Objective:To analyze the effect of mechanical assisted sputum drainage combined with early grade 4 rehabilitation exercise on Intensive Care Unit-acquired weakness (ICU-AW) .Methods:The convenient sampling method was used to select 98 patients who were hospitalized in ICU of Xinyang Central Hospital and underwent mechanical ventilation from June 2020 to June 2021. They were randomly divided into observation group and control group, with 49 cases in each group. During the ICU stay, the control group received ICU routine nursing, and the observation group received mechanical-assisted sputum expectoration combined with early stage 4 rehabilitation exercise on the basis of the control group. The incidence of ICU-AW, duration of mechanical ventilation, length of ICU stay, diaphragm thickness and diaphragmatic thickening fraction were compared between the two groups.Results:The occurrence time of ICU-AW in the observation group was later than that in the control group, the incidence of ICU-AW in the observation group was lower than that in the control group and mechanical ventilation time and length of ICU stay in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . After intervention, skeletal muscle mass, diaphragm thickness and diaphragm thickening fraction in the observation group were all higher than those in the control group, and the differences were statistically significant ( P<0.05) . The skeletal muscle mass, diaphragm thickness and diaphragm thickening fraction of the control group after the intervention were lower than those before the intervention, and the differences were statistically significant ( P<0.05) . There was no statistically significant difference in limb skeletal muscle mass, diaphragm thickness and diaphragm thickening fraction in the observation group after intervention compared with those before intervention ( P>0.05) . Conclusions:Mechanical assisted sputum drainage combined with early grade 4 rehabilitation exercise can effectively prevent the occurrence of ICU-AW in ICU patients undergoing mechanical ventilation, shorten the duration of mechanical ventilation and ICU stay, maintain limb skeletal muscle mass and diaphragm function, which benefits patients.

Objective:To explore the prevalence of malnutrition among stroke survivors with bulbar palsy and the risk factors involved, and to construct a prediction model.Methods:This was a retrospective study of 325 stroke survivors. The nutritional status of those with and without bulbar palsy was compared. Univariate and multivariate logistic regressions were evaluated to highlight risk factors. A risk prediction model was constructed and a receiver operating characteristics (ROC) curve was drawn.Results:The prevalence of malnutrition among the stroke survivors with bulbar palsy was 66%, significantly greater than among all patients (52%). Among the stroke survivors with bulbar palsy there were significant differences between the normal nutrition group and the malnutrition group in terms of age, National Institutes of Health Stroke Scale (NIHSS) scores, hemoglobin, daily activities and pulmonary infection. The multivariate logistic regressions showed that pulmonary infection, a higher NIHSS score and lower hemoglobin were independent risk factors predicting malnutrition among stroke survivors with bulbar palsy. A risk prediction model for malnutrition was constructed based on the 3 major indicators and the area under the ROC curve was 0.86, with sensitivity of 0.79 and specificity of 0.83. A Hosmer-Lemeshow test indicated that the model was well calibrated, indicating that it would have good predictive value.Conclusions:Malnutrition is prevalent among stroke survivors with bulbar palsy. Pulmonary infection, a high NIHSS score and low hemoglobin are independent risk factors. They should be treated as important by medical staff.

Objective:To investigate the value of applying B+ M type and shear-wave elastic ultrasound in determining the parameters of the geniohyoid muscles of stroke survivors with dysphagia.Methods:Forty stroke survivors with dysphagia formed an observation group, while 20 healthy counterparts were chosen as the control group. The thickness of the geniohyoid muscle, as well as the movement distance, time, rate and shear wave velocity were measured using B+ M ultrasound and shear wave elastic ultrasound when swallowing nothing or 5ml of water, respectively.Results:The average thickness of the geniohyoid muscle and the average shear wave velocity of the observation group were significantly smaller than among the controls. When swallowing either nothing or water, the geniohyoid muscle in the observation group tended to move farther than among the controls, acting more slowly and taking significantly more time.Conclusion:Ultrasound can quantify the thickness of the geniohyoid muscle and its motor parameters and stiffness. It can be used to evaluate the swallowing function of stroke survivors with dysphagia.

Objective:To investigate the expression characteristics of phosphorylated enhancer of Zeste homolog 2(EZH2)in head and neck squamous cell carcinoma(HNSCC)and their effect on chemosensitivity.Methods:Fifty-three patients with HNSCC treated between January 2018 and March 2021 in Tianjin Medical University Cancer Institute&Hospital were selected.Expression levels of p-EZH2S21,p-STAT3Y705,HIF-1α,and Ki-67 in HNSCC tissues were analyzed by immunohistochemical staining.Western blot was used to detect p-EZH2S21 expression in HNSCC tissues and cell lines.HNSCC cell lines stably transfected with wild type(EZH2-WT)or S21 mutant EZH2(EZH2-S21A)were construc-ted.CCK8 and colony formation assays were performed to detect the effect of EZH2 and S21 phosphorylation on HNSCC cell proliferation and their sensitivity to cisplatin(DDP)and 5-fluorouracil(5-FU).Results:Elevated levels of p-EZH2S21 were observed in HNSCC tissues and positively correlated with p-STAT3Y705(P<0.05)and HIF-1α(P<0.01)levels.p-EZH2S21 level correlated positively with lymph node metastasis(P<0.000 5),T(P<0.05),N(P<0.000 1)and AJCC stages(P<0.05).In vitro experiments confirmed that EZH2 expression promoted cell prolifer-ation and attenuated chemosensitivity of HNSCC cells.Inhibition of p-EZH2S21 restored HNSCC cell sensitivity to DDP and 5-FU.Conclusions:p-EZH2S21 plays an important role in tumor progression in HNSCC,and phosphorylation at S21 is an important way for EZH2 to affect HNSCC cell proliferation and chemotherapy sensitivity.