Objective To evaluate the effect of the modified balloon dilatation intervention on the pharyngeal constriction function of the brainstem stroke survivors with dysphagia using videofluoroscopy-based digital analysis.Methods Thirty brainstem stroke survivors with pharyngeal dysphagia were recruited and randomly divided into a treatment group and a control group,with 15 in each.The treatment group was treated with the modified balloon dilatation in addition to the routine treatment of 30min,respectively,once a daily,3 days a week,whiled a control group was treated with routine treatment of 30min twice a day,3 days a week.Before and after the treatment,the rate and duration of pharyngeal constriction were measured in both groups.Results After the treatment,the rate of pharyngeal constriction in the treatment group was (0.20 ± 0.030),(0.14 ± 0.05) and (0.15 ± 0.04) when swallowing thin liquid,thick liquid and pasty food,significantly better than before the treatment.The duration of the pharyngeal constriction was (990.34 ±96.14),(1010.47 ± 133.64) and (1180.10 ± 121.27) ms,respectively,also significantly better than before the treatment.In the control group,significant differences were also observed in the rate and duration of pharyngeal constriction before and after the treatment.Conclusions Digital analysis based on videofluoroscopy can be used to quantify swallowing function effectively,and the rate and duration of pharyngeal constriction can be used to evaluate the pharyngeal function before and after treatment.

Objective To screen and identify International Classification of Functioning,Disability and Health (ICF) core sets for spasticity and make a dedicated and comprehensive assessment tool for spasticity after stroke.MethodsFifty patients with spasticity after stroke were involved in this study.Information about them was collected by clinical investigation and self-completed questionnaires.The ICF scale was used to assess the severity of each item.Each item's frequency was calculated and those items with frequencies ≥ 30％ were selected as the first ICF core set for spasticity.The ICF check list was designed as a questionnaire and 8 doctors and 5 therapists were consulted.Items with frequency ≥50％ were chosen as the second level ICF core set for spasticity.The two results (termed ICF core sets Ⅰ and Ⅱ) were integrated with the initial ICF core sets for spasticity and sent to 42 experts in the area of neurological rehabilitation.Items with a frequency ≥80％ were chosen as the final ICF core set for spasticity.ResultsA total of 32 ICF items were included in the ICF core set for spasticity after stroke.There were 10body function items,4 body structure items,13 activity and participation items and 5 environmental items involved.ConclusionThe ICF core set for spasticity was identified in this study.The selected items covered content broader than other common spasm assessment scales.The result is a comprehensive description of spasticity.

Objective To assess the contraction and coordination changes in the anterior and posterior thigh muscles of patients recovering from cerebral infarction,and to provide objective references for targeted rehabilitation programs. Methods Eighteen cerebral infarction patients with mild hemiparesis (the patient group) and eighteen age- and sex-matched healthy volunteers (the healthy group) were investigated. The surface-electromyographic (sEMG) signals of their vastus medialis,rectus femoris,vastus lateralis,biceps femoris,semitendinosus and semimembranosus were recorded during knee joint flexion and extension in the prone position.The sEMG signals from both legs were recorded for the patient group,but only from the left leg in the healthy group.The standardized root mean square (stRMS) signals and the co-contraction ratios (CRs) were compared and analysed, Results The stRMSs of the rectus femoris,vastus lateralis and vastus medialis on the patients' affected side during knee extension were significantly higher than those in the healthy group at baseline and follow-up.The stRMSs of the biceps femoris and semitendinosus-semimembranous on the patients' unaffected side were significantly higher than those of the affected side and the healthy group during knee flexion at baseline.The CRs during knee flexion on the patientsˊ affected side at baseline and follow-up were significantly higher than those of the unaffected side at baseline. Conclusions After cerebral infarction,the functioning of both the anterior and posterior thigh muscles on the affected side are impaired.The rectus femoris are the most severely impaired knee extensors,and the biceps femoris,semitendinosus and semimembranous are impaired equally in knee flexion.The thigh flexors and extensors lose their normal antagonist-agonist contraction modes.The functions of both the anterior and posterior thigh muscles should be emphasized during rehabilitation to improve abnormal contraction.

