Objective To study the possibility and effects of fixed TH glue embolization through gastroesophageal and percutanenous. Methods Forty-six patients of bleeding esophageal varices were divided randomly into two groups: in treatment group:twenty-five patients treated with TH glue (?-cyanoacrylate) embolization PTVE+PSE. Absolute alcohol-cilia steel ring-TH glue ,but in control group, 21 patients of esophageal varices by variceal ligation. Analysis the percentage of rebleeding, death rate and improvement rate of liver functions. Results In the treatment group,the rebleeding of gastroesophageal varices was 8.7%, the percentage of death was 4.3%, the function of liver improved by 87.0% . In the control group, the percentage of rebleeding was 28.6%, death rate was in 19.1% and liver function improved by 48.0%. Conclusion PTVE+PSE fixed TH glue embolization is safe, less destroyed. Compared with dense edoscopic ligation, DEVL, the advantage is lessre bleeding, less death rate and higher liver function improvement rate. It is an effective method for gastroesophageal varices.

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 monitor the immediate effect of Passi-Muir speaking valve (PMV) on patients with tracheostomy after acquired brain damage.Methods Twelve patients with tracheostomy after acquired brain damage were recruited.All of them underwent the high resolution manometry to measure the pressure in pharynx and upper esophagus during swallowing before and immediately after wearing PMV.The parameters including the pharyngeal peak pressure,increasing rate of the pharyngeal pressure,pharyngeal pressure duration,upper esophageal sphincter (UES) residual pressure and UES relaxation duration were recorded.Results No significant differences were found in all the measurements before and immediately after wearing PMV (P＞0.05).Conclusion PMV has no instant impact on the swallowing function of patients with tracheostomy after acquired brain damage.

Objective To evaluate the characteristics of dysphagia after brain stem infarction,and to determine the mechanism of aspiration.Methods The fluoroscopic videos of 12 dysphagia patients who had suffered brain stem infarction and 10 healthy counterparts were analyzed quantitatively using a digital analysis system.Each participant was requested to twice swallow 5ml of thick liquid.The observations included the oral transit time (OTT),the swallow response time (SRT),the hyoid movement time (HMT),the upper esophageal sphincter opening time (UOT) and the laryngeal closure time (LCT).An 8-point penetration-aspiration scale (PAS) was used to evaluate the severity of aspiration,and the results were correlated with the other 5 quantitative observations.Results The average OTT [(3.091±1.803)s],HMT [(1.498±0.550)s] and LCT [(0.651±0.186)s] of the brain stem infarction patients were all significantly longer than those of the healthy controls.However,no significant differences were found between the patients and the healthy volunteers in terms of SRT or UOT.Aspiration severity was significantly correlated with SRT but not with LCT.Conclusion Dysphagia after brain stem infarction involves both the oral and pharyngeal phases.OTT,HMT and LCT can be used to quantify dysphagia after brain stem infarction,while SRT is a predictor of aspiration.

Objective To evaluate the effect of radiotherapy on the swallowing ability of persons with nasopharyngeal carcinoma (NPC) when swallowing food with different consistencies.Methods Twenty NPC patients were monitored fluoroscopically while swallowing materials with three different consistencies after radiotherapy.The oral transit time,oral residue,pharyngeal residue,penetration-aspiration and cricopharyngeal muscle function were observed.Results There were significant differences in all of the measurements when swallowing the three different foods.There were significant differences in all of the measurements between swallowing paste and liquids,but only in the oral transit time,oral residue and pharyngeal residue between swallowing thin and thick liquids.Conclusions The severity of swallowing dysfunction varies in NPC patients after radiotherapy.Foods with different consistencies have different effects on swallowing ability.Videofluoroscopy can evaluate swallowing objectively and provide an objective basis for food preparation.

