Objective:To observe the effect of functional electrical stimulation (FES) combined with an ankle-foot orthosis (AFO) and gait training on lower limb motor function, gait parameters and the joint angles of hemiplegic stroke survivors.Methods:Thirty-two stroke survivors who met the inclusion criteria were selected and randomly divided into a control group ( n=10), an orthosis group ( n=10), and a combination therapy group ( n=12). In addition to routine medication and rehabilitation, the control group received only gait training, the orthosis group received gait training and an AFO and the combination therapy group was given FES, an AFO and gait training. All three groups were treated for four weeks. Then, the Fugl-Meyer lower extremity assessment (FMA-LE), the Brunnstrom lower extremity assessment (BRL), and Functional Ambulation Categories (FACs) were used to evaluate the lower limb motor function and walking ability of the three groups. The gait parameters of the three groups were quantified using a three-dimensional gait analyzer, and the changes in the hemiplegic gait before and after treatment were compared among the three groups. Results:After the treatment the average FMA-LE, FAC and BRL scores, time-space parameters, and joint angle parameters of all three groups had all improved significantly. After the intervention the average indicators in the combined therapy group (including stride frequency, stride length and walking speed) were all significantly better than in the other two groups.Conclusions:Adding FES to gait training with an AFO can effectively improve lower limb motor function and the walking ability of hemiplegic stroke survivors.

Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.

Objective To observe the clinical effect of combining extracorporeal shock waves with pulsed radiofrequency irradiation of the dorsal root ganglia in the treatment of spinal cord-derived abdominal pain. Methods A total of 88 patients were randomly divided into a control group, a shock wave group, a pulsed irradiation group and a combination group, each of 22. All of the patients were given etocoxib and pregabalin medication for 3 weeks. In ad-dition to the drugs, the shock wave group received extracorporeal shock wave therapy, and the irradiation group re-ceived pulsed radio frequency irradiation of the dorsal root ganglia. The combination group received both. A visual an-alogue scale was used to assess perceived pain. The quality of life short form 36 ( QOL-SF36) , Hamilton anxiety scale and Hamilton depression scale were administered to all 4 groups before the treatments and after 1, 4 and 12 weeks of the treatments. The development of diseases, gastrointestinal function, medical treatment and medical expenses of the 4 groups were observed for two years after the treatments. Results After 4 weeks of treatment, the average scores of all four groups in all of the evaluations had improved significantly compared with before the treatment. In combination group′s average results were significantly better than those of the other 3 groups from 4 weeks until 12 weeks after the treatment. During the subsequent two years that group′s gastrointestinal symptoms, hospital visits and medical expen-ses were all significantly lower, on average, than those of the other groups. Conclusion Extracorporeal shock waves combined with pulsed radio frequency irradiation of the dorsal root ganglia has significant clinical efficacy for alleviating spinal cord-derived abdominal pain. It can significantly reduce medical costs and is worthy of clinical pro-motion.

Objective To investigate the effect of hyperbaric oxygen (HBO) on the behaviors, organizational morphology and the expression of protein kinase R-like ER kinase (PERK) in rats with spinal cord injury. Methods Thirty-six male Sprague-Dawley rats were randomly divided into normal group, sham group, model group and HBO group, with nine cases in each group. The normal group did not receive any treatment, the sham group received only laminectomy, and the other two groups were established spinal cord injury model with modified Allen's method. Six hours after operation, the model group was treated with regular air, and HBO group received HBO treatment for seven days. The recovery of locomotor function was evaluated by BBB (Basso Beattie and Bresnahan) on the day before operation and six hours, three days, seven days after operation. HE staining was used to observe the change of tissue morphology in injured spinal cord, and the expression of PERK in spinal cord was detected by Western blotting. Results There was no neurological deficit in the normal group and the sham group. The neurological score was lower in the model group than in the sham group three days and seven days after operation (P < 0.05), and was higher in HBO group than in the model group seven days after operation (P < 0.05). There was no obvious structural change in the normal group and the sham group, however, the model group showed swelling cells, condensed cytoplasm, and nucleus pycnosis hyperchromatic, and the HBO group showed slighter swelling cell compared with the model group. The expression of PERK was higher in the model group than in the sham group, and was lower in HBO group than in the model group seven days after operation (P < 0.05). Conclusion HBO could reduce the expression of PERK in the injured spinal cord, and improve the recovery of hind limb locomotor function in spinal cord injury rats.

OBJECTIVETo observe the effects of electroacupuncture (EA) on the activation of microglia cells in the Lto Lspinal cord in rats with neuropathic pain, so as to investigate whether EA could inhibit the activation of spinal microglial cells and regulate the expression of brain-derived neurotrophic factor (BDNF) to achieve the analgesic effect.

