Objective:To explore and compare the effectiveness of various non-invasive brain stimulations (NiBS) on poststroke lower extremity disorders. Methods:We searched for and gathered studies from Embase, PubMed, Web of Science, and Cochrane databases, with the most recent search carried out on 5 October 2024. All published studies meeting the eligibility criteria and investigating the effectiveness of NiBS in patients with poststroke lower limb disorders were included. A total of 29 studies involving 1,319 participants were reviewed. Two independent researchers extracted clinical characteristics and research data. Outcome measures included the Fugl-Meyer lower extremity scale, Barthel index, Berg balance scale (BBS), and timed up and go test. Standard pairwise meta-analysis results and treatment network geometry were generated using Stata MP version 15.0. Bayesian network analysis was conducted using R version 4.4.1 with the "BUGSnet" package. Conclusion:The meta-analysis shows that low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and rTMS + transcranial direct current stimulation (tDCS) are effective neurostimulation therapies for enhancing poststroke lower limb motor function. Probability rankings indicate that, among all NiBS interventions examined, rTMS + tDCS may be the most effective. In terms of body balance, intermittent theta burst stimulation (iTBS) and LF-rTMS improved poststroke balance, with iTBS possibly being the most effective. For activities of daily living, iTBS, LF-rTMS, and rTMS + tDCS demonstrated beneficial effects, with LF-rTMS potentially being the most effective among them.

目的:汉化上肢活动量表(arm activity measure,ArmA)并分析其信度和效度,为评估脑卒中患者痉挛后上肢功能障碍提供简单、有效的工具.方法:对英文版ArmA进行翻译和文化调试,并使用中文版ArmA对50例脑卒中患者进行自我评估,对其结果进行重测信度、内在一致性和效度分析.结果:试验共入组50例脑卒中患者,平均年龄(52.32±14.83)岁.中文版ArmA量表被动部分与主动部分Cronbachα系数分别为0.718和0.831;重测信度的总分组内相关系数ICC为0.990,各条目的ICC值范围为0.902-1.000;每个条目与其所在维度的相关系数均在0.4以上(P＜0.05),且均高于与其他维度的相关系数;结构效度主成分分析的结果共提取4个公因子;通过spearman相关分析发现,中文版ArmA量表主动部分与上肢Fugl-Meyer量表具有一定相关,与改良Ashworth量表(modified Ashworth scale,MAS)相关性无显著性差异(P＞0.05).结论:中文版ArmA量表在脑卒中患者中具有良好的信度和效度,且评测可操作性高,适用于评估我国脑卒中患者痉挛后上肢的活动功能.

《国际功能、残疾和健康分类》(International Classification of Functioning,Disability and Health,ICF),自2001年由世界卫生组织(WHO)颁布至今已近二十年,但我国大多数康复专业人员对ICF临床应用仍较为模糊.因此,探索ICF中国应用模式并加以推广应用具有重要意义.本ICF专家共识通过广泛征求专家意见并经反复讨论,分别从ICD到ICF的变革、ICF到ICF康复组合的演变、ICF类目在临床评估过程中的量化、ICF的临床应用模式、ICF数据平台的构建、ICF权重体系的构建等角度提出了ICF临床应用的专家共识,为ICF在国内临床康复中更好地应用提供了借鉴.