Objective To explore the changes in muscle activity patterns in the lower leg during ankle dorsiflexion and plantarflexion in stroke patients. Methods Ten recovering stroke patients with hemiparesis(Pa- tient group)and ten age-and sex-matched healthy volunteers(Healthy control group)were studied.The subjects performed ankle dorsiflexion and plantarflexion synchronized with a visual cue while supine.Surface electrodes were applied over the anterior tibialis(TA),caput laterale musculi gastrocnemius(IGM),caput mediale musculi gas-troenemius(mGM)and soleus muscles(SOL)for integrated electromyography(iEMG).Results During ankle dorsiflexion,the TA,lGM,mGM and SOL of the affected side showed a significantly lower iEMG signal than the unaffected side.Activity of the lGM,mGM and SOL of the affected side were significantly lower than in the healthy controls.During ankle plantaflexion,the TA,lGM and mGM on the affected side had significantly lower activity than those of the healthy controls.The mGM of the affected side showed significantly lower muscle activity than the unaffeeted side.The SOL contraction ratio on the affected side was significantly higher than on the unaffected side and in the healthy control group. Conclusion Except for the soleus,there is an obvious decline in muscle activi-ty in the affected lower extremities of stoke patients during ankle dorsiflexion and plantaflexion.The soleus on the affected side becomes the primary plantarflexor in patients with stroke,rather than the caput laterale musculi gas-trocnemius or caput mediale musculi gastroenemius as in healthy subjects.

Background Researches showed that platelet-derived growth factor (PDGF) modulate the expression of matrix metalloproteinase/tissue inhibitor of metalloproteinase (MMP/TIMP) in cells,but the association of expression of MMP/TIMP in retinal pigment epithelial (RPE) cells and the dose and active time of PDGF is unclear.Objective This study was to observe the effects of PDGF on the expressions of MMP-2,MMP-9 and TIMP-1 in cultured RPE cells in vitro.Methods RPE cell line,ARPE-19,was calculated in vitro,and the cells were divided into 5 groups when they reached 70％-80％ confluence.Different concentrations (0,0.1,1,10,50 mg/L) of PDGF was added into the medium respectively for 36 hours,and the expressing levels of mRNA and protein of MMP-2,MMP-9 and TIMP-1 were detected by reverse transcription PCR (RT-PCR) and Western blot assay.In addition,RPE cells in PDGF group were treated with 10 mg/L PDGF for 24,36,48 hours respectively to detect the expressions of mRNA and protein of MMP-2,MMP-9 and TIMP-1 in the cells and to compare with the control group without PDGF.Results PDGF stimulated proliferation of RPE cells in a dose-and time-dependent manner.As the increase of the PDGF concentrations,the expression values of MMP-2 mRNA and MMP-9 mRNA in RPE cells were gradually elevated,with a statistically significant difference among various groups (MMP-2 mRNA:F=79.304,P=0.000;MMP-9 mRNA:F =8.465,P=0.003),and the expressions of MMP-2 mRNA and MMP-9 mRNA were significantly higher in the 1,10,50 mg/L PDGF groups compared with 0 mg/L PDGF normal control group (all at P＜0.05).Also,the expression values of MMP-2 and MMP-9 proteins in RPE cells were gradually elevated with the increase of PDGF concentrations,showing statistically differences among the groups (MMP-2:F=26.550,P=0.000;MMP-9:F=80.993,P=0.000).Compared with the 0 mg/L PDGF group,MMP-2 and MMP-9 expression levels in the 1,10,50 mg/L PDGF groups were significantly up-regulated (all at P＜ 0.05).However,the expression levels of TIMP-1 mRNA and protein group in the cells were not significantly different among various groups (mRNA:F =0.143,P =0.962 ; protein:F =1.955,P =0.178).The expression levels of M MP-2 mRNA,M MP-9 mRNA in the cells were increased in the PDGF group compared with the control group at different time points (MMP-2 mRNA:Ftime =83.250,P=0.002 ; MMP-9 mRNA:Ftime =6.785,P =0.019).Also,the expression values of MMP-2 and MMP-9proteins in RPE cells were increased in the PDGF group compared with the control group at different time points (MMP-2:Ftime =1 l.185,P =0.041 ; MMP-9:Ftime =968.413,P =0.000).The expression levels of MMP-2 and MMP-9 mRNAs and proteins were significant between the two groups at different time points (all at Pgroup =0.000;all at Ptime＜0.05).While the expression changes of TIMP-1 werc not significant between the two groups and among various time points (all at P＞0.05) Conclusions PDGF up-regulates MMP-2 and MMP-9 expressions in RPE cells in a dose-and time-dependent manner.But,PDGF dose not alter the expression of TIMP-1.These results indicate that PDGF disrupt the balance of MMP/TIMP,which may damage the extracellular matrix and therefore facilitate the migration of RPE cells in the pathogenesis of proliferative vitreoretinopathy.