METHODSForty male Sprague Dawley rats were randomly divided into a normal group, a sham-model group, a model group and an EA group, 10 rats in each one. The rats in the normal group received no treatment; the rats in sham-model group were treated with operation to exposure sciatic nerve for 2 to 3 min (no knot); the rats in the remaining groups were treated with model establishment of chronic constrictive injury (CCI). 7 days after model establishment, the rats in the EA group were treated with EA at "Zusanli" (ST 36) and "Yanglingquan" (GB 34), 30 min per time, once a day for consecutive 7 days. Only immobilization was used in the remaining groups the mechanical withdrawal threshold (MWT) and thermal withdrawal latency (TWL) of affected side feet were respectively measured before model establishment and 3 days, 5 days, 7 days, 10 days, 12 days and 14 days after model establishment; 14 days after model establishment, rats were sacrificed; the immunohistochemical method was used to measure the expression of Iba1 and BDNF in the sample of Lto Lspinal cord; real-time fluorescent quantitative PCR was used to measure the expression BDNF mRNA.

RESULTSCompared with the sham-model group, the pain threshold was decreased significantly in the model group (<0.05), leading to hyperpathia. After EA treatment, compared with the model group, the pain threshold was increased significantly in the EA group (<0.05). 14 days after operation, the microglia cells in the Lto Lspinal cord, expression of BDNF and level of mRNA in the model group were significantly higher than those in the normal group and sham-model group (all<0.01); those in the EA group were significantly lower than those in the model group (all<0.01).

CONCLUSIONSThe analgesic effect on neuropathic pain is likely to be achieved by EA through inhibiting the activation of spinal microglia cells and down-regulating the expression of BDNF.

OBJECTIVETo evaluate the clinical therapeutic effects and safety on moderate and severe persistent allergic rhinitis treated with acupoint application therapy of the different intensity during the dog days.

METHODSOne hundred and sixty patients of moderate and severe persistent allergic rhinitis were randomized into a No.1 treatment group, a No.2 treatment group, a No.3 treatment group and a placebo group, 40 cases in each one. The same acupoints were used in the four groups, named Dazhui (GV 14), Dingchuan (EX-B1), Feishu (BL 13), Pishu (BL 20), Mingmen (GV 4), Gaohuang (BL 43), Shenshu (BL 23) and Qihai (CV 6). In the three treatment groups, the fine powder of the ingredients (,,,) of compoundformula was used. In the No.1 treatment group, the herbal paste (ginger-prepared paste) was prepared with ginger juice and the above herbal powder. In the No.2 and No.3 treatment groups, the herbal paste (honey-prepared paste) was prepared with honey with the above herbal powder. In the placebo group, the pseudo-herbal paste of the same appearance was prepared with millet powder and distilled water. The acupoint application was given for 2 h in the No.1 and No.2 groups and was for 6 h in the No.3 treatment group and the placebo group. The acupoint application therapy was given once every week during the dogdays, continuously for 5 weeks. The total nasal symptom score (TNSS), the score of the rhinoconjunctivitis quality of life questionnaire (RQLQ) and the count of blood eosinophils (EOS) were observed in the patients of the 4 groups before and after treatment. The clinical therapeutic effects were compared among the 4 groups. The incidences of the skin adverse reactions were observed in each treatment group.

RESULTSAfter treatment, the scores of TNSS and RQLQ were all reduced as compared with those before treatment in the three treatment groups (<0.05,<0.01), in which, the improvements in the No.3 treatment group were better than those in the No.1 treatment group and the No.2 treatment group (both<0.05). After treatment, the count of EOS was all reduced as compared with that before treatment in the three treatment groups (all<0.05). The differences were not significant statistically among the three treatment groups (all>0.05). The total effective rate was 85.0% (34/40) in the No.3 treatment group, better than 76.3% (29/38) in the No.1 treatment group, 71.8% (28/39) in the No.2 treatment group and 5.0% (2/40) in the placebo group (<0.05,<0.01). The incidences of the skin adverse reaction in the No.3 treatment group and the No.2 treatment group were lower than those in the No.1 treatment group (both<0.01).

CONCLUSIONThe acupoint application of the different intensity relieves the symptoms and improves the living quality in the patients of moderate and severe persistent allergic rhinitis. The stimulation of the ginger-prepared herbal paste is strong and induces skin blisters after 2 h herbal application. The stimulation of the honey-prepared herbal paste is moderate and does not induce blisters. The 6 h stimulation of the honey-prepared herbal paste is mild and the therapeutic effect is optimal.