OBJECTIVES:. The aim was to evaluate the effect of dihydropyridine calcium channel blocker on the prognosis for moderate-severe pulmonary acute respiratory distress syndrome in hypertension patients. DESIGN:. A retrospective, observational, multicenter cohort study. SETTING:. A total of 307 patients without propensity score matching and 186 adult inpatients with propensity score matching diagnosed with hypertension and moderate-severe pulmonary acute respiratory distress syndrome in five teaching hospitals in Jiangsu province, China, from December 2015 to December 2020 were enrolled. PATIENTS:. A total of 307 patients without propensity score matching and 186 patients with propensity score matching diagnosed with hypertension and moderate-severe pulmonary acute respiratory distress syndrome were included in the final analysis. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Demographic characteristics and clinical characteristics were recorded. The propensity score matching method was used to eliminate the difference between group with dihydropyridine calcium channel blocker and group without dihydropyridine calcium channel blocker. The primary outcome was in-hospital mortality. We used univariate and multivariate regression analyses for both patients with or without propensity score matching to assess the effect of these variables on mortality. In the subset of 186 patients with propensity score matching, in-hospital mortality was 53.2%. Inpatient mortality was significantly higher in patients treated with dihydropyridine calcium channel blocker than in those not treated with dihydropyridine calcium channel blocker of patients without propensity score matching (65.4% vs 40.4%; p < 0.01). Multivariate analysis for patients without propensity score matching showed that dihydropyridine calcium channel blocker (hazard ratio, 1.954; 95% CI, 1.415–2.699), lactate dehydrogenase greater than or equal to 600 U/L (hazard ratio, 3.809; 95% CI, 2.106–4.531), and lactate greater than or equal to 2 mmol/L (hazard ratio, 1.454; 95% CI, 1.041–2.029) were independently associated with in-hospital mortality. Based on univariate analysis for patients with propensity score matching, dihydropyridine calcium channel blocker (hazard ratio, 2.021; 95% CI, 1.333–3.064), lactate dehydrogenase greater than or equal to 600 U/L (hazard ratio, 4.379; 95% CI, 2.642–7.257), and lactate greater than or equal to 2 mmol/L (hazard ratio, 2.461; 95% CI, 1.534–3.951) were independently associated with in-hospital mortality. In contrast, patients not treated with dihydropyridine calcium channel blocker had a significant survival advantage over those treated with dihydropyridine calcium channel blocker in both patients without or with propensity score matching (p < 0.001; p = 0.001 by Kaplan-Meier analysis). CONCLUSIONS:. Dihydropyridine calcium channel blocker, lactate dehydrogenase greater than or equal to 600 U/L, and lactate greater than or equal to 2 mmol/L at admission were independent risk factors for patients with hypertension and moderate-severe pulmonary acute respiratory distress syndrome.

躯干对人体姿势的维持、稳定和直立有着重要作用,脑卒中偏瘫患者康复治疗过程中,躯干平衡及姿势控制的恢复是运动功能和日常生活活动能力恢复的基础和关键[1].临床研究证实,虚拟现实技术对患者姿势控制、平衡、步态等的改善具有显著作用[1].BioMaster虚拟现实训练系统(Virtual Reallity Training System,VRTS)包括姿势控制评估与虚拟训练系统两个部分,不仅能够提供视觉反馈基础上的平衡功能训练,同时可提供躯干摆动角度等客观评估指标,对躯干姿势控制及训练过程中摆动角度的评估具有一定的可探讨性.鉴于国内关于VRTS在躯干控制角度评估方面的研究并不多见,本研究采用该系统评估健康人群的坐位时躯干倾斜角度变化的信度,旨在明确其用于姿势控制评估的可信度.

Although various treatment methods have been investigated to reduce spasticity and intoeing gait in children with cerebral palsy (CP), methods to concurrently reduce an intoeing gait and associated ankle/knee stiffness and spasticity according to a child's specific needs are lacking. This study aimed to develop a training program to improve walking function and transverse-plane (pivoting) neuromuscular control and reduce spasticity and intoeing gait deviations. Eight children with diplegic CP and intoeing gait participated in this 6-week combined robotic ankle and/or knee intelligent stretching and pivoting neuromuscular control training program (Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training, [SS-POINT]). The effects of SS-POINT were evaluated using neuromechanical, functional, and clinical outcome measures and compared to those for eight children with CP and intoeing gait who participated in pivoting neuromuscular control training (POINT) alone in a previous study.RESULTS:After the SS-POINT program, subjects with CP showed reduced knee stiffness and intoeing angle, and improvements in both joint and leg functions in terms of ankle and knee active range of motion, ankle dorsiflexor strength, proprioception, walking speed, balance, and minimum pivoting angle. Furthermore, improvements in proprioceptive acuity and minimum pivoting angle after the SS-POINT were greater than those after the POINT.CONCLUSION:The SS-POINT approach can be used as a subject-specific training program for improving leg and walking functions and reducing intoeing during gait.SIGNIFICANCE:This approach can serve as an individualized intervention at the joint and walking levels to maximize intervention effects by adjusting training targets, sequences, and intensities to meet the individual needs of children with CP.