Objective To investigate the changes of thyroid autoantibody(TAA)in children with Turner syndrome(TS),and its association between TAA and thyroid dysfunction,age,karyotype and dyslipidaemia.Methods Thirty-two patients with TS diagnosed by chromosome analysis hospitalized at Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University from July 2007 to July 2015 were divided into 2 groups based on TAA-positive or TAA-negative,then the thyroid dysfunction,the age,the karyotype and the lipid metabolism were compared between 2 groups.Results Of the 23 cases of TAA-positive girls(23/32 cases,71.88％),9 girls(39.13％)suffered from thyroid dysfunction;of the 9 cases of TAA-negative girls(9/32 cases,28.12％),3 girls(33.33％)had thyroid dysfunction.As compared with the girls in TAA-negative group,the age in TAA-positive group was significantly higher[(12.08±2.90)years old vs.(8.89±4.17)years old],and the difference was significant(t=101.500,P=0.047).The patients were divided into 4 age groups:0-5 years old,>5-10 years old,>10-15 years old and >15 years old;the rates with TAA-positive were 25.00％(1/4 cases),75.00％(6/8 cases),82.35％(14/17 cases)and 66.67％(2/3 cases)respectively.Twenty patients received the lipid metabolism test,and 11 cases(11/20 cases,55.00％)of them suffered from dyslipidaemia,9 cases of them were TAA-positive(9/11 cases,81.82％),and 2 cases were TAA-negative(2/11 cases,18.18％).The differences in the prevalence of dyslipidaemia between the 2 groups were significant(x2=4.848,P=0.028).There was no significant difference in the numbers of TAA-positive cases among different karyotypes(x2 =4.246,P=0.120).Conclusions Patients with TS are prone to suffer from thyroid dysfunction and dyslipidaemia.Timely detection of TAA and thyroid function is recommended,as well as the lipid metabolism if necessary.

Objective To explore the effect of theta-burst stimulation (TBS) of the motor cortex on the suprahyoid muscles and the mechanism through which the bilateral motor cortex regulates the suprahyoid muscles.Methods Continuous TBS (cTBS) was applied to the left motor cortex followed by intermittent TBS (iTBS) applied to the right motor cortex of 24 healthy subjects.The motor-evoked potentials (MEPs) of the suprahyoid muscles on both sides were recorded before the stimulation and after 15 and 30 minutes.The MEP amplitudes of the left and right suprahyoid muscles were analyzed using repeated measures analysis of variance.Results Before stimulation, the average MEP amplitudes of the left and right suprahyoid muscles were (375.29 ± 176.09) μV and (368.17 ± 149.02) μV respectively, significantly lower than the values after the stimulation.Conclusion iTBS can distinctly enhance the excitability of the right motor cortex controlling the suprahyoid muscles and reverse the inhibition caused by cTBS applied to the left motor cortex.Clarifying the effect of TBS on the excitability of the bilateral motor cortex is important for the rehabilitation of dysphagic stroke survivors.

Objective To assess the effects of rehabilitation training on lower extremity muscle function in stroke patients using velocity-encoded phase-contrast MRI ( VE-PC MRI). Methods Twenty-nine stroke patients at the convalescence stage were divided into a treatment group (14 cases) and a control group (13 cases).The subjects performed calf muscles stretches supine in a scanner bed with voluntary ankle flexion-extension movements.Imaging data were collected from the tibialis anterior muscle (TA),the medial head of the gastrocnemius (MG) and the soleus muscle (SOL) of the affected side.The treatment group also underwent rehabilitation including treadmill training,while the control group received only walking training without the treadmill.Barthel index (BI) and Berg balance scale (BBS) scores were measured after rehabilitation. Results Compared with baseline,the contraction velocity of the TA (phases 2 to 7),the MG (phases 12 to 18 ) and the SOL (phases 13 to 16) on the affected side increased significantly in the treatment group.In the control group,the contraction velocity of the calf muscles on the affected side improved,but fewer phases were significant-for the TA phase 4,for the MG phases 13 to 15 and for the SOL phase 15.In both groups,BBS and BI scores improved significantly compared with baseline.The average improvement in the treatment group was significantly greater than that in the control group. Conclusions Rehabilitation including treadmill training can improve calf muscle contraction function on stroke patients' affected side,and also their ADL performance and balance.VE-PC MR1 can provide quantitative in vivo measurements of the contraction function of stroke patients' calf muscles.

