Objective To explore the efficacy of conventional physical therapy,acupuncture and hormone intervention for treating Bell's palsy so as to suggest an optimal treatment in clinical practice.Methods Clinical data on 1170 patients with Bell's palsy (BP) treated at the First Affiliated Hospital of Jinan University between October 2012 and November 2015 were collected and analyzed retrospectively.The Kruskal-Wallis test was used to compare the differences in disease course and in total cost among the patients.Seasons of the year,age,treatments,as well as the presence of immune-related diseases were the covariates studied.Multivariate logistic regression equation was used to test for any significant relationships.Results Physical therapy and hormones were found to have shortened the average course of treatment,but immune-related complicating diseases were shown to be risk factors.Patients receiving acupuncture for more than 1 month had longer courses of the disease than those without.Patients whose treatment combined hormones with physical therapy had the shortest disease course and lower total cost on average.Conclusion Early hormone intervention combined with physical therapy can shorten the course of BP and lower the cost of treatment.

Objective To relate the results of surface electromyography (sEMG) of the femoris among patients with hemiplegia after a brain lesion with scores on the modified Ashworth scale (MAS),and to decide whether sEMG can be used as a quantitative index for evaluating spasm.Methods The affected quadriceps femoris of sixty hemiplegic stroke survivors were assessed by the same therapist using the MAS.sEMGs were also recorded and the root mean square and average sEMG readings from the vastus medialis (VM),rectus femoris (RF) and vastus lateralis (VL) were extracted.The correlation between these sEMG indexes and the MAS grading was analyzed.Results The average sEMG signals from the VM,RF and VL were strongly correlated with the MAS grading,and they increased with increasing MAS grade.Spearman correlation analysis demonstrated highly significant correlation (P ≤ 0.001) when the quadriceps femoris was moved passively.Conclusions Surface EMG signals from the VM,RF and VL correlate well with MAS grades,rising when the affected quadriceps femoris of a stroke survivor is moved passively.sEMG can present the electrical activity during passive movements of the quadriceps femoris and can be useful in spasticity assessment and clinical treatment.

Objective To study the effect of bilateral arm training on cortical reorganization in cerebral infarction patients using blood oxygen level-dependent functional MRI (BOLD-fMRI).Methods Fourteen cerebral infarction subjects with moderate to severe upper limb impairment participated in this randomized and single-blinded training study.Subjects in the bilateral arm training group (n =7) practiced bilateral symmetrical or opposite activities,while the control group (n =7) performed conventional,mainly unilateral,arm training.Those in both groups received fMRI scans before and after the training with passive elbow movement as the task in the imaging.Results Both groups had significant improvements in their average scores on the Fugl-Meyer upper extremity assessment and in their modified Barthel index scores after the treatment,and there were no significant differences between the two groups.Brain activation had increased in both groups after the treatment,especially in the bilateral training group.After the treatment,the first motor area (M 1),the first somatosensory area and the supplementary motor area on both sides were activated in the bilateral training group.Moreover,for patients in the bilateral training group with injuries of moderate severity,the M1 of the opposite side tended to be activated,while for those more severely injured the same side had a tendency to be activated.Conclusion Convalescing subcortical infarction patients with moderate to severe upper limb impairment benefit from bilateral arm training in terms of motor activity and performing activities in daily life.It may be related to the normalization of inhibition between the hemispheres of the bilateral cerebral cortex and the reconnection of ipsilateral corticospinal pathways.

Objective To explore the effect of surface electromyographic biofeedback (SEMG-BFT) combined with electrical stimulation on the swallowing function of stroke survivors with dysphagia,and to evaluate the electromyographic activity of the submental muscles in swallowing various foods so as to provide a basis for future rehabilitation of such patients.Methods Sixty patients were randomly divided into a treatment group and a control group,each of 28.Both groups were given low-frequency electrical stimulation and conventional swallowing training.The treatment group was additionally provided with SEMG-BFT.Before the treatment as well as after 2 and 4 weeks of treatment,the swallowing function of both groups was evaluated using the Kubota drinking water test (KDWT) and a Gugging swallowing screen (GUSS).Surface electromyographs of the submental muscles were recorded during empty swallowing,swallowing 10 ml of dilute liquid and swallowing 10 ml of paste.Results After two and four weeks of treatment,the average KDWT and GUSS scores of both groups had improved significantly,but that of the treatment group was significantly higher than that of the control group at each time point.After 2 and 4 weeks of treatment,significant differences were found in swallowing duration and the average amplitude of the sEMGs compared with before the treatment in both groups.The difference between the groups was significant at each time point.Conclusions SEMG-BFT combined with electrical stimulation can significantly improve swallowing function.Paste food can be used safely in the early evaluation and treatment of swallowing dysfunction.