Hypoxia is a common pathological process caused by insufficient oxygen. Long noncoding RNAs (lncRNAs) have been proven to participate in this pathology. Hypoxia is reported to significantly reduce the secretion of tissue inhibitor of metalloproteinase 2 (TIMP2) and TIMP2 induces pheochromocytoma-12 (PC12) cell cycle arrest. Thus, our study aimed to explore the mechanism by which lncRNA maternally expressed gene 3 (MEG3) was implicated in hypoxia-induced PC12 cell injury through TIMP2 promoter methylation. To elucidate the potential biological significance of MEG3 and the regulatory mechanism between MEG3 and TIMP2, a hypoxia-induced PC12 cell injury model was generated. The hypoxia-exposed cells were subjected to a series of overexpression plasmids and short hairpin RNAs, followed by the measurement of levels of MEG3, TIMP2, lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxygen species (ROS), Bcl-2-associated X protein, B-cell lymphoma-2, and caspase-3, as well as the changes in MMP, cell proliferation, apoptosis, and cell cycle progression. On the basis of the findings, MEG3 was upregulated in hypoxia-injured PC12 cells. MEG3 recruited methylation proteins DNMT3a, DNMT3b, and MBD1 and accelerated TIMP2 promoter methylation, which in turn inhibited its expression. Moreover, PC12 cells following MEG3 silencing and TIMP2 overexpression exhibited significantly decreased levels of LDH, MDA, and ROS along with cell apoptosis, yet increased SOD and MMP levels, as well as cell cycle entry to the S phase and cell proliferation. In conclusion, MEG3 silencing suppresses hypoxia-induced PC12 cell injury by inhibiting TIMP2 promoter methylation. This study may provide novel therapeutic targets for hypoxia-induced injury.

Background: Electroacupuncture (EA) has been observed to exerts in inflammatory pain. However, the invasiveness of EA may bring risk of infection. Transcutaneous electrical acupoint stimulation (TEAS)with similar parameters as EA without the risk of infection. Previous studies have shown that TEAS treatment can alleviate postoperative pain. However, its analgesic role in inflammatory pain has not been investigated. Methods: Complete Freund’s adjuvant (CFA)was injected into the male Sprague‐Dawley of rats to generate an inflammatory model. EA or TEAS treatment at the Zusanli (ST36) and Sanyinjiao (SP6) acupoints was given 4 days of CFA injection of mechanical and thermal sensitivity were determined. Microdialysis was performed before and after EA or TEAS. Adenosine concentration of dialysates as measured by high performance liquid chromatography. Results: TEAS treatment showed similar analgesic effects to EA treatment as assessed of rat’s paw withdrawal latency in response to mechanical and thermal stimulation. EA treatment significantly elevated adenosine concentration for at least 30 minutes, while TEAS induced a significant adenosine increase with similar amplitude over 60 minutes. Conclusion: TEAS may be a more convenient and more effective substitute for EA in inflammatory pain treatment.

Objective:To explore electrical acupuncture (EA) therapy effects on complete freund's adjuvant (CFA) induced inflammatory pain model rats. Methods:A total of 30 SD male rats were randomly divided into normal saline + Sham Electroacupuncture (NS+SE) group, CFA+Sham EA (CFA+SE) group and CFA+ Electroacupuncture (CFA+EA) group, with 10 rats in each group.Mechanical and thermal allodynia were assessed before and after EA treatment at Day 4 after CFA injection. Dialysate of the rats was collected from the right tibialis anterior muscle by microdialysis at Day 5 from 1.5 hours before the treatment until 1.5 hours after treatment. Adenosine concentration in the dialysate was analyzed by HPLC. Results:At Day 4 after injection of paclitaxel, EA treatment can obviously increase the pain threshold of CFA-induced inflammatory pain rat model. The mechanical allodynia showed that the Von Frey result of the CFA+EA group was significantly decreased (P＜0.05) after treatment, and the PWL results also significantly prolonged (P＜0.05) compared with the NS+SE group and the CFA+SE group. Conclusion:EA can increase rats pain threshold of CFA-induced inflammatory pain, and alleviate inflammatory pain. The alleviate of inflammatory pain might through adenosine increasment in the local tissue fluid around the acupoints.