Objective To explore the characteristics of calf muscle movement of the normal volunteer in vivo by velocity encoded phase contrast MRI (VE-PC MRI ).MethodsTwenty four healthy subjects were divided into the young group (30-40 years) and the elderly group (60—78 years).All subjects were positioned on the scanner table and did ankles flexion-extension voluntary movement,the moving images of tibialis anterior muscles (TA),medial gastrocnemius (MG) and soleus muscle (SOL)on the left were scanned with VE-PC MRI.The calf muscles contraction velocity were analyzed by software.The Mann-Whitney U test was used for comparison of calf muscles contraction velocity in vivo between the young group and the elderly group. Results During cyclic ankle flexion-extension,dorsiflexion phase (1—10 phases)in the two groups,TA showed concentric contraction,plantar flexion phase (11—20 phases),MG and SOL did concentric contraction. At 3-6 phases during dorsiflexion,velocity of TA (M value:-37.66,-53.00, -60.66, -56.00 mm/s) in the young group is higher than in the elderly group (M-value:- 30.33, - 42.49, - 53.00, - 48.67 mm/s),at 13—15 phases during plantar flexion,velocity of MG (M-value:- 47.66, - 60.00, - 66.33 mm/s) in the young group showed higher velocity than in the elderly group (M-value:-25.17,-37.99,-50.98 mm/s),at 12—14 phases during plantarflexion,SOL showed higher velocity in the young group (M-value:-27.21, -40.10, -49.13 mm/s) than in the elderly group (M-value:- 20.66,- 29.61,- 37.16 mm/s) ( all P ＜ 0.05).Conclusions During active ankle cyclic flexion-extension movement,velocity of TA,MG and SOL in the elderly group are decreased as compared to the young group. VE-PC MRI can reflect biomechanical characteristics of calf muscle in vivo,and provide a new kind of measurement for lower extremities.

OBJECTIVETo investigate the effect of D-AP5 (D-2-amino-5-phosphonopentanoate, a specific NMDA-antagonist) on the increase of intracellular free Ca2+ concentration ([Ca2+]i) induced by glutamate in isolated cochlear inner hair cells (IHCs), and to detect the autoreceptors of the IHC membrane.

METHODSWhen a laser scanning confocal microscope (LSCM) was used, the exogenous glutamate (Glu)-induced changes in [Ca2+]i of isolated IHCs and OHCs of guinea pig cochlea were observed with fluo-3, a fluorescent probe for [Ca2+]i. After D-AP5 or CNQX (6--cyano--7--nitroguinoxaline--2, 3--dione, a specific AMPA- antagonist) was administered, the exogenous glutamate (Glu)-induced changes in [Ca2+]i of isolated IHCs were recorded.

RESULTSIn the presence of a low concentration Glu (3.85 mumol/L), there was an increase of [Ca2+]i in IHCs, whereas there was no change in OHCs. When 50 mumol/L of D-AP5 was administrated in advance, Glu did not induce a corresponding increase in [Ca2+]i in IHCs, and 50 mumol/L of CNQX did not completely block the increase of [Ca2+]i in IHCs.

CONCLUSIONSThese results suggest that the autoreceptors existing in the IHC membrane are mainly of NMDA type, while there are relatively few AMPA receptors. Exogenous Glu is capable of increasing [Ca2+]i in IHCs by acting on the NMDA autoreceptor of IHCs in a positive feedback manner.

2-Amino-5-phosphonovalerate ; pharmacology ; 6-Cyano-7-nitroquinoxaline-2,3-dione ; pharmacology ; Animals ; Calcium ; metabolism ; Excitatory Amino Acid Antagonists ; pharmacology ; Glutamic Acid ; pharmacology ; Guinea Pigs ; Hair Cells, Auditory, Inner ; drug effects ; metabolism ; In Vitro Techniques ; Receptors, N-Methyl-D-Aspartate ; antagonists & inhibitors