Rehabilitation therapy with the integrative traditional and western medicine is the devel opment trend in China,and it is also the aim of talent education of Nanjing University of Chinese Medicine.Based on the introduction of rehabilitation therapy education in our university,this article makes a discussion on the research and practice of curriculum reformation of rehabilitation therapy with the integrative traditional and western medicine.Additionally,it puts forward some implement measures.

OBJECTIVETo observe the effects of moxibustion on factors related with apoptosis of myocardial cells after sports fatigue in mice as well as the relationship among histone acetyltransferases p300 (p300), CREB binding protein (CBP) and cell apoptosis to discuss the role of p300 and CBP in moxibustion against apoptosis of myocardial cells.

METHODSSixty clean-grade male Kunming mice were randomly divided into a control group, a sport group and a moxibustion group, 20 cases in each one. Mice in all group received identical feeding environment. Mice in the control group did not received sport nor moxibustion; mice in the sport group and moxibustion group received non-weight swimming training which lasted from 30 min per day to 90 min per day gradually for 21 days; 1 h after swimming training, mice in the moxibustion group received moxibustion with seed-sized moxa cone at "Zusanli" (ST 36) and "Guanyuan" (CV 4), 5 cones at each acupoint, once a day for 21 days. 24 h after the final swimming training, cardiac muscle tissue was collected to test factor associated suicide (Fas), B cell lymphoma/lewkmia-2 (Bcl-2) by immunohistochemical method and expression of p300 and CBP.

RESULTSCompared with the control group, the apoptosis rate of myocardial cells in the sport group was significantly increased (P<0.01), and apoptosis body with dense distribution and deep coloring can be seen in the field of microscope; the expression of Fas protein was significantly increased (P<0.01), and expression of Bcl-2, p300 and CBP was reduced (all P<0.01). The equally distributed apoptosis body with slight coloring was seen in the moxibustion group. Compared with the sport group, the apoptosis rate of myocardial cells in the moxibustion group was significantly reduced (P<0.05); the expression of Fas protein was significantly reduced (P<0.05), and expression of Bcl-2, p300 and CBP was increased (all P<0.05).

CONCLUSIONMoxibustion could promote the expression of p300 and CBP in myocardial cells after sports fatigue in mice to inhibit the starting of apoptotic process, therefore reducing the apoptosis of myocardial cells after heavy exercise and protecting heart function.

Acupuncture Points ; Animals ; Apoptosis ; Exercise ; Fatigue ; etiology ; metabolism ; physiopathology ; therapy ; Humans ; Male ; Mice ; Moxibustion ; Myocardium ; cytology ; metabolism ; Myocytes, Cardiac ; cytology ; metabolism ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; p300-CBP Transcription Factors ; metabolism

BACKGROUND:Studies have different views on the effect of repetitive transcranial magnetic stimulation applied in stroke patients for improving motor function.
OBJECTIVE:To evaluate the effect of repetitive transcranial magnetic stimulation on rehabilitation of motor function in patients with stroke.
METHODS:We searched Cochrane Central Register of Control ed Trials, PubMed, ISI Web of science, Medline, EMBASE, China Biology Medicine disc, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodical, Wanfang Data (from database building to July 2013) for randomized control ed trials concerning repetitive transcranial magnetic stimulation on improving motor function in patients with stroke. The included studies were evaluated according to the method recommended by the Cochrane Col aboration. Meta analysis was performed in qualified literatures. The extracted data were analyzed by RevMan 5.1 software and GRADEprofiler 3.6 software.
RESULTS AND CONCLUSION:A total of 23 trials were included (intervention group n=400, control group n=301). Quantitative analysis was conducted in seven studies, and descriptive study was performed in the remaining studies. Meta-analyses analyzed Fugl Meyer Motor Scale and Barthel index. Results showed that Fugl Meyer Motor Scale [SMD=0.48, 95%CI(0.10, 0.86)] and Barthel index [SMD=1.38, 95%CI (0.68, 2.09)] were significantly higher in the intervention group than that in the control group. In accordance with The Grading of Recommendations Assessment, Development and Evaluation, outcome indexes were evaluated, and the two indexes were graded low quality. The current evidence shows that repetitive transcranial magnetic stimulation appears to enhance motor function and activities of daily living of the patients with stroke. Considering the limitations of the included studies, more multi-central randomized control ed trials with large sample sizes and high qualities are required in future to verify the therapeutic efficacy of repetitive transcranial magnetic stimulation on motor function of stroke patients.