Objective To explore any effect of repetitive transcranial magnetic stimulation (rTMS) on the cognitive ability of patients suffering from cognitive impairment after cerebral venous thrombosis (CVT).Methods Forty-three CVT patients with cognitive impairment were recruited and randomly assigned into an rTMS group (n =23) or a control group (n=20).Both groups received routine drug therapy and cognitive function training,while the rTMS group was additionally given rTMS.The treatment lasted 4 weeks.The Montreal cognitive assessment (MoCA),the Hamilton depression scale (HAMD),the modified auditory Barthel Index (MBI) and event-related potential P300 were used to test both groups before and after the treatment.Results After the treatment the average MoCA and MBI scores of both groups had increased significantly,while their average HAMD scores had decreased significantly compared to before the treatment.For both groups,the P300 latency had shortened significantly and the amplitude increased significantly after the treatment.The improvement in all of these indicators was significantly greater in the rTMS group than in the control group.Conclusion Supplementing drug therapy with rTMS can significantly improve the cognitive ability of CVT patients and is worth applying in clinical practice.

Objective To observe the cortical functioning of healthy volunteers during acupuncture as a way of exploring acupuncture's neural mechanisms.Methods Twenty healthy volunteers received acupuncture applied to the left hegu and waiguan acupoints while their cortical activity was examined using blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI).Brain activation,especially of the regions related to motor function,were observed and analyzed.Results Acupuncture applied to the left hegu and waiguan acupoints was observed to significantly activate the left middle frontal gyrus and the inferior frontal gyrus,with many activated regions in the left insula and a few in the left cerebellum,the left precentral gyrus,the left postcentral gyrus,the left inferior parietal lobule,the left medial frontal gyrus,the left precuneus,the left anterior cingulate gyrus and the left claustrum.The right side of the brain was excited mainly in the right middle frontal gyrus and the right medial frontal gyrus.The right inferior parietal lobule and the right precentral gyrus were also activated to some extent.There was slight activation of the right middle temporal gyrus,the right superior temporal gyrus,the right insula,the right inferior frontal gyrus and the right postcentral gyrus.The negatively activated regions were mainly located on both sides of the limbic lobe,including the hippocampus,the parahippocampal gyrus and the cingulate gyrus.The left superior temporal gyrus,the left middle temporal gyrus and the right middle frontal gyrus also had small negative activation zones.Conclusions In brain regions associated with motor function,in addition to partial activation of the contralateral primary sensorimotor area,acupuncture at these two points clearly generates bilateral activation of secondary motor areas with some activation in the ipsilateral cerebellum.This may serve as a neuropathological basis for acupuncture treatment of motor dysfunction.BOLD-fMRI imaging displays the neural effects of acupuncture in an intuitive way.It can be a useful technique for further study of the neural effects of acupuncture on pathological conditions.

Objective To explore any changes in the surface electromyography (sEMG) signals measured on the spastic upper limb muscles of stroke parents during maximum isometric voluntary contraction and to analyze any abnormal synergy patterns quantitatively in order to design better rehabilitation programs for developing coordination.Methods Ten stroke survivors with hemiparesis were selected into a patient group and ten healthy counterparts were recruited into a control group.sEMG signals were recorded bilaterally from the flexor carpi ulnaris (FCU),biceps brachii (BB),triceps brachii (TB) and deltoid (D) during maximum isometric voluntary contractions involving wrist flexion and extension,elbow flexion and extension,and shoulder abduction.The two groups' co-contraction ratios (CR) and co-activation ratios were calculated and compared.Results During elbow flexion and extension the average CR of the BB on the affected side was significantly higher than that on the unaffected side and also significantly higher than the control group average.The average CR of the TB on the affected side was significantly higher than that of the healthy controls.In all cases the average CR of the BB was larger than that of the TB.The difference in CR between the TB and the BB on the affected side was significantly larger than on the unaffected side and the control group average.During elbow flexion,the co-activation ratio of the FCU,TB and D on the affected side was significantly higher than on the unaffected side and among the healthy controls,and the co-activation ratio of the FCU on the affected side was significantly higher than that of the D and TB.During elbow extension,the co-activation ratio of the FCU,BB and D on the affected side was significantly higher in the same way,and the co-activation ratio of the FCU on the affected side was again significantly higher than that of the D and BB.During wrist flexion,the average co-activation ratio of the BB and D on the affected side was significantly greater than that on the unaffected side and among the healthy controls,and the co-activation ratio of the BB on the affected side was significantly higher than that of the D and TB.During shoulder abduction,the co-activation ratio of the BB on the affected side was significantly larger than on the unaffected side and among the healthy controls.Conclusion After a stroke the upper limbs often show flexor spasticity and abnormal synergy patterns.Rehabilitation strategy should be adopted to tackle these so as to enhance overall limb coordination.

