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 observe the effect of Astragalus injection on the expressions of inflammatory cytokines in human primary macrophages stimulated by lipoteichoic acid (LTA) and lipopolysaccharide (LPS),and investigate its effects on inflammatory reactions of Gram-positive (G+) and Gram-negative (G-) bacteria sepsis and its mechanisms.Methods Percoll density gradient centrifugation was used to isolate the human peripheral blood mononuclear cells,then they were purified by immune Anti-Biotin Microbeads with magnetic character and under the induction of recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF),the cells were cultivated for 12 days in vitro,eventually the human monocyte-derived macrophage was formed.The cultured human macrophages were inoculated in 96-well plates (each group 3 wells) and 6-well plates (each group 3 wells).The cells were divided into control group (200 μL DMEM added in each well),LTA 1 mg/L group,LPS 0.1 mg/L group and low astragalus injection (0.1 mg/L) and high astragalus injection (0.2 mg/L) dose groups.After the incubator plates were put in an incubator for 24 hours,the protein content of IL-8 and IL-10 in supernatant were detected by enzymelinked immunosorbent assay (ELISA),and the mRNA expression levels of IL-8 and IL-10 were detected by real time fluorescence quantitative reverse transcription-polymerase chain reaction (RT-qPCR).Results LTA and LPS all can obviously up-regulate the expression levels of pro-inflammatory factor IL-8 and anti-inflammatory factor IL-10 of macrophage.The expressions of IL-8 and IL-10 protein and mRNA in LTA group and LPS group were significantly higher than those in control group after cuhure for 8 hours and 24 hours,the degrees of increment were more significantly at 24 hours [LTA stimute group:IL-8 protein (ng/L,× 103):41.57± 1.90 vs.1.58 ±0.24,IL-8 mRNA (A value):21.49±8.05 vs.1.00±0.16;IL-10 protein (ng/L):5.90±3.02 vs.2.91 ± 1.54,IL-10 mRNA (A value):1.35±0.34 vs.0.95±0.14;LPS stimute group:IL-8 protein (ng/L,× 103):345.00±22.80 vs.5.60±0.31,IL-8 mRNA (A value):29.84 ± 8.93 vs.1.00 ± 0.16,IL-10 protein (ng/L):122.37 ± 39.26 vs.44.79 ± 3.67,IL-10 mRNA (A value):7.38 ± 1.58 vs.1.35 ± 0.34,all P ＜ 0.05].The Astragalus injection could regulate LTA and LPS to stimulate the macrophage to decrease the expression levels of pro-inflammatory factor IL-8 protein and mRNA and increase the expression levels of anti-inflammatory factor IL-10 protein and mRNA in the macrophage;the changes of regulatory effect in the 24 hour-culture of Astragalus injection high dose group was the most significant [LTA stimute group:IL-8 protein (ng/L,×103):22.63±1.91 vs.41.57±1.90,IL-8 mRNA (A value):12.10±1.93 vs.21.49±8.05,IL-10 protein (ng/L):14.03±2.22 vs.5.90±3.02,IL-10 mRNA (A value):10.37±6.08 vs.1.35±0.34;LPS stimute group:IL-8 protein (ng/L,× 103):167.75 ± 19.90 vs.345.01 ±22.80,IL-8 mRNA (A value):15.61 ± 3.63 vs.29.84±8.93;IL-10 protein (ng/L):243.22±14.41 vs.122.37±39.26,IL-10 mRNA (A value):16.14±4.10 vs.7.38± 1.58,all P ＜ 0.05].Conclusions In the process of inflammatory response,the pro-inflammatory and anti-inflammatory factors co-exist simultaneously.Astragalus injection can inhibit the expression levels of pro-inflammatory factor gene and protein in the inflammatory response of G+ and G-bacteria sepsis and in the mean time,it can promote the expression levels of anti-inflammatory factor gene and protein,thus the immune mechanism of sepsis is affected,achieving the balance between pro-inflammation and anti-inflammation.

