OBJECTIVE: To observe the clinical therapeutic effect of three-needle therapy combined with acupuncture on complex regional pain syndrome typeⅠ(CRPS-Ⅰ) after stroke. METHODS: A total of 96 patients with CRPS-Ⅰ after stroke were randomized into an observation group and a control group, 48 cases in each one. In the control group, based on the routine treatment, acupuncture was applied at Neiguan (PC 6), Shuigou (GV 26), Sanyinjiao (SP 6) and other supplementary acupoints, once a day, 6 times a week for 3 weeks. Based on the treatment in the control group, three-needle therapy was added at coracoid process, greater tuberosity of humerus and infraglenoid tubercle, the muscular fascia was released by fan-shaped separation technique for 3-6 times, and the treatment was given once every 2 days, 3 times a week for 3 weeks. Visual analogue scale (VAS) score, hand swelling level, Fugl-Meyer assessment (FMA) score and Barthel index score were observed to evaluate the pain and swelling severity, motor function and living ability of patients before and after treatment. RESULTS: ① Compared before treatment, the VAS score, hand swelling level, the FMA score and the Barthel index after treatment and 40 days after treatment were improved in both of the two groups (<0.01). ② After treatment, the VAS score in the observation group was superior to the control group (<0.01), 40 days after treatment, the VAS and FMA scores in the observation group were superior to the control group (<0.01). ③ There were no significant differences after treatment and 40 days after treatment of the hand swelling level and the Barthel index between the two groups (>0.05). CONCLUSION three-needle therapy combined with acupuncture can improve the pain severity and the motor function of affected limbs in patients with CRPS-Ⅰ after stroke, and the therapeutic effect may be sustained for a long term. However, the treatment seems to be ineffectual on extremity swelling.
Acupuncture Points ; Acupuncture Therapy ; Complex Regional Pain Syndromes ; therapy ; Humans ; Needles ; Stroke ; Treatment Outcome

BACKGROUNDThe lateral pillar of the femoral head is an important site for disease development such as osteonecrosis of the femoral head. The femoral head consists of medial, central, and lateral pillars. This study aimed to determine the biomechanical effects of early osteonecrosis in pillars of the femoral head via a finite element (FE) analysis.

METHODSA three-dimensional FE model of the intact hip joint was constructed from the image data of a healthy control. Further, a set of six early osteonecrosis models was developed based on the three-pillar classification. The von Mises stress and surface displacements were calculated for all models.

RESULTSThe peak values of von Mises stress in the cortical and cancellous bones of normal model were 6.41 MPa and 0.49 MPa, respectively. In models with necrotic lesions in the cortical and cancellous bones, the von Mises stress and displacement of lateral pillar showed significant variability: the stress of cortical bone decreased from 6.41 MPa to 1.51 MPa (76.0% reduction), while cancellous bone showed an increase from 0.49 MPa to 1.28 MPa (159.0% increase); surface displacements of cortical and cancellous bones increased from 52.4 μm and 52.1 μm to 67.9 μm (29.5%) and 61.9 μm (18.8%), respectively. In addition, osteonecrosis affected not only pillars but also adjacent structures in terms of the von Mises stress and surface displacement levels.

CONCLUSIONSThis study suggested that the early-stage necrosis in the femoral head could increase the risk of collapse, especially in lateral pillar. On the other hand, the cortical part of lateral pillar was found to be the main biomechanical support of femoral head.

BACKGROUNDLateral compartmental osteoarthritis (LCOA), a major complication after medial mobile-bearing unicompartmental knee arthroplasty (UKA), is highly associated with the increased stress of the lateral compartment. This study aimed to analyze the effects on the stress and load distribution of the lateral compartment induced by lower limb alignment and coronal inclination of the tibial component in UKA through a finite element analysis.

METHODSEight three-dimensional models were constructed based on a validated model for analyzing the biomechanical effects of implantation parameters on the lateral compartment after medial Oxford UKA: postoperative lower limb alignment of 3° valgus, neutral and 3° varus, and the inclination of tibial components placed in 4°, 2° valgus, square, and 2° and 4° varus. The contact stress of femoral and tibial cartilage and load distribution were calculated for all models.

RESULTSIn the 3° valgus lower limb alignment model, the contact stress of femoral (3.38 MPa) and tibial (3.50 MPa) cartilage as well as load percentage (45.78%) was highest compared to any other model, and was increased by 36.75%, 47.70%, and 27.63%, respectively when compared to 3° varus. In the condition of a neutral position, the outcome was comparable for the different tibial tray inclination models. The inclination did not greatly affect the lateral compartmental stress and load distribution.

CONCLUSIONSThis study suggested that slightly varus (undercorrection) lower limb alignment might be a way to prevent LCOA in medial mobile-bearing UKA. However, the inclination (4° varus to 4° valgus) of the tibial component in the coronal plane would not be a risk factor for LCOA in neutral position.

