterior muscle and the gastrocnemius. The total glucosides form Shaoyao Gancao decoction could significantly improve the efficacy of the rehabilitation exercise therapy in the treatment of spasticity after apoplectic hemiparalysis, and its mechanism might involve the decrease of muscular tension.

Xiaoxuming decoction for acute ischemic stroke: a systematic review and meta-analysis.

ETHNOPHARMACOLOGICAL RELEVANCE: Xiaoxuming decoction (XXMD) is a well-known traditional Chinese herbal prescription in treatment of patients with stroke. The objective of this study is to assess the efficacy and safety of XXMD for acute ischemic stroke. MATERIALS AND METHODS: A systematic literature search was conducted in 6 databases until June 2012 to identify randomized controlled trials (RCTs) of XXMD for acute ischemic stroke compared with western conventional medicine (WCM). The primary outcome measures were National Institutes of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores. The secondary outcome measures were the clinical effective rate and adverse events at the end of treatment course. The methodological quality of RCTs was assessed independently using 12-item criteria according to the Cochrane Back Review Group. All data were analyzed using Review Manager 5.0 software. RESULTS: Eight RCTs with 601 individuals published from 1992 to 2012 were identified. The studies were deemed to have a high risk of bias. Compared with WCM, 1 RCT showed significant effects of XXMD for improving mRS after stroke (p<0.05); 3 RCTs for improving NIHSS scores [n=186, weighted mean difference (WMD): -1.86, 95% CI: -3.25 to -0.48, z=2.63, p<0.01]; 7 RCTs for improving the clinical effective rate [n=531, risk ratio (RR)=1.17, 95% CI, 1.09 to 1.26, z=4.38, p<0.01]. Five trials contained safety assessments and stated that no adverse event was found, whereas the other 3 trials did not provide the information about adverse events. CONCLUSIONS: This systematic review showed positive but weak evidence of XXMD for acute ischemic stroke because of the poor methodological quality and the small quantity of the included trials. The difficulties of fitting Chinese herbal medicine (CHM) into the double blinded RCTs have raised as follows: (A) traditional Chinese medicine (TCM) as whole systems of healthcare offers unique methodological and theoretical challenges for RCTs; (B) suspicions against the placebo and unwillingness to stop taking other CHMs make recruitment more difficulty, time-consumption, and cost; (C) the shortcomings of the TCM diagnostic process includes the lack of standardization in terminology, disagreement of pattern differentiation (Bianzheng), and neglect of formula corresponding to syndrome (TCM Zheng); (D) It is difficult to design credible herbal placebos with similar appearance, smells and tastes to the experimental CHM and at the same time is absent of any pharmacological activity; (E) the achieving efficacy of CHM complex interventions is often nonspecific and the outcome measures is subjective using Chinese quantitative instrument.

[Electroacupuncture for post-stroke urinary incontinence: a multi-center randomized controlled study].

OBJECTIVE: To evaluate the clinical efficacy of electroacupuncture(EA) for apoplectic urinary incontinence. METHODS: Two hundred and four cases of apoplectic urinary incontinence were randomized into an EA group (136 cases) and an indwelling catheter group (68 cases). The EA was applied at Qugu (CV 2), Zhongji (CV 3), Shuidao (ST 28), Qihai (CV 6) and Guanyuan (CV 4), etc. in the EA group,5 times a week. Indwelling catheter was applied in the indwelling catheter group at intervals of 2-4 hours, and periodic bladder irrigation along with bladder rehabilitation training were also given. The efficacies were evaluated after 4 weeks of treatment. Before and after treatment, the urination diary (including the interval of urination, nocturia frequency, urination difficulty, urinary incontinence severity), bladder capacity, patients' satisfaction of the two groups were observed and the efficacy was evaluated. RESULTS: The total effective rate was 96.2% (125/130) in the EA group, which was apparently superior to 87.5% (56/64) in the indwelling catheter group (P < 0.05); except for nocturia frequency in the indwelling catheter group, the total score and the subitem score in the urination diary were all improved significantly after treatment in both groups (all P < 0.001), which were more obvious in the EA group (P < 0.001, P < 0.05); the patients' satisfaction and bladder capacity were all improved significantly after treatment in both groups (all P < 0.001), which were more obvious in the EA group (both P < 0.001). CONCLUSION: The EA has an obvious effect for apoplectic urinary incontinence in urinary incontinence alleviation and bladder capacity increase, which has better efficacy than indwelling catheter therapy.