OBJECTIVE： To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL： We retr...OBJECTIVE： To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL： We retrieved data from the Chinese National Knowledge Infrastructure （1979-2012）, Wanfang （1980-2012）, VIP （1989-2012）, Chinese Biomedical Literature （1975- 2012）, PubMed （1966-2012）, Ovid Lww （-2012）, and Cochrane Library （-2012） Database using the internet. SELECTION CRITERIA： Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the in- cluded articles scored at least 4 points on the Jadad scale. Exclusion criteria： other acupuncture therapies as treatment group, not stroke-induced depression patients, score 〈 4 points, non-ran- domized controlled trials, or animal trials. MAIN OUTCOME MEASURES： These were the Hamilton Depression Scale scores, clinical ef- fective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. RESULTS： A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with fill- form needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval （C/）： 1.03-1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale （17 items） scores were lower than in the antide- pressant drug group （mean difference = -2.34, 95%CI： -3.46 to -1.22, P 〈 0.000,1）. At 4 weeks, Hamilton Depression Scale （24 items） scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 arti- cles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group. CONCLUSION： Early filiform needle acupuncture for poststroke depression can perfectly con- trol depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.展开更多
To the editor, I read with interest the recent report on ＂filiform needle acupuncture for poststroke depression＂ （Zhang et al., 2014）. Zhang et al. （2014） performed a meta-analysis and conclud- ed that ＂early ...To the editor, I read with interest the recent report on ＂filiform needle acupuncture for poststroke depression＂ （Zhang et al., 2014）. Zhang et al. （2014） performed a meta-analysis and conclud- ed that ＂early filiform needle acupuncture for poststroke depression can perfectly control depression：＇ In fact, the in- cluded meta-analysis might support the clinical effectiveness of filariform needle acupuncture for poststroke depression. However, there are several concerns. First, the hospital infection due to acupuncture manipulation with filiform is a big topic to be addressed. As Gang et al. （2012） noted, ＂aseptic technic principles aren＇t strictly followed; disinfection and isolation systems are unsound;展开更多
Objective: To explore the effect of zopiclone combined with Deanxit on cytokines and neurotransmitters in patients with poststroke depression. Methods: A total of 78 patients with poststroke depression who were treate...Objective: To explore the effect of zopiclone combined with Deanxit on cytokines and neurotransmitters in patients with poststroke depression. Methods: A total of 78 patients with poststroke depression who were treated in Zaozhuang Mining Group Dongjiao Hospital between January 2015 and February 2017 were divided into control group (n=41, receiving conventional Deanxit therapy) and zopiclone group (n=37, receiving zopiclone combined with Deanxit therapy). The differences in serum nerve injury marker, inflammatory cytokine and monoamine neurotransmitter levels were compared between the two groups before treatment and after 12 weeks of treatment. Results: Before treatment, serum levels of nerve injury markers, inflammatory cytokines and monoamine neurotransmitters were not significantly different between the two groups. After 12 weeks of treatment, serum nerve injury markers NSE and S100B levels of zopiclone group were lower than those of control group whereas BDNF level was higher than that of control group;serum inflammatory cytokines IL-1, IL-2, IL-23 and TNF-α levels of zopiclone group were lower than those of control group;serum monoamine neurotransmitters NE, 5-HT and DA levels of zopiclone group were higher than those of control group. Conclusion: Zopiclone combined with Deanxit therapy can effectively optimize the neurological function, reduce the inflammatory response and increase the secretion of monoamine neurotransmitters in patients with poststroke depression.展开更多