Objective To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients,and to discuss its value in administration of early enteral nutrition (EN).Methods A perspective study was conducted.85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled.EN was conducted after ICU admission or within 12-24 hours after high catabolic state.The patients were divided into four groups according to the AGI classification,i.e.grade Ⅰ,Ⅱ,Ⅲ,and Ⅳ,and they were treated according to the treatment procedure for AGI.The primary end points were 7-day rate of intake of standard EN,the degree of disease and nutrition,and their correlation with AGI classification.Secondary endpoint was rate of giving EN within 48 hours.Results Gastrointestinal dysfunction patients accounted for 49.42％ (85/172) of the ICU patients,and number of patients in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ were 29,28,19,9 respectively.On the first day of ICU stay,there were no statistical differences in age,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,serum albumin (ALB) and prealbumin (PA) among four groups,and it was demonstrated that the baseline data were comparable.APACHE Ⅱ score on the seventh day of ICU stay was significantly lower than that on the first day in grade Ⅰ,Ⅱ and Ⅲ patients (grade Ⅰ:20.48 ± 2.45 vs.22.59 ± 2.06,t=-3.120,P=0.031 ; grade Ⅱ:19.34 ± 1.80 vs.21.65 ± 2.22,t=-4.316,P=0.012; grade Ⅲ:20.63 ± 1.34 vs.23.31 ± 1.70,t=-5.640,P=0.000),and serum PA (g/L) was significantly increased (grade Ⅰ:24.37 ± 6.54 vs.10.62 ± 7.24,t=-4.866,P=0.000; grade Ⅱ:19.79± 12.48 vs.11.57±8.94,t=-2.116,P=0.031; grade Ⅲ:19.15±8.43 vs.13.78 ± 6.59,t=-3.601,P=0.000).On the seventh day ofICU stay,the APACHE Ⅱ score was higher in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (22.87 ± 3.31 vs.20.48 ± 2.45,19.34 ± 1.80,20.63 ± 1.34,P＜0.05 or P＜0.01),and PA was obviously lower in grade Ⅳ than that in grade Ⅰ,Ⅱ and Ⅲ patients (g/L:14.02 ± 8.70 vs.24.37 ± 6.54,19.79 ±12.48,19.15 ± 8.43,P＜0.05 or P＜0.01).There was no statistically significant difference among four groups in respect of serum ALB (F=0.454,P=0.722).The rate of giving EN in 24 hours in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients was 95.4％,72.1％,52.0％ and 0,respectively (x2=8.310,P=0.016),and in 48 hours it was 100.0％,83.0％,76.0％,and 0 (x2=5.470,P=0.025).7-day standard EN intake rate was 100.0％,88.7％,84.0％ and 34.0％ respectively in grade Ⅰ,Ⅱ,Ⅲ,Ⅳ patients (x2 =0.720,P=0.017).Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62,P=0.04) and 7-day standard EN intake rate (r=-0.76,P=0.02).Conclusions AGI classification can be used to estimate the gastrointestinal function of patients with critical illness,and it has a significant correlation with early EN support.An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.

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.

Objective To investigate the correlation between Bispectral index (BIS) value and the prognosis of patients with coma in ICU.Methods A total of 208 patients with coma in ICU were divided into 4 groups according to the BIS value.In group I,BIS value was 0 to 20; groupⅡ,BIS value 21 to 40; group Ⅲ,BIS value 41 to 60; and group Ⅳ,BIS value greater than 60.Comparison of the difference in BIS value with the differences in prognosis of patients with coma was carried out between four groups,and the prognosis of patients with coma was stratified into consciousness,coma,vegetative state,and brain death.Subsequently,the best cutoff score of BIS value calculated for determining the correlation between BIS and mental state was proposed.Results There are no significant differences in the age and APACHE Ⅱ scores between four groups (P ＞ 0.05).It was inverse correlation between BIS value and mental state (r =-0.749,P =0.00).According to the ROC curve,as BIS value was greater than 42.5,there were higher sensitivity and specificity in Conscious-Coma patients.Conclusions BIS value is correlated with the prognosis of patients with coma in ICU,and BIS value can be a useful marker for estimating the prognosis of comatose patients.

