A study on the optimal dilution of serum to detect anti HBc-IgM with ELISA. was carried out. Samples were diluted to 10-1to 10-7. Among 26 samples of normal individuals, 22 were negative, but two samples of 10-1 dilution, one sample of 10-2, and one sample of 10-1-10-3 were positive though the control wells were all negative. 42 samples of the patients with variours types of hepatitis B were examined. It was found that when serum dilution was 10-1, only 6 cases were positive; when the dilution was 10-2, 20 cases were positive; when the dilutions were 10-3, 5?10-3, and 10-4, high positive rates were obtained and they were 88.1%, 78.5%, and 69% respectively; and when the samples were further diluted, the positive rate decreased.In order to get goodfresults and minimize false results, either false negative or false positive, it is suggested that 5?10-3 be the optimal dilution.

Objective To explore effective precautions and interventions for choking in dysphagia patients.Methods Clinical data on f dysphagia patients hospitalized from September 1,1996 to Aug 8,2014 were retrospectively analyzed to correlate choking with gender,age,consciousness,type of aspiration,food-intake pathway and food texture.Results Only 0.17％ of the patients (n =8) were found to have choked,and 6 of them were men.Children,teenagers,the middle-aged and the aged constituted 25％,12.5％,37.5％ and 25％ of the patients respectively.75％ were conscious and 62.5％ displayed silent aspiration.6 cases used oral intake and 2 used nasogastric tube feeding.Among the 8 choking patients,half ate solid food,2 semisolid and 2 liquid food.Six survived and 2 died.Conclusion The risk factors for choking include silent aspiration and oral intake of solid or semisolid food.The successful rescue rate for choking is relatively low,so clinicians should be aware of and try to eliminate these risk factors.

Objective To explore the rehabilitation for dysphagia in young patient after tracheotomy and cricopharyngeal achalasia with-out cough reflex. Methods A child was reviewed, who accepted tracheotomy after resection of cerebellar pilocytic astrocytoma for dyspha-gia. The features characterized as severe silent aspiration and failure of cricopharyngeus muscle relaxation. Therapies included Passy-Muir valve placement, breathing exercises, balloon dilatation, surface electromyography biofeedback, and electrical stimulation. Results The aspi-ration was observed when she drank thin liquid with weak cough reflex, and disappeared as eating thick liquid and paste food, with complete cricopharyngeus muscle opening, 7 weeks after treatment. She was removed the tracheotomy tube and nasal feeding tube 11 weeks after treatment, and got sufficient nutrition by fully oral intake. Conclusion The application of Passy-Muir valve and comprehensive swallowing training is helpful for patient post tracheotomy with silent aspiration in decreasing the risk of aspiration, improving cough reflex and prompt-ing swallowing function.

Objective To develop a quality of life scale suitable for aphasic Chinese stroke patients by translating and evaluating the psychometric properties of the original 39-generic version of the Stroke and Aphasia Quality of Life scale (SAQOL-39g).Methods The SAQOL-39g was translated into Chinese and edited.The well edited and translated self-rated and non-self-rated scales were used to test 86 aphasia patients and their caretakers to evaluate the feasibility,internal consistency,test-retest reliability,content validity,and construct validity of the scale.Results The feasibility of the Chinese version of the SAQOL-39g scale was sufficient,with 97％ of the ques tionnaires completed.The average time taken to complete the self-report version was (21.4±4.37) minutes,with (13.25±5.61) minutes needed for the proxy version.The Cronbach's alpha values for the overall survey ranged from 0.879 to 0.950 and for the subdomains from 0.863 to 0943 for both forms,suggesting satisfactory internal reliability.The test-retest coefficients for the two forms ranged from 0.804 to 0.974 and from 0.861 to 0.987.A total of 3 common factors were extracted using factor analysis,and the cumulative contribution rate was 59.7％.The consistency between the self-reports and the proxy-reports was good.Conclusion The Chinese version of the SAQOL-39g scale demonstrates good feasibility,reliability and validity,and good consistency between the self-reported and proxy-reported versions.It seems suitable for assessing the quality of life of Chinese stroke patients with aphasia.

Objective To develop the quality of life questionnaire applicable to the Chinese patients with dysphagia by the translation and modification,as well as psychometric evaluation of the original swallowing quality of life questionnaire (SWAL-QOL).Methods The English version of the SWAL-QOL was translated into Chinese according to the well-accepted scale translation procedure.Then 103 patients with dysphagia were tested using the translated Chinese SWAL-QOL.The inter-rater reliability,test-retest reliability,internal consistency reliability,the content validity and construct validity were tested.Results The inter-rater reliability correlation coefficient of the SWAL-QOL was between 0.945-0.990 (P＜0.01).Its test-retest coefficients ranged from 0.965 to 0.992 (P＜0.01).The Cronbach coefficients ranged from 0.708 to 0.933 (P＜0.01).There revealed significant correlation between each item of SWAL-QOL and its domain,with correlation coefficients between 0.723 and 0.982 (P＜0.01).Factor analysis of each item of the 10 domains of SWAL-QOL extracted 10 common factors,which were with a cumulative contribution of 79.029％.Factor analysis of the total score of the 10 dimensions extracted 2 common factors including dysphagia-related quality of life and general quality of life,with a cumulative contribution of 54.718％.Conclusions The Chinese version of SWAL-QOL is reliable and valid.It can be used as an effective measuring tool to evaluate the quality of life of dysphagia patients.