Objective To compare the rehabilitation effect of free rehabilitation, the needle therapy and the hand function recovery machine combined with free rehabilitation on movement function, the feeling function as well as the movement pattern of newly stroke patients with hemiplegia. Methods 49 newly stroke patients were divided into the free rehabilitation group, the acupuncture group and the hand function recovery machinegroup, each group received corresponding intervention. The movement function, the feeling function as well as the movement pattern were compared among the three groups using blind method. Results Brunnstrom evaluation for hands feeling-movement function, the Fugl- Meyer evaluation score showed obvious progress compared to before the treatment, score of fine hand - function assessment of Carrshepherd showed no change. Two weeks after treatment,Brunnstrom evaluation for hands feeling-movement function and the Fugl - Meyer evaluation score showed no difference between the free rehabilitation group and the acupuncture group, but the hand function recovery machine group showed better results than the other two groups. One months after treatment,Brunnstrom evaluation for hands feeling-movement function was different among these groups, but not the Fugl-Meyer evaluation score, the hand function recovery machine group showed better results than the other two groups, still score of fine hand-function assessment of Carrshepherd showed no change. Conclusions Acupuncture, free rehabilitation, hand function recov - ery machine all make progress in hand function recovery for newly stroke patients with hemiplegia, but hand function recovery machine combined with free rehabilitation proved to be the best method. Its effect for hand intricate function needs to be enhanced.

Objective To study the effectiveness and feasibility of low intensity of aerobic bicycle ergometer training on hemiplegic stroke patients unable to perform assistive or independent ambulation.Methods Thirty stroke patients unable of assistive or independent ambulation were randomly divided into a control group and a aerobic training group.Patients in the aerobic training group performed low intensity of aerobic bicycle ergometer training for 30 min,3 times a week for 6 weeks in addition to a routine rehabilitation regime.The training duration and course of routine rehabilitation training were the same in both groups.The related cardiovascular response in aerobic training and changes in motor performance as well as the risk factors for stroke were observed in both groups.Results Twenty-four patients(12 patients in each group)completed the experiment.Patients in aerobic training group performed all training regime safely without any adverse response.Their motor function(including FMA score,Rivermead index,BI ADL ability),exercise endurance duration in exercise test,glucose level at 2 h in oral glucose tolerance test,fasting insulin level and HOMA-IR index all improved greatly as compared to the control group(P ＜ 0.05).Conclusion Low intensity of aerobic bicycle ergometer training can be safely and effectively administered in hemiplegic stroke patients unable of assistive ambulation or independent ambulation.

Objective To explore the effects of computer game united occupational therapy on the fine motor function of children with spastic cerebral palsy. Methods 22 patients with spastic quadriplegia cerebral palsy were divided randomly into control group (n=11) and computer game group (n=11). The control group received routine occupational therapy and the computer game group received computer game treatment in addition. Peabody Developmental Motor Scale-2 (PDMS-2) concluding fine motor quotient (FMQ)， grasp capacity index, capacity index of visual-motor integration were accessed. Results There was a significantly improvement in both groups after treatment (P<0.001), and the computer game group improved more than the control group (P<0.05). Conclusion Computer game can improve the efficacy of the routine occupational therapy on the fine motor function of children with spastic cerebral palsy.

