This paper introduces FU Wenbin's clinical experience in treatment of post-stroke depression with holistic therapy of acupuncture and moxibusiton for Shugan Tiaoshen (soothing the liver and regulating the mind). In pathogenesis, post-stroke depression is associated with the loss of the mind control and the failure of the liver in maintaining the free flow of qi. In treating principle, soothing the liver qi and regulating the mind are equally important, and the holistic regulation is applicable with the combination of multiple therapies. During treatment, the four-gate points are stimulated at first to promote liver qi flowing, the acupoints of the conception vessel and the governor vessel (e.g. Zhongwan [CV12], Guanyuan [CV4], Baihui [GV20], Yintang [GV24⁺]) are combined to regulate the mind and regain the consciousness. The conditions of illness are differentiated in terms of excess and deficiency, and the point prescription is modified accordingly. Refined moxibustion is applied specially at Fengchi (GB20), Fengfu (GV16) and Wangu (GB12) to warm meridians, strengthen yang and nourish the mind. In the last step of treatment, shallow needling techniques, such as the pricking and bloodletting, intradermal needling and auricular acupuncture, are used to consolidate the curative effect.
Humans ; Acupuncture Therapy ; Depression/etiology* ; Stroke/psychology* ; Female ; Male ; Middle Aged ; Acupuncture Points ; Moxibustion ; Aged ; Adult

Based on his extensive clinical experience and the team's mechanistic research, Professor XU Nenggui has proposed the academic concept that "the governor vessel governs the brain and treats cerebral viscus diseases", and established a novel acupuncture approach for encephalopathy treatment centered on the integrated theory of "governor vessel-brain-mind", and developed a staged acupuncture protocol of "governor vessel regulating spirit" for ischemic stroke. This article introduces the academic features of this method in treating post-stroke dysphagia from four aspects: theoretical framework, treatment principles and point selection, mechanistic research, and clinical case studies. In clinical application, the method emphasizes syndrome differentiation based on meridians, harmonization between the conception and governor vessels; precise acupoint selection to treat both form and spirit; stage-specific differentiation with targeted needling. Furthermore, Professor XU integrates basic research with clinical practice, focusing on the neurobiological mechanisms underlying the efficacy of acupuncture in treating post-stroke dysphagia.
Acupuncture Therapy/methods* ; Humans ; Deglutition Disorders/psychology* ; Stroke/complications* ; Meridians ; Acupuncture Points

There is a growing interest in the use of music therapy in neurological rehabilitation. Of all the major neurological illnesses, stroke rehabilitation has been observed to have some of the strongest potential for music therapy's beneficial effect. The current burden of stroke has raised the need to embrace novel, cost-effective, rehabilitation designs that will enhance the existing physical, occupation, and speech therapies. Music therapy addresses a broad spectrum of motor, speech, and cognitive deficits, as well as behavioral and emotional issues. Several music therapy designs have focused on gait, cognitive, and speech rehabilitation, but most of the existing randomized controlled trials based on these interventions have a high risk of bias and are statistically insignificant. More randomized controlled trials with greater number of participants are required to strengthen the current data. Fostering an open and informed dialogue between patients, healthcare providers, and music therapists may help increase quality of life, dispel fallacies, and guide patients to specific musical interventions.
Humans ; Music/psychology* ; Music Therapy ; Quality of Life/psychology* ; Stroke/therapy* ; Stroke Rehabilitation