Objective To evaluate the effects of the selective serotonin reuptake inhibitor(SSRI) paroxetine on the functional capacities of poststroke depression.Method Seventy five patients were randomly assigned to 3 groups,du...Objective To evaluate the effects of the selective serotonin reuptake inhibitor(SSRI) paroxetine on the functional capacities of poststroke depression.Method Seventy five patients were randomly assigned to 3 groups,during 8 weeks of therapy,patients were treated wtih paroxetine,doxepin, and placebo.Before and at the end of the observation,we assessed ADL by Barthel index,degree of neurological deficit by Chinese stroke scale and depressive symptomatology by Hamilton depression rating scale.Results The three groups ameliorated ADL capacities and neurological deficitto different extents.The greatest improvement was observed in the paroxetine treated group.Conclusion Paroxetine may facilitate recovery in patients with poststroke depression undergoing rehabilitation.The effects of SSRI as an adunct to physical therapy warrant further investigation.展开更多
The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small do...The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small dose of reserpine. After intragastric perfusion with 45 mg/100 g, 15 mg/100 g, and 7.5 mg/100 g of Xingnao Jieyu for 7, 14 and 21 days, neuronal morphology in the frontal lobe and hippocampus was improved, depression state and voluntary behaviors were also effectively improved in rats with post-stroke depression. Moreover, the effects of Xingnao Jieyu at a dose of 45 and 15 mg/100 g were similar to the traditional antidepressant Prozac.展开更多
A number of studies have assessed the influence of depression on the risk of cardiovascular disease. A growing literature indicates a link between depression and cerebrovascular events, although the direction of this ...A number of studies have assessed the influence of depression on the risk of cardiovascular disease. A growing literature indicates a link between depression and cerebrovascular events, although the direction of this association remains unclear. Numerous data have emerged suggesting an association between depressive symptoms and subsequent risk of stroke, thus leading to the hypothesis that a direct causality between depression and stroke exists. Notwithstanding, how depression may act as a risk factor for stroke is still unclear. Depression might be linked to stroke via neuroendocrine and inflammation effects, through correlation with major comorbidities such as hypertensionand diabetes or by intervention of lifestyle behavioral mediators. Finally, antidepressant medications have recently drawn attention for a possible association with increased risk of stroke, although such findings remain uncertain. Depression has been also established as an important consequence after stroke, exerting a significant adverse impact on the course of motor recovery, social functioning and, overall, on quality of life. Post stroke depression occurs in nearly one third of stroke cases, but the exact mechanism leading to depression after stroke is still incompletely understood. In this article, we will review contemporary epidemiologic studies, discuss potential mechanisms and specific aspects of the complex relation between depression and stroke.展开更多
Background： The pathophysiology of poststroke depression （PSD） remains elusive because of its proposed multifactorial nature. Accumulating evidence suggests that brain-derived neurotrophic factor （BDNF） plays a k...Background： The pathophysiology of poststroke depression （PSD） remains elusive because of its proposed multifactorial nature. Accumulating evidence suggests that brain-derived neurotrophic factor （BDNF） plays a key role in the pathophysiology of depression and PSD. And the cerebellar dysfunction may be important in the etiology of depression; it is not clear whether it also has a major effect on the risk of PSD. This study aimed to explore the expression of BDNF and high-affinity receptors tyrosine kinase B （TrkB） in the cerebellum of rats with PSD. Methods： The rat models with focal cerebral ischemic were made using a thread embolization method. PSD rat models were established with comprehensive separate breeding and unpredicted chronic mild stress （UCMS） on this basis. A normal control group, depression group, and a stroke group were used to compare with the PSD group. Thirteen rats were used in each group. Immunohistochemistry and reverse transcription-polymerase chain reaction （RT-PCR） for detecting the expression of BDNF and TrkB protein and mRNA in the cerebellum were used at the 29th day following the UCMS. Results： Compared with the normal control group and the stroke group, the number of BDNF immunoreactive （IR） positive neurons was less in the PSD group （P 〈 0.05）. Furthermore, the number ofTrkB 1R positive cells was significantly less in the PSD group than that in the normal control group （P 〈 0.05）. The gene expression of BDNF and TrkB in the cerebellum of PSD rats also decreased compared to the normal control group （P 〈 0.05）. Conclusions： These findings suggested a possible association between expression of BDNF and TrkB in the cerebellum and the pathogeuesis of PSD.展开更多