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 search specific biomarkers of pathogenic bacteria in patients with sepsis so as to guide early using rationally antibiotic treatment.Methods Prospective survey of 147 patients with sepsis in ICU was carried out from Jan 2012 to Mar 2015.When patients blood culture was positive, clinical data including age, gender, vital signs, blood and, urine routine examination, DIC, blood biochemistry, c-reactive protein (CRP), procalcitonin (PCT), microbial detection, etc were recorded.Cultured blood samples were from central venous catheter and peripheral vessel.ELISA method was employed to detect soluble toll-like receptor 2 ( sTLR2 ) and interleukin-8 ( IL-8 ) , and the Acute Physiology and Chronic Health Evaluation Ⅱ( APACHEⅡ score ) was calculated.The chi-square test and analysis of variance were performed where necessary.Receiver operating characteristic ( ROC ) curves were used to calculate cut-points ( CP ) and area under the curve ( AUC) .Results According to the results of blood culture, patients were divided into three groups:GP group [ gram-positive bacteria ( G+) group];GN group [ gram-negative bacteria ( G-) group];FG group ( fungi group) .There were no significantly statistical differences in age, APACHEⅡ score, vital signs and markers of inflammation among three groups (P>0.05).Gram negative pathogenic bacterium was the most common microbe.Compared with GN group, the level of sTLR2 in the GP group was obviously higher ( P=0.000); but there was no significant difference in sTLR2 level between GP group and FG group (P=0.187). The amount of (1, 3) -beta glucan in the FG group was significantly higher than that in the GP group ( P=0.000).The sTLR2 level in FG group was obviously higher than that in the GN group (P=0.000).There were no significantly statistical differences in PCT, CRP and IL-8 among the three groups (P>0.05).For the diagnosis of gram negative bacteria infection, sTLR2 area under the curve was 0.768, and the sensitivity and specificity were 88.90%and 59.60%, respectively and the best cut-off point was 8.083 pg/mL.Namely, the diagnosis of gram negative bacteria infection was less likely, when level of sTLR2 was higher than 8.083 pg/mL.The markers of PCT, CRP, (1, 3) -beta glucan and IL-8 were less valuable for the diagnosis of Gram negative bacteria infection because the area under the curve was less than 0.5.Conclusions The combination of inflammatory indicators such as sTLR2 and (1, 3) -beta glucan etc, can imply the kind of pathogenic microorganisms partly.

Objective To examine the inter- rater reliablity of Myoton-3 Myometer in assessment of muscle tone in healthy subjects.Methods 20 healthy volunteers were assessed their muscle tone of biceps brachii and flexor carpi radialis muscles in relaxed state with Myoton-3 by 2 testers within 24 h. The frequency of damping oscillations (F value) measured by Myoton-3 was as the characteristic of the muscletone. The intraclass correlation coefficient (ICC) and Bland-Altman analysis were performed. Results The ICC was 0.72~0.88 and 0.79~0.89 in triple scan and ten-time scan pattern, respectively. The Bland-Altman analysis revealed no systematic errors between testers. ConclusionThe Myoton-3 Myometer is reliable between testers for measuring the muscle tone in healthy adults.

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 observe the effect of surface electromyographic biofeedback (sEMG-BFB) combined with routine swallow training on dysphagic patients with cerebral infarction at recovery stage.Methods Fiftyone dysphagic patients with cerebral infarction were randomly divided into two groups:control group (26 cases) and biofeedback training group (25 cases).The control group was given routine training including orofacial function training,balloon dilatation and behavioral swallowing training,while the biofeedback training group was given behavioral swallowing training was conducted with the guidance of sEMG-BFB in addition to the routine training.Before and after the treatment,videofluoroscopy swallowing study (VFSS) was performed to observe the opening of upper esophageal sphincter (UES).Functional oral intake scale (FOIS) was used to evaluate swallow function.Results Before treatment,there were no significant difference between the two groups in terms of FOIS score and UES opening (P ＞0.05).The FOIS score increased in both groups after treatment (P ＜ 0.05),and the FOIS score was higher in the biofeedback training group than that of the control group (P ＜ 0.05).After treatment,the number of UES complete opening and incomplete opening was 18 and 8,respectively,in the control group,versus 20 and 5,respectively,in the biofeedback training group.UES opening improved in both groups after treatment (P ＜ 0.05).Conclusion Routine swallowing training combined with sEMG-BFB can benefit the dysphagic patients with cerebral infarction for their UES opening and swallowing ability at recovery stage.