OBJECTIVE: To compare the clinical effect of Tongdu Xingshen (promoting the governor vessel and regaining consciousness) acupuncture and moxibustion combined with cognitive training and the simple cognitive training for post-stroke mild cognitive impairment (PSMCI). METHODS: Eighty-four patients with PSMCI were randomly divided into an observation group and a control group, with 42 cases in each group (3 cases in the observation group and 2 cases in the control group dropped off). The observation group was treated by Tongdu Xingshen acupuncture and moxibustion combined with cognitive training, acupuncture was given at Baihui (GV 20), Sishencong (EX-HN 1), Shenting (GV 24), etc., and moxibustion was given at Shenting (GV 24) , Baihui (GV 20), Shendao (GV 11), Fengfu (GV 16) and Xinshu (BL 15). The control group was only given cognitive training. All the above treatment was given once a day, 5 times a week, for 4 consecutive weeks. The scores of Montreal cognitive assessment (MoCA), mini-mental state examination (MMSE), activity of daily living (ADL) and stroke-specific quality of life (SS-QOL) were compared between the two groups before treatment, after treatment, 4 weeks and 12 weeks after treatment. RESULTS: After treatment, 4 weeks and 12 weeks after treatment, the MoCA, MMSE and SS-QOL scores of the two groups were all higher than those before treatment (P<0.05), and the ADL scores were lower than those before treatment (P<0.05). In the observation group, the MoCA and MMSE scores were higher than those of the control group after treatment, 4 weeks and 12 weeks after treatment (P<0.05), and the SS-QOL score was higher than that of the control group 12 weeks after treatment (P<0.05). CONCLUSION Both Tongdu Xingshen acupuncture and moxibustion combined with cognitive training and simple cognitive training can improve cognitive function, daily living ability and quality of life in patients with PSMCI, and the combined therapy is superior to simple cognitive training in improving cognitive function and long-term quality of life in patients with PSMCI.
Acupuncture Points ; Acupuncture Therapy ; Cognition ; Cognitive Dysfunction/therapy* ; Humans ; Moxibustion ; Quality of Life ; Stroke/psychology* ; Treatment Outcome

OBJECTIVE: To observe the curative effect of Shugan Tiaoshen (soothing liver and regulating mind) acupuncture combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of post-stroke depression (PSD), and to explore its mechanism. METHODS: Ninety patients of PSD were randomly divided into an acupuncture+rTMS combination group (30 cases), a rTMS combination group (30 cases, 1 case dropped off) and a western medication group (30 cases, 1 case dropped off). The western medication group was treated with escitalopram oxalate tablets, 10 mg orally each time, once a day; on the basis of the treatment in the western medication group, the rTMS combination group was additionally given rTMS, and the frequency was 20 Hz, 20 min each time, once a day, 5 times a week; on the basis of the treatment in the rTMS combination group, the acupuncture+rTMS combination group was additionally treated with Shugan Tiaoshen acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Yintang (GV 24⁺), Shenting (GV 24), etc. for 40 min each time, once a day, weekly 5 times, and each group was treated for 4 weeks. Before and after treatment, the scores of Hamilton depression scale-17 (HAMD-17), Montreal cognitive assessment scale (MoCA), Pittsburgh sleep quality index (PSQI) were observed, and serum levels of 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were detected in each group. RESULTS: After treatment, the HAMD-17 scores in the three groups were lower than those before treatment (P<0.01), and the PSQI scores in the acupuncture+rTMS combination group and the rTMS combination group were lower than those before treatment (P<0.01); the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were lower than those in the western medication group (P<0.05), and the PSQI score in the acupuncture+rTMS combination group was lower than that in the rTMS combination group (P<0.05). After treatment, the MoCA scores and serum BDNF levels in the acupuncture+rTMS combination group and the rTMS combination group were higher than those before treatment (P<0.01), and the serum 5-HT levels in the three groups were higher than those before treatment (P<0.01); and the above indexes in the acupuncture+rTMS combination group and the rTMS combination group were higher than those in the western medication group (P<0.05), and which in the acupuncture+rTMS combination group were higher than those in the rTMS combination group (P<0.05). CONCLUSION On the basis of western medication escitalopram oxalate, the addition of Shugan Tiaoshen acupuncture combined with rTMS therapy can effectively improve cognitive function and sleep quality in patients with PSD, and the effect is better than that of western medication alone or rTMS combined with western medication. Its mechanism of action may be related to the increase of peripheral serum 5-HT and BDNF levels.
Humans ; Transcranial Magnetic Stimulation ; Brain-Derived Neurotrophic Factor ; Depression/therapy* ; Serotonin ; Treatment Outcome ; Acupuncture Therapy ; Stroke/psychology*