目的:探讨急性脑梗死(又称缺血性脑卒中)早期给予涤痰化瘀汤治疗对患者并发抑郁、神经功能康复的影响。方法:选取在安徽中医药大学附属滁州中西医结合医院脑病科住院治疗的痰瘀互结型急性脑梗死患者100例,随机分为中药组和常规治疗组,...目的:探讨急性脑梗死(又称缺血性脑卒中)早期给予涤痰化瘀汤治疗对患者并发抑郁、神经功能康复的影响。方法:选取在安徽中医药大学附属滁州中西医结合医院脑病科住院治疗的痰瘀互结型急性脑梗死患者100例,随机分为中药组和常规治疗组,各50例,两组均给予常规基础治疗,中药组加用涤痰化瘀汤,入院72 h开始服用,疗程为6个月。分别检测两组治疗前、治疗3个月、治疗6个月中性粒细胞与淋巴细胞比值(Neutrophil to Lymphocyte Ratio,NLR)、血尿酸(Uric Acid,UA)、脑血流动力学指标[大脑后动脉平均血流速度(Vm)、搏动指数(Pulsatility Index,PI)和阻力指数(Resistance Index,RI)]变化情况,并观察两组治疗前后美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、改良Barthel指数(Modified Barthel Index,MBI)评分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分、中医证候积分(痰证积分、血瘀证积分)变化情况,同时随访两组6个月脑梗死复发情况。结果:治疗前两组NIHSS评分、MBI评分、中医证候积分无差异(P>0.05),治疗3个月,两组NIHSS评分均较治疗前降低(P<0.05),MBI评分均较治疗前升高(P<0.05),但中药组优于常规治疗组(P<0.05),常规治疗组中医证候积分较治疗前无明显变化(P>0.05),但中药组中医证候积分较治疗前下降(P<0.05),且两组差异有统计学意义(P<0.05)。治疗6个月后两组NIHSS评分较治疗3个月时明显下降(P<0.05),MBI评分明显上升(P<0.05),差异有统计学意义(P<0.01),常规治疗组中医证候积分较3个月时无明显变化(P>0.05),但中药组较3个月时明显下降(P<0.05),且差异有统计学意义(P<0.05)。治疗3个月后常规治疗组HAMD评分、NLR、UA显著高于中药组;治疗6个月后,两组HAMD评分、NLR、UA均降低,且中药组低于常规治疗组(P<0.05)。治疗3个月后,常规治疗组的Vm低于中药组,PI、RI高于中药组(P<0.05),治疗6个月后两组Vm、PI、RI均较治疗前改善,中药组优于常规治疗组(P<0.05)。中药组治疗3个月后出现10例并发抑郁,6个月后为6例,常规治疗组治疗3个月后有20例并发抑郁,治疗6个月后为15例,差异有统计学意义(P<0.05)。治疗6个月后,中药组3例脑梗死复发,常规治疗组为10例。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:涤痰化瘀汤早期治疗急性缺血性脑梗死能明显改善患者神经功能缺损,提高日常生活能力,改善中医证候、脑血流动力,降低NLR、UA水平,减少卒中后抑郁发生率,同时降低脑梗死复发率,临床应用无明显不良反应,安全性好。展开更多
基金supported by the Guangdong Provincial"211 Engineering"Stage-III Key Disciplines Construction Project in China,No.Yue 2009431
文摘OBJECTIVE： To evaluate the effectiveness and safety of filiform needle acupuncture for poststroke depression, and to compare acupuncture with the therapeutic efficacy of antidepressant drugs. DATA RETRIEVAL： We retrieved data from the Chinese National Knowledge Infrastructure （1979-2012）, Wanfang （1980-2012）, VIP （1989-2012）, Chinese Biomedical Literature （1975- 2012）, PubMed （1966-2012）, Ovid Lww （-2012）, and Cochrane Library （-2012） Database using the internet. SELECTION CRITERIA： Randomized controlled trials on filiform needle acupuncture versus antidepressant drugs for treatment of poststroke depression were included. Moreover, the in- cluded articles scored at least 4 points on the Jadad scale. Exclusion criteria： other acupuncture therapies as treatment group, not stroke-induced depression patients, score 〈 4 points, non-ran- domized controlled trials, or animal trials. MAIN OUTCOME MEASURES： These were the Hamilton Depression Scale scores, clinical ef- fective rate, Self-Rating Depression Scale scores, Side Effect Rating Scale scores, and incidence of adverse reaction and events. RESULTS： A total of 17 randomized controlled clinical trials were included. Meta-analysis results displayed that after 4 weeks of treatment, clinical effective rate was better in patients treated with fill- form needle acupuncture than those treated with simple antidepressant drugs [relative risk = 1.11, 95% confidence interval （C/）： 1.03-1.21, P = 0.01]. At 6 weeks, clinical effective rate was similar between filiform needle acupuncture and antidepressant drug groups. At 2 weeks after filiform needle acupuncture, Hamilton Depression Scale （17 items） scores were lower than in the antide- pressant drug group （mean difference = -2.34, 95%CI： -3.46 to -1.22, P 〈 0.000,1）. At 4 weeks, Hamilton Depression Scale （24 items） scores were similar between filiform needle acupuncture and antidepressant drug groups. Self-Rating Depression Scale scores were lower in filiform needle acupuncture group than in the antidepressant drug group. Side Effect Rating Scale was used in only two articles, and no meta-analysis was conducted. Safety evaluation of the 17 arti- cles showed that gastrointestinal tract reactions such as nausea and vomiting were very common in the antidepressant drug group. Incidence of adverse reaction and events was very low in the filiform needle acupuncture group. CONCLUSION： Early filiform needle acupuncture for poststroke depression can perfectly con- trol depression. Filiform needle acupuncture is safe and reliable. Therapeutic effects of filiform needle acupuncture were better than those of antidepressant drugs.