Objective To observe the effects of therapy of wound-pus promoting granulation tissue growth guided by drug-wound interaction theory on the related factors in granulation tissue during the healing of chronic skin ulcer in rats based on drug-wound interaction. Methods Twenty-four rats were randomly divided into normal group, model group, control group, and treatment group, 6 rats in each group. The rats in the normal group had no skin ulcer and was given normal feeding,and the rats with chronic skin ulcer in the other 3 groups were induced by compound factors-overlapped method of hormone intervention-skin defect-bacterial infection. After modeling,the model group was given external use of saline gauze dressing,the control group given external use of vaseline gauze dressing,and the treatment group given external use of Shengji Xiangpi Ointment,changing fresh dressing for wound daily,the treatment lasting for 14 days. Wound sample was taken from the left back of rats, and therapeutic effect was evaluated according to the changes in the wound surface of the rat right back. After intervention for 3,7,and 14 d,the secreta and granulation tissue in the wound surface of rats were observed, the expression levels of vascular endothelial growth factor (VEGF), inducible nitric oxide synthase(iNOS), arginine-1 (Arg-1), and Notch1 in granulation tissue of rat ulcer wound were measured by enzyme-linked immunosorbent assay (ELISA). Results The wound in the treatment group has been healed after treatment for 14 days (P < 0.05 or P < 0.01 as compared with the diameter of the ulcer in the model group and the control group) . At the early stage of wound repairing (3 d),the expression levels of VEGF and Arg-1 in the treatment group were increased, and Notch1 expression level was decreased, the difference being statistically significant as compared with those of the model group and the control group (P < 0.05). At the late stage of wound repairing (14 d),the expression level of iNOS in the treatment group was increased,and the difference was statistically significant as compared with that of the model group(P < 0.05). Conclusion The therapy of wound-pus promoting granulation tissue growth guided by drug-wound interaction theory can promote the healing of chronic skin ulcerative wound in rats and improve the general condition of rats. The therapeutic mechanism may be associated with firstly inhibiting the expression of iNOS induced by M1 type macrophage at early stage and then promoting M2 type macrophage phenotype index Arg-1 expression,and regulating the expression of VEGF and Notch1 in the granulation tissue.

Objective:To study the optimal nutritional support strategy in critical patients with acute ischemic stroke.Methods:50 critical patients with acute ischemic stroke were divided into two groups.One group were started with enteral nutrition alone within 24h after admission,while the other group received sequential parenteral and enteral nutrition.The incidence of pulmonary infection,gastric retention,upper gastrointestinal bleeding,hypoglycemia and hyperglycemia were compared between the two groups.Another endpoint was discharge from ICU at day 20,and it was compared between the two groups using Kaplan-Meier methods.Results:There was no difference between the two groups in the rate of hypoglycemia or hyperglycemia (P ＞ 0.05).The incidences of pulmonary infection,gastric retention,upper gastrointestinal bleeding and diarrhea were lower in the PN+EN group than EN group (P ＜ 0.01).The length of ICU stay was also shorter in the PN+EN group.Conclusion:The strategy of sequential parenteral and enteral nutrition decreased the complication rate related to nutrition support,such as pulmonary infection,gastric retention,upper gastrointestinal bleeding.Also,it shortened the ICU stay in critical patients with acute ischemic stroke.

Background: Lateral compartmental osteoarthritis (LCOA), a major complication after medial mobile?bearing unicompartmental knee arthroplasty (UKA), is highly associated with the increased stress of the lateral compartment. This study aimed to analyze the effects on the stress and load distribution of the lateral compartment induced by lower limb alignment and coronal inclination of the tibial component in UKA through a finite element analysis. Methods: Eight three?dimensional models were constructed based on a validated model for analyzing the biomechanical effects of implantation parameters on the lateral compartment after medial Oxford UKA: postoperative lower limb alignment of 3° valgus, neutral and 3° varus, and the inclination of tibial components placed in 4°, 2° valgus, square, and 2° and 4° varus. The contact stress of femoral and tibial cartilage and load distribution were calculated for all models. Results: In the 3° valgus lower limb alignment model, the contact stress of femoral (3.38 MPa) and tibial (3.50 MPa) cartilage as well as load percentage (45.78%) was highest compared to any other model, and was increased by 36.75%, 47.70%, and 27.63%, respectively when compared to 3° varus. In the condition of a neutral position, the outcome was comparable for the different tibial tray inclination models. The inclination did not greatly affect the lateral compartmental stress and load distribution. Conclusions: This study suggested that slightly varus (undercorrection) lower limb alignment might be a way to prevent LCOAin medial mobile?bearing UKA. However, the inclination (4° varus to 4° valgus) of the tibial component in the coronal plane would not be a risk factor for LCOA in neutral position.