PURPOSE: This study aimed to elucidate which echocardiographic criteria at three time points, for cardiac resynchronization therapy (CRT) response, are accurate in discriminating the hierarchical clinical composite end point (HCCEP). MATERIALS AND METHODS: We included 120 patients (age, 66.1±12.6 years; men, 54.2%) who underwent CRT implantation for heart failure (HF). Echocardiography was performed before and at 3, 6, and 12 months after CRT implantation. The 1-year HCCEP included all-cause mortality, hospitalization for HF, and New York Heart Association functional class for 12 months. CRT response criteria were decrease in left ventricular (LV) end-systolic volume (LVESV) >15%, decrease in LV end-diastolic volume >15%, absolute increase in LV ejection fraction (LVEF) ≥5%, relative increase in LVEF ≥15%, and decrease in mitral regurgitation ≥1 grade. Temporal changes in CRT response rates, accuracy of CRT response criteria at each time and cutoff value for the discrimination of improvement in HCCEP, and agreements with improvement in HCCEP were analyzed. RESULTS: HCCEP improvement rates were 65.8% in total group. In nonischemic group, CRT response rates according to all echocardiographic criteria significantly increased with time. In ischemic group, CRT response rate did not significantly change with time. In total group, ΔLVESV at 6 months (ΔLVESV6) had the most significant accuracy for the discrimination of HCCEP (area under the curve=0.781). The optimal cutoff value of ΔLVESV6 was 13.5% (sensitivity=0.719, specificity=0.719). ΔLVESV6 had fair agreement with HCCEP (κ=0.391, p < 0.001). CONCLUSION: ΔLVESV6 is the most useful echocardiographic CRT response criterion for the prediction of 1-year HCCEP.
Cardiac Resynchronization Therapy* ; Discrimination (Psychology) ; Echocardiography ; Heart ; Heart Failure ; Hospitalization ; Humans ; Male ; Mitral Valve Insufficiency ; Mortality ; Stroke Volume*

BACKGROUND AND OBJECTIVES: A risk prediction is needed even in the contemporary era of acute myocardial infarction (AMI). We sought to develop a risk scoring specific for patients with AMI being treated with guideline-adherent optimal therapies, including percutaneous coronary intervention and all 5 medications (aspirin, thienopyridine, β-blocker, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statin). METHODS: From registries, 12,174 AMI patients were evaluated. The primary outcome was 1-year all-cause death or AMI. The Korea Working Group in Myocardial Infarction (KorMI) system was compared with the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX AMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC), and Global Registry of Acute Coronary Events scores (GRACE) models. RESULTS: Ten predictors were identified: left ventricular dysfunction (hazard ratio [HR], 2.3), bare-metal stent (HR, 2.0), Killip class ≥II (HR, 1.9), renal insufficiency (HR, 1.8), previous stroke (HR, 1.6), regional wall-motion- score >20 on echocardiography (HR, 1.5), body mass index ≤24 kg/m2 (HR, 1.4), age ≥70 years (HR, 1.4), prior coronary heart disease (HR, 1.4), and diabetes (HR, 1.4). Compared with the previous models, the KorMI system had good discrimination (time-dependent C statistic, 0.759) and showed reasonable goodness-of-fit by Hosmer-Lemeshow test (p=0.84). Moreover, the continuous-net reclassification improvement varied from −27.3% to −19.1%, the integrated discrimination index varied from −2.1% to −0.9%, and the median improvement in risk score was from −1.0% to −0.4%. CONCLUSIONS: The KorMI system would be a useful tool for predicting outcomes in survivors treated with guideline-adherent optimal therapies after AMI.
Angioplasty ; Angiotensins ; Body Mass Index ; Coronary Disease ; Discrimination (Psychology) ; Drug Therapy ; Echocardiography ; Humans ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Registries ; Renal Insufficiency ; Stents ; Stroke ; Survivors ; Ventricular Dysfunction, Left

INTRODUCTIONEarly initiation of stroke thrombolysis is associated with improved outcomes. Procurement of consent is a key factor in prolonging the door-to-needle duration. This study aimed to determine the attitudes and preferences of stroke patients and their next of kin (NOK) towards decision-making for stroke thrombolysis in Singapore.