文摘To the editor, I read with interest the recent report on ＂filiform needle acupuncture for poststroke depression＂ （Zhang et al., 2014）. Zhang et al. （2014） performed a meta-analysis and conclud- ed that ＂early filiform needle acupuncture for poststroke depression can perfectly control depression：＇ In fact, the in- cluded meta-analysis might support the clinical effectiveness of filariform needle acupuncture for poststroke depression. However, there are several concerns. First, the hospital infection due to acupuncture manipulation with filiform is a big topic to be addressed. As Gang et al. （2012） noted, ＂aseptic technic principles aren＇t strictly followed; disinfection and isolation systems are unsound;
基金Shandong Provincial Natural Science Foundation Project(Grant No.81471371).
文摘Objective: To explore the effect of zopiclone combined with Deanxit on cytokines and neurotransmitters in patients with poststroke depression. Methods: A total of 78 patients with poststroke depression who were treated in Zaozhuang Mining Group Dongjiao Hospital between January 2015 and February 2017 were divided into control group (n=41, receiving conventional Deanxit therapy) and zopiclone group (n=37, receiving zopiclone combined with Deanxit therapy). The differences in serum nerve injury marker, inflammatory cytokine and monoamine neurotransmitter levels were compared between the two groups before treatment and after 12 weeks of treatment. Results: Before treatment, serum levels of nerve injury markers, inflammatory cytokines and monoamine neurotransmitters were not significantly different between the two groups. After 12 weeks of treatment, serum nerve injury markers NSE and S100B levels of zopiclone group were lower than those of control group whereas BDNF level was higher than that of control group;serum inflammatory cytokines IL-1, IL-2, IL-23 and TNF-α levels of zopiclone group were lower than those of control group;serum monoamine neurotransmitters NE, 5-HT and DA levels of zopiclone group were higher than those of control group. Conclusion: Zopiclone combined with Deanxit therapy can effectively optimize the neurological function, reduce the inflammatory response and increase the secretion of monoamine neurotransmitters in patients with poststroke depression.
文摘Objective To evaluate the effects of the selective serotonin reuptake inhibitor(SSRI) paroxetine on the functional capacities of poststroke depression.Method Seventy five patients were randomly assigned to 3 groups,during 8 weeks of therapy,patients were treated wtih paroxetine,doxepin, and placebo.Before and at the end of the observation,we assessed ADL by Barthel index,degree of neurological deficit by Chinese stroke scale and depressive symptomatology by Hamilton depression rating scale.Results The three groups ameliorated ADL capacities and neurological deficitto different extents.The greatest improvement was observed in the paroxetine treated group.Conclusion Paroxetine may facilitate recovery in patients with poststroke depression undergoing rehabilitation.The effects of SSRI as an adunct to physical therapy warrant further investigation.
基金supported by the Major Program of "13115" Science and Technology Innovation Project (Preclinical study of Xingnao Jieyu capsule), No. 2010ZDKG-65
文摘The present study established a rat model of post-stroke depression using incomplete ischemia induced by unilateral carotid artery ligation in combination with solitary raising and subcutaneous injection of a small dose of reserpine. After intragastric perfusion with 45 mg/100 g, 15 mg/100 g, and 7.5 mg/100 g of Xingnao Jieyu for 7, 14 and 21 days, neuronal morphology in the frontal lobe and hippocampus was improved, depression state and voluntary behaviors were also effectively improved in rats with post-stroke depression. Moreover, the effects of Xingnao Jieyu at a dose of 45 and 15 mg/100 g were similar to the traditional antidepressant Prozac.
文摘A number of studies have assessed the influence of depression on the risk of cardiovascular disease. A growing literature indicates a link between depression and cerebrovascular events, although the direction of this association remains unclear. Numerous data have emerged suggesting an association between depressive symptoms and subsequent risk of stroke, thus leading to the hypothesis that a direct causality between depression and stroke exists. Notwithstanding, how depression may act as a risk factor for stroke is still unclear. Depression might be linked to stroke via neuroendocrine and inflammation effects, through correlation with major comorbidities such as hypertensionand diabetes or by intervention of lifestyle behavioral mediators. Finally, antidepressant medications have recently drawn attention for a possible association with increased risk of stroke, although such findings remain uncertain. Depression has been also established as an important consequence after stroke, exerting a significant adverse impact on the course of motor recovery, social functioning and, overall, on quality of life. Post stroke depression occurs in nearly one third of stroke cases, but the exact mechanism leading to depression after stroke is still incompletely understood. In this article, we will review contemporary epidemiologic studies, discuss potential mechanisms and specific aspects of the complex relation between depression and stroke.