Uncertainties still remain in terms of the efficacy of anti-hypertensive treatment on the risk of major cardiovascular (CV) events within prehypertensive levels. This review aims to assess the efficacy and safety of anti-hypertensives on the CV risks in populations within prehypertensive levels. Randomized controlled trials (RCTs) concerning active treatment vs placebo in populations within prehypertensive levels were identified through electronic database and manual search. Outcomes included the first co-primary outcomes, stroke, heart failure (HF), myocardial infarction (MI), all-cause mortality, and cardiovascular mortality. The first co-primary outcomes were defined as composite cardiovascular disease (CVD) events in the included studies. A total of 29 RCTs involving 127,641 participants were identified. Pooled analysis showed active treatment was associated with a significant 7% reduction in risk of the first co-primary outcomes, 14% in stroke, and 10% in HF as compared to placebo (0.86, 0.77–0.96; 0.93, 0.89–0.98; and 0.90, 0.83–0.97). However, there were no significant reductions in risk of MI, all-cause mortality, and cardiovascular mortality. A significant reduction in risk of the first co-primary outcomes was observed in subpopulations with systolic blood pressure (SBP) 130–139 mmHg (0.94, 0.89–0.99) or prior CVDs (0.88, 0.82–0.94). Meta-regression analyses showed no significant relative risk reductions proportional to the magnitude of the mean baseline BP, mean on-treatment BP, the mean absolute change in BP, the proportion of patients with hypertension, and mean age. In summary, anti-hypertensive treatment has beneficial cardiovascular effects in populations within prehypertensive levels, especially in subpopulations with SBP 130–139 mmHg or prior CVDs.

Functional electrical stimulation can improve motor function after stroke. The mechanism may involve activity-dependent plasticity and brain remodeling. The aim of our study was to investigate the effectiveness of a patterned electrical stimulation FES mimic to gait in motor recovery among stroke survivors and to investigate possible mechanisms through brain fMRI. Forty-eight subjects were recruited and randomly assigned to a four-channel FES group (n=18), a placebo group (n=15), or a dual-channel FES group (n=15). Stimulation lasted for 30 minutes in each session for 3 weeks. All of the subjects were assessed at baseline and after weeks 1, 2, and 3. The assessments included the Fugl-Meyer Assessment, the Postural Assessment Scale for Stroke Patients, Brunel’s Balance Assessment, the Berg Balance Scale, and the modified Barthel Index. Brain fMRI were acquired before and after the intervention. All of the motor assessment scores significantly increased week by week in all the three groups. The four-channel group showed significantly better improvement than the dual-channel group and placebo groups. fMRI showed that fractional anisotropy was significantly increased in both the four-channel and dual-channel groups compared with the placebo group and fiber bundles had increased significantly on the ipsilateral side, but not on the contralateral side in the group given four-channel stimulation. In conclusion, when four-channel FES induces cycling movement of the lower extremities based on a gait pattern, it may be more effective in promoting motor recovery and induce more plastic changes and brain remodeling than two-channel stimulation. This trial is registered with clinical trial registration unique identifier ChiCTR-TRC-11001615.

Objective: To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke. Data Sources: Electronic databases, including PubMed, EMBase, Cochrane Library, PEDro (Physiotherapy Evidence Database), and PsycINFO, were searched from the inception to January 2017. Study Selection: We selected the randomized controlled trials (RCTs) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment. Data Extraction: The primary outcome was defined as lower limb motor function, and the secondary outcomes included gait speed, Berg Balance Scale, timed Up and Go, 6-minute walk test, Modified Ashworth Scale, and range of motion. Data Synthesis: Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles. Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function (standard mean difference 0.42, 95% confidence interval 0.26-0.58), especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks. NMES also had significant benefits on gait speed, balance, spasticity, and range of motion but had no significant difference in walking endurance after NMES. Conclusions: NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors. These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities. (C) 2018 by the American Congress of Rehabilitation Medicine