Objective To investigate the relation of autophagy and postherpetic neuralgia in elderly patients,and provide new methods for prevention and treatment of postherpetic neuralgia.Methods One hundred thirty-five specimens were obtained from elderly patients with herpes zoster,containing 83 patients with herpes zoster plus neuralgia and 52 cases with non-neuralgia herpes zoster.The level of autophagy was determined by acridine orange-stain.The protein expressions of autophagy marker protein LC3 and autophagy related protein Beclinl were detected by Western blot.Results Flow cytometer detection after acridine orange-stain showed that mean fluorescence intensity (MFI) of herpes zoster plus neuralgia patients was 0.775±0.068 and non-neuralgia herpes zoster patients was 0.342±0.025.The level of autophagy of non-neuralgia herpes zoster patients was significant lower than herpes zoster plus neuralgia patients (P＜0.05).The expressions of autophagy marker protein LC3 and autophagy related protein Beclin1 detected by Western blot also showed the level of autophagy of non-neuralgia herpes zoster patients was decreased compared with herpes zoster plus neuralgia patients.Conclusions High level autophagy is risk factor for postherpetic neuralgia in elderly patients.

Objective To investigate the effects of playing virtual reality games on the recovery of hemiplegic upper extremities after stroke.Methods Thirty stroke patients with hemiplegic upper extremities were randomly assigned to a treatment group (n=15) or a control group (n=15).Both groups received routine medication and conventional physical therapy,while the treatment group was additionally given (Nintendo) gaming-based virtual reality therapy.Before and after 2 weeks of treatment,the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities (FMA-UE),Brunnstrom staging and co-contraction ratios (CRs).Surface electromyogram signals from the biceps brachii and triceps brachii were also recorded during maximum isometric voluntary flexion and extension of the affected elbow.Results No significant differences in any of the measurements were observed between the 2 groups before or after the intervention.Both groups demonstrated significant increases in their average FMA-UE score,Brunnstrom staging and CRs.Conclusions Virtual reality gaming using a Wii controller is as effective as conventional therapy in enhancing upper extremity motor function and elbow flexion and extension after stroke.

Objective: To explore the effect of the aortic arch type on technical indicators in patients with carotid artery stent implantation.
Methods: We retrospectively analyzed 224 consecutive patients treated in Fu Wai hospital for unilateral carotid artery stent implantation from 2011-01 to 2012-12. We summarized the catheter category, type and the operating techniques including ① retracement, turn and insertion of the catheter, ② retracement, turn of catheter+the guidance of guide wire,③ retracement, turn of catheter+the guidance of guide wire+the supporting of another catheter, ④ using special graphic catheter+the guidance of guide wire+the supporting of another catheter. The procedural X-ray exposure time, dosage of contrast agent and operation related complications were recorded. According to Myla classiifcation, the aortic arches were divided into Myla I, Myla II and Myla III types.
Results: There were 7/224 (3.1%) patients with Myla I aortic arch, 113 (50.4%) with Myla II aortic arch and 104 (46.4%) with Myla III aortic arch. A total of 48/104 (46.2%) Myla III patients used special techniques (tech③, tech④), it was more than the patients with Myla I, (1/7,14.3%) and Myla II (17/113, 15.0%), P<0.01. The patients with Myla III aortic arch had the longer X-ray exposure time and used the higher dose of contrast agent, all P<0.01. The procedural success rate in patients with
Myla III was 96.2%, it was lower than those with Myla I (100%) and Myla II (100%), P=0.045. The procedural complication rate in patients with Myla III was 22.1%, it was higher than those with Myla I (0%) and Myla II (8.9%), P=0.007.
Conclusion: The aortic arch type is the important inlfuential factor for the techniques used in carotid stent implantation. There were more dififculties and complications for stent implantation in patients with Myla III aortic arch.

OBJECTIVE:To observe therapeutic efficacy of zoledronic acid in the treatment of acute pain of vertebral compres-sion fractures during different courses. METHODS:207 patients with acute thoracic or (and) lumbar vertebral compression frac-tures were selected and randomly divided into trial group(107 cases)and control group(100 cases). Control group was given calci-um carbonate(1 200 mg/d)diclofenac sodium sustained-released tablet(75 mg/d).Trial group was additionally given zoledronic ac-id 5 mg added into 5%Glucose solution 100 ml,intravenous dripping for 15-30 min,on the basis of control group. RESULTS:Af-ter treatment,VAS score of two group decreased significantly,and trial group the decrease was more significant than control group,with statistical significance (P<0.05),there was no statistical significance in VAS score between course≤one month and one month 0.05);after 4d treatment,there was statistical significance in VAS score between course≤one month and one month 0.05);after one week,there was statistical significance in VAS score between one month 2 months (P<0.05).CONCLUSIONS:Zoledronic acid may partly alleviate the pain of acute vertebral fractures,the analgesic effect is more clear in early stage.