基金Acknowledgments We would like to thank Dr. Tricia for her invaluable comments in the writing of this manuscript. I This research- was supported by a grant from the Yunnan Natural Science Foundation （No. 2009ZC126M）.
文摘Background： The pathophysiology of poststroke depression （PSD） remains elusive because of its proposed multifactorial nature. Accumulating evidence suggests that brain-derived neurotrophic factor （BDNF） plays a key role in the pathophysiology of depression and PSD. And the cerebellar dysfunction may be important in the etiology of depression; it is not clear whether it also has a major effect on the risk of PSD. This study aimed to explore the expression of BDNF and high-affinity receptors tyrosine kinase B （TrkB） in the cerebellum of rats with PSD. Methods： The rat models with focal cerebral ischemic were made using a thread embolization method. PSD rat models were established with comprehensive separate breeding and unpredicted chronic mild stress （UCMS） on this basis. A normal control group, depression group, and a stroke group were used to compare with the PSD group. Thirteen rats were used in each group. Immunohistochemistry and reverse transcription-polymerase chain reaction （RT-PCR） for detecting the expression of BDNF and TrkB protein and mRNA in the cerebellum were used at the 29th day following the UCMS. Results： Compared with the normal control group and the stroke group, the number of BDNF immunoreactive （IR） positive neurons was less in the PSD group （P 〈 0.05）. Furthermore, the number ofTrkB 1R positive cells was significantly less in the PSD group than that in the normal control group （P 〈 0.05）. The gene expression of BDNF and TrkB in the cerebellum of PSD rats also decreased compared to the normal control group （P 〈 0.05）. Conclusions： These findings suggested a possible association between expression of BDNF and TrkB in the cerebellum and the pathogeuesis of PSD.
文摘目的:探讨急性脑梗死(又称缺血性脑卒中)早期给予涤痰化瘀汤治疗对患者并发抑郁、神经功能康复的影响。方法:选取在安徽中医药大学附属滁州中西医结合医院脑病科住院治疗的痰瘀互结型急性脑梗死患者100例,随机分为中药组和常规治疗组,各50例,两组均给予常规基础治疗,中药组加用涤痰化瘀汤,入院72 h开始服用,疗程为6个月。分别检测两组治疗前、治疗3个月、治疗6个月中性粒细胞与淋巴细胞比值(Neutrophil to Lymphocyte Ratio,NLR)、血尿酸(Uric Acid,UA)、脑血流动力学指标[大脑后动脉平均血流速度(Vm)、搏动指数(Pulsatility Index,PI)和阻力指数(Resistance Index,RI)]变化情况,并观察两组治疗前后美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、改良Barthel指数(Modified Barthel Index,MBI)评分、汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分、中医证候积分(痰证积分、血瘀证积分)变化情况,同时随访两组6个月脑梗死复发情况。结果:治疗前两组NIHSS评分、MBI评分、中医证候积分无差异(P>0.05),治疗3个月,两组NIHSS评分均较治疗前降低(P<0.05),MBI评分均较治疗前升高(P<0.05),但中药组优于常规治疗组(P<0.05),常规治疗组中医证候积分较治疗前无明显变化(P>0.05),但中药组中医证候积分较治疗前下降(P<0.05),且两组差异有统计学意义(P<0.05)。治疗6个月后两组NIHSS评分较治疗3个月时明显下降(P<0.05),MBI评分明显上升(P<0.05),差异有统计学意义(P<0.01),常规治疗组中医证候积分较3个月时无明显变化(P>0.05),但中药组较3个月时明显下降(P<0.05),且差异有统计学意义(P<0.05)。治疗3个月后常规治疗组HAMD评分、NLR、UA显著高于中药组;治疗6个月后,两组HAMD评分、NLR、UA均降低,且中药组低于常规治疗组(P<0.05)。治疗3个月后,常规治疗组的Vm低于中药组,PI、RI高于中药组(P<0.05),治疗6个月后两组Vm、PI、RI均较治疗前改善,中药组优于常规治疗组(P<0.05)。中药组治疗3个月后出现10例并发抑郁,6个月后为6例,常规治疗组治疗3个月后有20例并发抑郁,治疗6个月后为15例,差异有统计学意义(P<0.05)。治疗6个月后,中药组3例脑梗死复发,常规治疗组为10例。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:涤痰化瘀汤早期治疗急性缺血性脑梗死能明显改善患者神经功能缺损,提高日常生活能力,改善中医证候、脑血流动力,降低NLR、UA水平,减少卒中后抑郁发生率,同时降低脑梗死复发率,临床应用无明显不良反应,安全性好。