BACKGROUND The role of nicotinic acetylcholine receptor alpha7 subunit (a7nAchR) in the treatment of acute cerebral ischemia by VNS has not been thoroughly clarified to date. Therefore, this study aimed to investigate the specific role of a7nAchR and explore whether this process is involved in the mechanisms of VNS-induced neuroprotection in rats undergoing permanent middle cerebral artery occlusion (PMCAO) surgery. MATERIAL AND METHODS Rats received a7nAChR antagonist (A) or antagonist placebo injection for control (AC), followed by PMCAO and VNS treatment, whereas the a7nAChR agonist (P) was utilized singly without VNS treatment but only with PMCAO pretreatment. The rats were randomly divided into 6 groups: sham PMCAO, PMCAO, PMCAO+VNS, PMCAO+VNS+A, PMCAO+VNS+AC, and PMCAO+P. Neurological function and cerebral infarct volume were measured to evaluate the level of brain injury at 24 h after PMCAO or PMCAO-sham. Moreover, the related proteins levels of a7nAChR, p-JAK2, and p-STAT3 in the ischemic penumbra were assessed by Western blot analysis. RESULTS Rats pretreated with VNS had significantly improved neurological function and reduced cerebral infarct volume after PMCAO injury (p<0.05). In addition, VNS enhanced the levels of a7nAchR, p-JAK2, and p-STAT3 in the ischemic penumbra (p<0.05). However, inhibition of a7nAchR not only attenuated the beneficial neuroprotective effects induced by VNS, but also decreased levels of p-JAK2 and p-STAT3. Strikingly, pharmacological activation of a7nAchR can partially substitute for VNS-induced beneficial neurological protection. CONCLUSIONS These results suggest that a7nAchR is a pivotal mediator of VNS-induced neuroprotective effects on PMCAO injury, which may be related to suppressed inflammation via activation of the a7nAchR/JAK2 anti-inflammatory pathway.

OBJECTIVE:To clarify the effects of TNFSF4 (rs3850641) polymorphisms on coronary heart disease (CHD) risk.METHOD:Published literature from Pubmed, Embase, ISI Wed of Knowledge, Cochrane Library, and Chinese databases were retrieved. All studies evaluating the association between TNFSF4 (rs3850641) polymorphisms and CHD risk were included. Summary odds ratios (ORs) and 95% confidence intervals (CI) were calculated employing random-effects models irrespective of between-study heterogeneity.RESULTS:A total of 9 eligible studies was included in this meta-analysis. Overall analysis showed that the rs3850641 G allele was not associated with CHD, compared with the A allele, with OR of 1.10 (95% CI, 0.96-1.27; p = 0.174). Genotypic analysis showed that there was no significant association between the GG, GA, GG + GA, and CHD, compared with participants with AA, with ORs of 1.23 (95% CI, 0.75-2.03; p = 0.409), 1.04 (95% CI, 0.84-1.29; p = 0.705), and 1.07 (95% CI, 0.85-1.34; p = 0.589), respectively. On the other hand, in the subgroup analysis by ethnicity, source of controls, genotyping methods, or matching criteria, there was still no statistically significant association between TNFSF4 (rs3850641) polymorphisms and CHD risk.CONCLUSIONS:This meta-analysis reveals that TNFSF4 (rs3850641) polymorphisms is not associated with CHD risk.

Background: In patients at high risk of atherosclerotic cardiovascular diseases (ASCVDs), residual cardiovascular risk persists despite the achievement of target LDL cholesterol levels with statin therapy. It is still unclear whether adding lipid-modifying agent to statin treatment can further improve clinical outcomes.Methods: Randomized controlled trials (RCTs) in terms of adding lipid-modifying agent to statin versus statin monotherapy in patients at high risk of ASCVD were identified by electronic and manual searches. Results were expressed as relative risk (RR) with 95% confidence intervals (CIs).Results: Eleven RCTs with 109,244 patients were included in this meta-analysis. Overall, the incidences of major adverse cardiovascular events (MACEs) were 9.70% in the statin combination groups and 9.92% in the statin monotherapy groups. No significant difference was observed in the risk of MACEs either in overall (RR 0.99, 95% CI 0.93-1.05, P = 0.76) or subgroup analysis (CETP inhibitor: RR 1.07, 95% CI 0.93-1.23, P = 0.37; niacin: RR 1.03, 95% CI 0.85-1.25, P = 0.79; n-3 fatty acid: RR 0.98, 95% CI 0.88-1.09, P = 0.70; fenofibrate: RR 0.93, 95% CI 0.80-1.09, P = 0.38), with the exception of the statin/ezetimibe combination subgroup (RR 0.92, 95% CI 0.87-0.97, P = 0.004). Adding lipid-modifying agent to statin significantly increased liver injury risk. Adding ezetimibe to statin did not alter side effect profile.Conclusion: Adding niacin, CETP inhibitors, n-3 fatty acid or fibrates to statin therapy has all failed to achieve a clinical benefit. Adding ezetimibe to statin therapy further lowers LDL-cholesterol safely and translates into a clinical benefit in patients at high risk of ASCVD. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