Objective:To investigate the short-term efficacy of laparoscopic total gastrec-tomy with hand-sewn esophagojejunostomy versus Roux-en-Y anastomosis.Methods:The propen-sity score matching and retrospective cohort study was conducted. The clinicopathological data of 159 patients who underwent laparoscopic total gastrectomy in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2014 to July 2021 were collected. There were 107 males and 52 females, aged 63(range, 28?79)years. Of 159 patients, 71 cases undergoing totally laparoscopic total gastrectomy with hand-sewn esophagojejunostomy were allocated into totally laparoscopic group and 88 cases undergoing laparoscopic-assisted total gastrectomy with Roux-en-Y anastomosis were allocated into laparoscopic-assisted group, respectively. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher's exact probability method. The rank sum test was used for comparison of ordinal data. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 159 patients, 112 cases were successfully matched, including 56 cases in the totally laparoscopic group and 56 cases in the laparoscopic-assisted group. Before propensity score matching, age, cases with tumor located in cardia or gastric body in the totally laparoscopic group were 61(range, 30?76)years, 26, 45, respectively. The above indicators in the laparoscopic-assisted group were 65(range, 28?79)years, 50, 38, respectively. There were significant differences in the above indicators between the two groups ( Z=?2.89, χ2=6.43, P<0.05). After propensity score matching, the males and females, age, body mass index, cases of American Society of Anesthesiologists classification Ⅰ, Ⅱ, Ⅲ and Ⅳ, tumor diameter, cases with tumor located in cardia or gastric body, cases in TNM stage Ⅰ, Ⅱ and Ⅲ of patients in the totally laparoscopic group were 40, 16, (62±9)years, (22.7±2.8)kg/m 2, 22, 26, 7, 1, 3.5(range, 0.6?17.0)cm, 24, 32, 22, 9, 25. The above indicators of patients in the laparoscopic-assisted group were 38, 18, (62±10)years, (22.7±3.2)kg/m 2, 19, 32, 5, 0, 4.0(range, 0.6?15.0)cm, 23, 33, 21, 7, 28, respectively. There was no significant difference in the above indicators between the two groups ( χ2=0.17, t=?0.09, ?0.04, Z=?0.12, ?0.82, χ2=0.04, Z=?0.42, P>0.05). The elimination of age and tumor location confounding bias ensured comparability between the two groups. (2) Intraoperative and postoperative conditions: after propensity score matching, the total operation time, time of esophagojejunostomy, postopera-tive 24-hour pain numerical score and time to first out-off bed activities were (310±49)minutes, (37±10)minutes, 2.3±0.8 and (2.4±0.7)days for patients in the totally laparoscopic group, versus (344±77)minutes, (44±12)minutes, 3.1±1.2 and (2.9±1.0)days in the laparoscopic-assisted group, showing significant differences between the two groups ( t=?2.85, ?3.05, ?4.20, ?3.10, P<0.05). (3) Perioperative complications: after propensity score matching, 6 cases of the patients in the totally laparoscopic group had Clavien-Dindo grade 2 or higher complications, including 2 cases of anas-tomotic leak, 1 case of anastomotic stenosis, 1 case of pleural effusion, 1 case of abdominal infection and 1 case of intestinal obstruction. The incidence of Clavien-Dindo grade 2 or higher complications was 10.7%(6/56). In the laparoscopic-assisted group, 5 patients had Clavien-Dindo grade 2 or higher complications, including 2 cases of anastomotic leak, 1 case of abdominal infection, 1 case of intestinal obstruction and 1 case of cholangitis. The incidence of Clavien-Dindo grade 2 or higher complications was 8.9%(5/56). There was no significant difference in the incidence of Clavien-Dindo grade 2 or higher complications between the two groups ( χ2=0.10, P>0.05). Patients with anas-tomotic leak were improved after puncture and drainage, secondary surgery and conservative treat-ment, and other complications were improved after symptomatic treatment. Conclusions:Com-pared with Roux-en-Y anastomosis in laparoscopic total gastrectomy, the time of hand-sewn esophagojejunostomy and esophago-jejunal anastomosis are shorter, patients have less postopera-tive pain and faster postoperative recovery. Both methods have good peri-operative safety.

Objective To observe the expression of tyrosine kinase 2(JAK2)and signal transducer and activator of transcription 3(STAT3)in myocardial tissue of rats with myocardial ischemia-reperfusion injury(MIRI)by electroacupuncture at"Neiguan"point,and explore the mechanism of electroacupuncture in up regulating JAK2/STAT3 signal pathway,promoting the expression of anti-inflammatory factors,and reducing MIRI injury.Methods Thirty male SD rats with normal echocardiography were randomly divided into sham operation group,model group and electroacupuncture group,with 10 rats in each group.MIRI models were prepared by ligation of left anterior descending coronary artery(LAD)in model group and electroacupuncture group,while in sham operation group,only threading was performed without ligation.In the electroacupuncture group,electroacupuncture(density wave,2 Hz/100 Hz,2 mA)at bilateral"Neiguan"points was performed on the 1st,3rd and 5th days after the modeling operation,once a day,20 minutes each time.The left ventricular ejection fraction(LVEF)of rats on the 1st,3rd and 5th day after operation was observed by echocardiography to evaluate cardiac function;HE staining was used to observe the pathological changes of rat myocardium;The myocardial fibrosis was observed by Masson staining;The expression of IL-4 and IL-6 in myocardium was detected by ELISA;The expressions of IL-1β and IL-10 in myocardial tissue were detected by immunohistochemistry;The expression of JAK2,p-JAK2,STAT3,p-STAT3 protein in myocardial infarction area was measured by Western blot.Results Compared with sham operation group,EF in model group decreased significantly(P<0.05),fibrosis area increased(P<0.05),IL-4,IL-6,IL-10,IL-1β The content of JAK2,p-JAK2,STAT3,p-STAT3 protein increased(P<0.05);Compared with the model group,the EF of rats in the electroacupuncture group increased(P<0.05),the fibrotic area of rats in the electroacupuncture group decreased(P<0.05),the content of IL-4 and IL-10 increased,and IL-6 and IL-1β The expression of JAK2,p-JAK2,STAT3,p-STAT3 protein increased(P<0.05).Conclusion Electroacupuncture at Neiguan point can significantly up regulate JAK2/STAT3 signal pathway,reduce the secretion of proinflammatory factors,increase the expression of anti-inflammatory factors,and alleviate myocardial ischemia reperfusion injury in rats.