MATERIALS AND METHODSWe surveyed acute ischaemic stroke patients (n = 171) who presented beyond the 4.5-hour therapeutic window and their NOK (n = 140) using a questionnaire with scenarios on obtaining consent for intravenous thrombolysis.

RESULTSIn the patient survey, 83% were agreeable for their NOK to decide on their behalf if mentally incapacitated and 74% were agreeable for the doctor to decide if the NOK was absent. In the NOK survey, the majority (81%) wanted to be consulted before mentally capacitated patients made their decision; 72% and 74%, meanwhile, were willing to decide on behalf of a mentally capacitated and mentally incapacitated patient, respectively. In the scenario where a doctor recommended a mentally incapacitated stroke patient to undergo thrombolysis but the family declined, there was a near equal split in preference to follow the family's or doctor's decision in both the patient and NOK surveys.

CONCLUSIONThe survey found that in the decision-making process for stroke thrombolysis, there was no clear consensus on the preference for the decision maker of the mentally incapacitated patient. In Singapore, there is a strong influence of the NOK in decision-making for thrombolysis.

Attitude to Health ; Brain Ischemia ; complications ; psychology ; therapy ; Decision Making ; Dissent and Disputes ; Humans ; Informed Consent ; Mental Competency ; Proxy ; Singapore ; Stroke ; etiology ; psychology ; therapy ; Surveys and Questionnaires ; Thrombolytic Therapy ; Time-to-Treatment

OBJECTIVETo verify the clinical effect of the penetration acupuncture at the acupoints of governor vessel(GV) and bladder meridian on head for mild cognitive disorder after stroke.

METHODSOne hundred and ten patients were randomly divided into an observation group and a control group, 55 cases in each one. Penetration acupuncture was used at the acupoints of GV and bladder meridian on head in the observation group,namely Wuchu (BL 5) to Chengguang (BL 6) and Tongtian (BL 7) to Luoque (BL 8) bilaterally, and Shenting (GV 24) to Xinhui (GV 22), Qianding (GV 21) to Baihui (GV 20), Houding (GV 19) to Qiangjian (GV 18). Body acupuncture and conventional western medication were applied in the both two groups. Acupuncture was adopted once a day, five times a week and eight weeks totally. The changes of Montreal Cognitive Assessment (MoCA), Mini mental state examination scale(MMSE), self-rating depressive scale (SDS) and activities of daily living scale (Barthel index) were compared between the two groups before treatment, in the middle of treatment(at the forth week) after treatment(at the eighth week) and in three weeks after treatment(follow-up).

RESULTSAfter treatment of four and eight weeks and at the time of follow-up, the results of MoCA, MMSE, SDS and Barthel index were apparently im proved compared with those before treatment in the two groups (all P < 0.01). After treatment of eight weeks and at the time of follow-up, the scores of MoCA and SDS were obviously improved in the observation group compared with those in the control group (P < 0.01, P < 0.05). The improvements of MMSE in the observation group were more marked than those in the control group at all times (P < 0.01, P < 0.05). But there was no statistical significance about the change of Barthel index between the two groups (all P > 0.05).

CONCLUSIONPenetration acupuncture at the acupoints of GV and bladder meridian on head can remarkablely improve the cognitive function of the patients with mild cognitive disorder after stroke,and have some efficacy of relieving the bad mood such as depression.

Activities of Daily Living ; Acupuncture Points ; Acupuncture Therapy ; Aged ; Aged, 80 and over ; Cognition ; Cognitive Dysfunction ; drug therapy ; etiology ; psychology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Meridians ; Middle Aged ; Stroke ; complications ; Treatment Outcome

OBJECTIVE: To Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients. METHODS: Thirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as 'short-term' CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment. RESULTS: No significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not. CONCLUSION: Short-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect.
Biofeedback, Psychology* ; Hand Strength ; Humans ; Occupational Therapy ; Sample Size ; Stroke* ; Upper Extremity* ; Wolves