Neural stem cells (NSCs) are important in rehabilitation following stroke. Electroacupuncture (EA) treatment has been observed to promote the recovery of neurological functions subsequent to stroke, however, the effects of EA on the proliferation and differentiation of NSCs and its potential mechanisms remain to be elucidated. In the present study, rats, in which a stroke was induced through middle cerebral artery occlusion (MCAO), were treated with EA or control manipulation for 21 days. The modified Neurological Severity score and Morris water maze tests were used to assess the neurological functions of the rats. Bromodeoxyuridine (BrdU)/glial fibrillary acidic protein (GFAP) or BrdU/neuronal marker (NeuN) double immunofluorescence staining were used to examine the proliferation and differentiation of the NSCs. Reverse transcription quantitative polymerase chain reaction (RT‑qPCR) and western blot analyses were performed to detect the expression levels of Notch1 and Hes1 in the dentate gyrus (DG) of the hippocampus of rats following MCAO. The results demonstrated that EA treatment significantly improved the neurological functional recovery of rats following stroke. A significant increase was observed in the number of BrdU+/GAFP+ and BrdU+/NeuN+ cells in the DG area in the EA‑treated rats compared with that of the control group. RT‑qPCR analysis revealed that EA treatment significantly increased the expression levels of Notch1 and Hes1, which may account for the enhanced proliferation and differentiation of NSCs. In conclusion, to the best of our knowledge, the present study was the first to demonstrate that EA treatment promoted NSC proliferation and neurogenesis in the DG area through the upregulation of Notch signaling following a stroke; therefore, EA may be a useful novel therapeutic strategy in future stroke treatment.

Previous studies have shown that proliferation of endogenous neural precursor cells cannot alone compensate for the damage to neurons and axons. From the perspective of neural plasticity, we observed the effects of functional electrical stimulation treatment on endogenous neural precursor cell proliferation and expression of basic fibroblast growth factor and epidermal growth factor in the rat brain on the infarct side. Functional electrical stimulation was performed in rat models of acute middle cerebral artery occlusion. Simultaneously, we set up a placebo stimulation group and a sham-operated group. Immunohistochemical staining showed that, at 7 and 14 days, compared with the placebo group, the numbers of nestin (a neural precursor cell marker)-positive cells in the subgranular zone and subventricular zone were increased in the functional electrical stimulation treatment group. Western blot assays and reverse-transcription PCR showed that total protein levels and gene expression of epidermal growth factor and basic fibroblast growth factor were also upregulated on the infarct side. Prehensile traction test results showed that, at 14 days, prehension function of rats in the functional electrical stimulation group was significantly better than in the placebo group. These results suggest that functional electrical stimulation can promote endogenous neural precursor cell proliferation in the brains of acute cerebral infarction rats, enhance expression of basic fibroblast growth factor and epidermal growth factor, and improve the motor function of rats.

Objective. To investigate the effectiveness of four-channel FES based on a normal gait pattern on improving functional ability in subjects early after ischemic stroke. Methods. Forty-five subjects were randomly assigned into a four-channel FES group (n=16), a placebo group (n=15), or a dual-channel group (n=14). Stimulation lasted for 30 min in each session with 1 session/day, 5 days a week for 3 weeks. All subjects were assessed at baseline, at 3 weeks of treatment, and at 3 months after the treatment had finished. The assessments included Fugl-Meyer Assessment (FMA), the Postural Assessment Scale for Stroke Patients (PASS), Berg Balance Scale (BBS), Functional Ambulation Category (FAC), and the Modified Barthel Index (MBI). Results. All 3 groups demonstrated significant improvements in all outcome measurements from pre- to posttreatment and further gains at followup. The score of FMA and MBI improved significantly in the four-channel group at the end of the 3 weeks of training. And the scores of PASS, BBS, MBI, and FAC in the four-channel group were significantly higher than those of the placebo group. Conclusions. This study indicated that four-channel FES can improve motor function, balance, walking ability, and performance of activities of daily living in subjects with early ischemic stroke.