OBJECTIVETo compare the effect difference between acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise and acupuncture.

METHODSSixty patients with periarthritis were randomly divided into an acupuncture group and an acupuncture combined with exercise group (active acupuncture group), 30 cases in each group. Acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) was given in both groups. The active shoulder joint during acupuncture was applied in the active acupuncture group. The treatment was given once every two days, 5 times as one course and a total of 2 courses were required. The activity-related pain (VAS score), shoulder joint activity (Melle score), and daily living ability (ADL score) were observed before and after treatment in the two groups.

RESULTSThe VAS score, Melle score and ADL score were significantly lower in the two groups after treatment compared with those before treatment (all <0.05); the VAS score, Melle score, and ADL score in the active acupuncture group were lower than those in the acupuncture group (all <0.05).

CONCLUSIONThe curative effect of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) combined with local exercise on periarthritis is superior to that of acupuncture from Tiaokou (ST 38) to Chengshan (BL 57) alone.

OBJECTIVETo observe the effects of preventative moxibustion on adenosine monophosphate-activated protein kinase (AMPK) and mammalian target of rapamycin (mTOR) in myocardial tissue in rats with exhaustive exercise, and to explore the action mechanism of preventative moxibustion for myocardial injury by exhaustive exercise.

METHODSEighteen SD male rats were randomly divided into a blank group, an exhaustive exercise group and a moxibustion group, 6 rats in each one. Rats in the blank group were treated with immobilization for 5 min per day, without any intervention. Rats in the exhaustive exercise group were treated with no intervention in the first 10 days. Rats in the moxibustion group were treated with moxibustion at "Zusanli" (ST 36) and "Guanyuan" (CV 4), 5 cones for each acupoint, for 10 days.On 11th day, rats in the exhaustive exercise group and moxibustion group were sacrificed to collect sample after exhaustive swimming, and time of exhaustive exercise was recorded. HE staining was used to observe the inflammatory changes of myocardial tissue; colorimetric method was used to measure lactic dehydrogenase (LDH), activity of superoxide dismutase (SOD) and malonaldehyde (MDA); immune suppression method was used to measure the content of creatine kinase isoenzyme (CK-MB) in serum; Elisa method was used to measure the content of troponinT (cTnT) in serum; western blot method was applied to measure the content of AMPKα2 and mTOR in myocardial tissue.

RESULTSThe time of exhaustive exercise was (4 831.17±689.88) s in the moxibustion group, which was longer than (3 509.50±1 232.49) s in the exhaustive exercise group (<0.05); HE staining indicated structure of the myocardium was clear and inflammatory cell infiltration was reduced in the moxibustion group. Compared with the blank group, the contents of serum LDH, CK-MB, cTnT were increased in the exhaustive exercise group (all<0.05); MDA content was increased and SOD activity was decreased (both<0.05); the AMPK α2 content in myocardial tissue was increased and the mTOR content was decreased (both<0.05). Compared with the exhaustive exercise group, the contents of serum LDH, CK-MB, cTnT were reduced in the moxibustion group (all<0.05); MDA content was decreased and SOD activity was increased (both<0.05); the AMPKα2 content in myocardial tissue was increased, and the mTOR content was decreased (both<0.05); AMPKα2 and mTOR were negatively correlated (=-0.764,<0.05).

CONCLUSIONSPreventative moxibustion is likely to regulate the expression of AMPK and mTOR to induce signaling pathway to recover myocardial injury by exhaustive exercise.