Objective To evaluate the relationship between muscle fibrosis and the displacement of the hyoid bone while swallowing among patients with nasopharyngeal carcinoma (NPC) after radiation therapy.Methods Twenty-six NPC patients with dysphagia were recruited.Shear wave elastography was performed to assess the fibrosis of the mylohyoid muscle.The horizontal and vertical displacement of the hyoid bone were measured based on the videofluoroscopic swallowing study,and the severity of dysphagia was determined using the penetration-aspiration scale (PAS).The correlation between the modulus value of the mylohyoid muscle and the horizontal and vertical displacement of the hyoid bone were analyzed,respectively.Receiver-operating characteristic (ROC) curve were constructed to assess the diagnostic ability of modulus value for the severity of dysphagia above grade 5 of PAS.Results For patients whose PAS was higher than grade 5,the modulus value of mylohyoid muscle was negatively correlated with the displacement of hyoid bone,while such correlation was absent for patients whose PAS grading were less than or equal to 5.Sensitivity and specificity by modulus value to detect dysphagia were 80％ and 81.8％,respectively,with the best cut-off value of 14.37 kPa.Conclusion The reduction of hyoid bone displacement can be partially attributed to muscle fibrosis for post-radiation NPC patients with severe dysphagia.The modulus value measured by Shear wave elastography could be used as a supplementary way to monitor the development of dysphagia.

Objective:To explore the efficacy of doctor-nurse co-led care involving education and engagement of patients on improving compliance of patients, and a treat-to-target urate-lowering rate for gout.Methods:Nurses were trained in practice management of gout. Patients diagnosed with gout in the departments of rheumatology and immunology of Anqing Municipal Hospital in Anhui Province were prospectively enrolled from January 1 to June 30, 2019. The patients were divided into the continuous-care group and the conventional management group by random number table method. The patients of continuous-care group received telephone follow-up, WeChat tracking and regular face-to-face communication. The patients of conventional management group were told to follow up regularly in the outpatient department, and the nurses did not follow up. Patients were evaluated before intervention and 12 months after intervention. The treat-to-target rate of blood uric acid and the frequency of gout flares were observed.Results:After 12 months of intervention, the patients of serum uric acid concentrations below 360 μmol/L were 92.39% (85/92) in the continuous-care group, and 26.74% (23/86) in the conventional management group. There was significant difference ( χ2 value was 80.282, P<0.001). After 12 months of intervention, the average serum uric acid concentration of patients in the continuous-care group was (301.6±61.4) μmol/L, and that in the conventional management group was (419.0±98.0) μmol/L, both of which were significantly lower than before intervention, continuous-care group (466.1±119.7) μmol/L, conventional management group (477.8±113.1) μmol/L. But the average serum uric acid concentration of patients in the continuous-care group was significantly lower than that in the conventional management group. There was significant difference between them ( t value was 96.678, P<0.001). At the end of 12 months, the patients of uric-acid-lowering therapy increased in both groups. The proportion of patients was 94.56% (87/92) in the continuous-care group, which was significantly higher than that in the conventional management group (58.14%, 50/86), there was significant difference ( χ2 value was 33.260, P<0.001). Conclusions:The mode of continuing nursing combined with specialized physician-led treatment can significantly improve the compliance and the control rate of treat-to-target for gout, and this management method is simple and feasible which provides a new management concept for clinical treatment of gout.

Objective: To compare a new agar thickener with xanthan gum as a thickener in treating dysphagia patients with nasopharyngeal carcinoma after radiotherapy. Methods: Twenty nasopharyngeal carcinoma patients with dysphagia after radiotherapy were asked to swallow moderately and extremely thick liquids thickened with the agar and xanthan gum, and their swallowing was recorded with a videofluoroscope. Results: The average pharyngeal constriction ratio when swallowing agar thickener was significantly lower than when swallowing the traditional thickener. The average oral transit time, the initiation of pharyngeal swallowing were both significantly quicker. There was no significant difference in the average penetration aspiration scale scores between the two thickeners. In the subjective evaluation, the agar thickener was adjudged smoother and with better residual mouthfeel than the xanthan gum, but the scent of the xanthan gum was preferred. Conclusion The new agar thickener is smooth and not sticky. It produces faster transport with less oropharyngeal residue. It can be widely used among nasopharyngeal carcinoma patients with dysphagia after radiotherapy.