Objective To explore the therapeutic efficacy of the water soluable photosensitizer D-galactopyranosyl zinc phthalocyanines (T1)-mediated photodynamic therapy (PDT) applied to HepG2 human hepatocellular carcinoma cells in vitro and in vivo,as well as its mechanism.Methods HepG2 cells in their logarithmic growth phase were cultured and divided into different concentrations ofT1 (0 μM,0.06 μM,0.125 μM,0.25 μM,0.5 μM and 1 μM).Methyl thiazolyl tetrazolium (MTT) assays were employed to determine the effect of the T1-PDT on the proliferation of the HepG2 cells.Cell apoptosis and necrosis were measured using a cell analyzer with Annexin VFITC/PI/Hochest33342 triple-staining.The reactive oxygen species (ROS) and the mitochondrial membrane potentials of the HepG2 cells were detected using fluorescence microscopy.Confocal microscopic assays were used to observe T1's subcellular localization on the HepG2 cells.Real-time quantitative polymerase chain reactions (RT-PCRs)were used to detect any apoptosis of Bcl-2-and Bax-related genes.H-22-bearing mice were used to calculate the antitumor rate of T1-PDT,and the expression levels of Bcl-2 and Bax mRNA were detected using RT-PCRs.Twenty-four healthy mice were randomly divided into a control group,a low-dose group,a middle-dose group and a high-dose group,each of 6.Each group was given different doses of T1-PDT and the tumor inhibition rate was calculated.Results The MTT assays showed that T1-PDT could significantly inhibit HepG2 cell growth,but T1 or PDT alone had little effect.The confocal microscope assay showed that T1 was mainly localized in the mitochondria in HepG2 cells with little in the lysosome.Cell analyzer results showed that T1-PDT could induce HepG2 apoptosis.The ROS levels of HepG2 cells increased after T1-PDT.The RT-PCR results showed that T1-PDT could increase the expression of Bax and decrease the expression of Bcl-2.The in vivo experiments demonstrated that T1-PDT significantly inhibited the growth of H-22-xenografied tumors.Conclusions T1-mediated PDT has a significant lethal effect on HepG2 cells in vitro and in vitro.The lethal effect of PDT on cancer cells is shown in the apoptosis and can be attributed to T1's subcellular localization in the mitochondria,increasing ROS levels,and regulating apoptosis-related genes.

Objective To compare the effectiveness of comprehensive rehabilitation therapy with that of surgical intervention for patients with recurrent lumbar disc herniation (LDH).Methods A total of 124 LDH patients were recruited antd randomly divided into an experimental group and a control group,each of 62.The experimental group was given comprehensive rehabilitation consisting of medicine,physical therapy,and spinal stabilization exercises,while the control group received lumbar spine surgery.The patients' back and leg pain scores and their Oswestry Disability Index (ODI) scores were compared at admission and discharge,as well as 3 and 12 months after discharge.Anxiety and depression were also assessed at admission and 3 months after discharge.Results At discharge and 3 and 12 months later the average back and leg pain scores and ODI ratings were significantly lower than that at admisshin for both groups.There were no significant inter-group differences.In terms of anxiety and depression,however,these had decreased signifieantly in both groups,but the experimental group's average rating was significantly better at diseharge.Conclusions Comprehensive rehabilitation is superior to surgical intervention in relieving the depression of patients with recurrent LDH.Comprehensive rehabilitation should be considered as the first ehoiee for patients with rccurrent LDH,and only supplemented by surgical intervention if it is not effective.

Objective To compare the therapeutic effect of low-frequency electrical stimulation at the acupoints with that of conventional Western medication among patients with post-stroke insomnia,and explore the underlying mechanism.Methods Totally 120 stroke survivors with insomnia were randomly divided into an intervention group,a medication group and a placebo group,each of 40.The intervention group received low-frequency electrical stimulation at the Dazhui and Shenshu acupoints once a day for 30 consecutive days.The medication group received 1 mg estazolam capsules and the placebo group took 1 mg starch capsules.The average levels of plasma dopamine (DA) of the 3 groups were compared before and after the intervention and therapeutic efficacy was estimated.Results After the intervention,the total effective rate of the intervention group was 95％ (38/40).For the medication group it was 92.5％ (37/40) and for the placebo group it was 17.9％ (7/39).The former two treatments were significantly more effective than no treatment (the placebo).There was no significant change in the average level of plasma DA before and after the treatment in the placebo group,but significant improvement was observed in the other two groups.There was no significant difference in plasma DA between the two treatment groups after the treatment.Conclusion Low-frequency electrical stimulation at acupoints is safe and equally as effective as estazolam for treating post-stroke insomnia.Both may alleviate post-stroke insomnia by increasing plasma DA levels.