Large-scale randomized controlled trials (RCTs) have well demonstrated the beneficial effects of cholesterol-lowering treatment with statins in patients at high risk of vascular disease. However, large statin RCTs were usually restricted to the typical 5–6 years. Moreover, non-cardiovascular events, especially the risk of cancer, probably failed to emerge within a restricted period of 6 years. The aim of this study was to evaluate the long-term efficacy and safety of statin treatment by performing a meta-analysis of statin RCTs with extended follow-up beyond 6 years. Six RCTs with post-trial follow-up were eligible for inclusion, involving 47,296 patients with total follow-up ranging from 6.7 to 14.7 years. During the post-trial period, all the surviving participants were advised to take a statin and the cholesterol level were almost identical between the original statin group and the original placebo group. Over the entire 6.7–14.7 years of follow-up, a significant reduction in the rates of all-cause mortality (relative risk 0.90, 95% confidence interval 0.85–0.96; P = 0.0009), cardiovascular mortality (0.87, 0.81–0.93; P < 0.0001) and major coronary events (0.79, 0.72–0.86; P < 0.00001) was observed in favour of the original statin group. During 2-year post-trial period, further reduction in all-cause mortality (0.83, 0.74–0.93; P = 0.001), cardiovascular mortality (0.81, 0.69–0.95; P = 0.01) and major coronary events (0.77, 0.63–0.95; P = 0.01) was observed among initially statin-treated patients. Over the entire follow-up period, statin treatment did not increase the incidence of cancers (0.99, 0.95–1.04; P = 0.79), deaths from cancers (1.00, 0.93–1.07; P = 0.98) and non-cardiovascular mortality (0.95, 0.90–1.00; P = 0.07). In conclusion, statin treatment beyond 6 years is effective and safe in patients at high risk of vascular events. Moreover, earlier treatment with statin may not only preserve the initial benefit but also have further survival benefit for additional 2 years. Further studies are called for to explore the underlying mechanisms.

Backgroud Angiotensin converting enzyme inhibitors (ACEIs) have been linked to reduced risk of new-onset diabetes, but the evidence was insufficient. Objective and methods The aim of this study was to evaluate the effect of ACEIs on the development of new-onset type 2 diabetes. Randomized controlled trials (RCTs) about ACEIs and new-onset diabetes were identified by electronic and manual searches. Results Nine RCTs with 92,404 patients (72,128 non-diabetic patients at baseline) were included in this study. Compared with control group, incidence of new-onset diabetes was significantly reduced in the ACEIs group [OR 0.80, (0.71, 0.91)], irrespective of achieved blood pressure levels at the follow-up. ACEIs therapy was associated with significant reduction in the risk of new-onset diabetes compared with beta-blockers/diuretics [OR 0.78, (0.65, 0.93)], placebo [OR 0.79, (0.64, 0.96)], or calcium channel blockers [OR 0.85, (0.73, 0.99)]. ACEIs treatment was associated with significant reduction in the risk of new-onset diabetes in patients with hypertension [OR 0.80, (0.68, 0.93)], coronary artery disease (CAD) or cardiovascular disease [OR 0.83, (0.68, 1.00)], or heart failure [OR 0.22, (0.10, 0.47)]. Among patients with impaired glucose tolerance or impaired fasting glucose, ramipril did not significantly reduce the incidence of diabetes [OR 0.91, (0.79, 1.05)], but significantly increased regression to normoglycemia. Conclusion ACEIs have beneficial effects in preventing new-onset diabetes. ACEIs provide additional benefits of lowering the risk of new-onset diabetes in patients with hypertension, CAD or other cardiovascular disease.