Objective To observe the application of dysphagia ventilation swallowing and speaking valve inchildren with swallowing disorder after tracheostomy.Methods Four children with tracheostomy done and swallowing disorders(3 with brainstem encephalitis caused by hand,foot and mouth disease and 1 post-surgery case of cerebellar astrocytoma)were observed.Videofluoroscopic swallowing studies(VFSS)showed cricopharyngeal achalasia and silent aspiration.After VFSS assessments,ventilation swallowing and speaking valves(Passy-Muir,USA,PMVs)were applied to the 4 children.After that they received comprehensive swallowing trainings including balloon dilatation,breathing exercises,sensory stimulation and electrical stimulation.Results Four children could pronounce with PMVs immediately.After(36.50 ± 35.63)d of comprehensive intervention,all of them could live without tracheostomy tube or nasal feeding tube,their swallowing function improved obviously and could take food per os.Conclusions The application of PMVs combining with swallowing training is effective for children with swallowing disorder and dysphonia after tracheostomy.It is helpful to decrease the risk of aspiration,to open the cricopharyngeus muscle and to restore pronunciation.

ObjectiveTo study the effects and feasibility of balloon dilatation on cricopharyngeal achalasia in children with dysphagia. MethodsOne 21-month-old child was reported. ResultsAfter 14 times dilatation therapy, the video fluoroscopic swallowing study showed that the bolus can pass the cricopharyngeus. The residuals in the epiglottis and piriform sinuses reduced. No bucking and aspiration happened and the cricopharygeus muscle relaxed normally. The gastric tube can be removed and the child got full per-oral nutrition. ConclusionBalloon dilatation is effective to relax the cricopharygeus muscle and improve the swallowing function of children with dysphagia because of cricopharyngeal achalasia.

Objective To explore the effects of modified balloon dilatation therapy for treating upper esophageal sphincter dysfunction after a brainstem stroke.Methods Ten healthy adult volunteers and 20 dysphagic patients with upper esophageal sphincter dysfunction after a brainstem stroke were recruited.The 20 patients were divided into a balloon dilatation therapy group of ten who were treated with catheter balloon dilatation therapy, and a control group of ten who received conventional therapy.All were given block-designed task fMRI scans guided by a matched visual presentation system before and after the treatment.Results Widespread activation was observed in both hemispheres, including the bilateral cerebral cortex, the brainstem and the cerebellum, but the activated areas were significantly smaller in the stroke patients before treatment.After the treatment, seven patients in the balloon dilatation group were totally orally fed, while only three patients in the control group recovered totally oral intake.After dilatation, significantly more regions were activated, including the anterior cingulate, insula, supplementary motor area, precuneus and the frontal lobe.They were activated with relatively low voxels in the treatment group, while in the control group significant activation was observed only in the precuneus after treatment.Conclusion Modified balloon dilatation therapy can increase activation of the cortex and subcortical structures related to swallowing, promoting better swallowing function.

Objective To analyze temporal and kinematic parameters of video fluoroscopic images of swallowing using a digital acquisition and analysis system and to verify the reliability of this method.Methods Eighteen patients with dysphagia were requested to completed six swallows (3 ml and 5 ml of thin liquid, thick liquid, and paste mixed with 600 kg/m3 barium sulfate suspension) in the natural sitting position.Video fluoroscopy was used to measure the oral transit times, soft palate elevation times, hyoid movement times, laryngeal closure times, cricopharyngeal muscle opening times, hyoid anterior movement (HAM) , hyoid superior movement (HSM) , cricopharyngeal muscle opening diameter and pharyngeal constriction rate.Each was extracted from the videos four times by two raters working separately with an interval of 4 weeks between the sets of evaluations.Results Reliability varied among the different observations.HAM and HSM showed inter-rater reliability between 0.41 and 0.60 and intra-rater reliability between 0.61 and 0.80.The other observations all demonstrated acceptable reliability.Conclusion The self-designed digital acquisition and analysis system tested showed acceptable reliability and could be applied to analyze swallowing function clinically.

Objective To investigate the efficacy of two different methods of catheter balloon dilatation therapy in treating cricopharyngeal achalasia and benign strictures,and to correlate balloon capacity with improve-ments in swallowing function. Methods Twenty-three cricopharyngeal achalasia patients and 7 with benign stric-tures of the cricopharyngeal muscles were diagnosed using videonuoroscopic swallowing study(VFSS).All cases re-ceived active dilatation or passive balloon dilatation therapy,combined with manipulation,indirect training,direct training and feeding instruction.Efficacy and the correlation were evaluated using VFSS and a swallowing function scale. Results Passive and active dilatation had the same efficacy.The correlation coefficient between balloon ca-pacity and swallowing function was 0.92 1.Re-evaluation using VFSS showed that opening of the cricopharyngeal muscles had improved significantly.Conclusions Balloon catheter dilation is an effective treatment for cricopha-ryngeal achalasia and benign strictures.The improvement in swallowing function is highly correlated with balloon ca-pacity in balloon dilatation therapy.Comprehensive treatment for dysphagia would provide better outcomes.