Objective To investigate the effects of neuromuscular electrical stimulation (NMES) combined with swallowing training for relieving dysphagia in stroke patients.Methods A total of 150 chronic stroke patients at least 3 months post-stroke who were afflicted with dysphagia were randomly and evenly divided into a conventional swallowing training group,an NMES group,and an NMES combined with conventional swallowing training group.Prior to and after treatment,surface electromyography (sEMG) signals from the swallowing muscles were detected,swallowing function was evaluated using the standardized swallowing assessment (SSA),their swallowing was studied videofluoroscopically (VFSS),and a swallowing-related quality of life questionnaire (SWAL-QOL) was administered.Results There were significant differences in the maximum amplitude of sEMG signals,and the scores on the SSA,VFSS and SWAL-QOL in both groups between prior to and after treatment.After 4 weeks of treatment,the maximum amplitude of the sEMG signals and all three assessment scores were significantly higher where NMES had been combined with conventional swallowing training group compared with the other two groups.Indeed,there was no significant difference between the group which had received conventional swallowing training and the NMES groups.The analysis of coefficients revealed correlation between sEMG maximum amplitude and the SSA,VFSS and SWALQOL results.Conclusions NMES combined with conventional swallowing training is helpful for improving swallowing function in chronic stroke patients with dysphagia.

ObjectiveTo observe the effect of acupuncture plus rehabilitation training on the function recovery of patients with post-stroke depression.MethodNinety-eight patients with post-stroke depression were randomized into two groups to receive conventional management and anti-depressants. The control group was intervened by sham-acupuncture plus Fluoxetine tablets and comprehensive rehabilitation training, while the observation group was by acupuncture plus Fluoxetine tablets and comprehensive rehabilitation training. Prior to the intervention and after 8-week treatments, the depression state, motor function and activities of daily life (ADL) were evaluated by using Hamilton Depression Scale (HAMD), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI). The indexes and quality of life were also determined during the 3-month follow-up study.ResultBefore intervention, there were no significant differences in comparing HAMD, FMA and MBI scores (P>0.05). After 8-week treatment, the HAMD, FMA and MBI scores were significantlyimprovedin both groups (P<0.01,P<0.05). After treatment, the HAMD, FMA, and MBI scores in the observation group were significantlydifferent fromthat in the control group (P<0.01,P<0.05). The total effective rate was 90.0% in the observation group versus 79.2% in the control group, and the difference was statistically significant (P<0.05). The 3-month follow-up study showed significant differences in comparing the indexes between the two groups (P<0.05, P<0.01).ConclusionAcupuncture plus rehabilitation training benefits the improvement of depression state, motor function, cognitive function and quality of life in patients withpost-stroke depression, and is worth promotion.

Objective To study the therapeutic effects of extracorporeal shock wave therapy (ESWT) on temporomandibular joint disorders (TMDs).Methods Sixty patients with a temporomandibular joint disorder were randomly divided into an ESWT group and a control group,each of 30.Both groups were given routine rehabilitation training,but the treatment group additionally received ESWT for 2 weeks.Fricton's index was used to evaluate temporomandibular joint function.The subjects used a visual analogue scale (VAS) to evaluate their pain levels.The SF-36 scale was applied to assess their life quality.Results After two weeks of treatment,the average assessment score and VAS score had decreased significantly in both groups.After treatment the average scores for mandibular movement,muscle palpation,joint noise and joint palpation,and the palpation,dysfunction and craniomandibular indexes were all significantly lower in the ESWT group than in the control group.Significant differences were also found in the average VAS scores and on the social functioning domain of the SF-36 between the ESWT group and the control group.Conclusion ESWT combined with rehabilitation training can significantly relieve the symptoms and pain of TMDs.

Objective To study the expression of vascular endothelial growth factor (VEGF) and its receptors(VEGFR) mRNA at different time points after focal cerebral ischemic-reperfusion(CIR) in rats. Methods Following the establishment of the of transient ischemia modelof middle cerebral artery in rats by Zea-Longa′s method, the expression of VEGF and its receptors mRNA was measured with semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) at different time points. Results The expression of VEGF mRNA increased 3 h after CIR,and peaked at 6 h, and then declined, returned to the baseline at 7 d. The expression of Flt-1 and Flk-1 mRNA was enhanced at 3 h, and reached its peak at 3 d, then declined gradually. Conclusion The expression of VEGF、Flt-1 and Flk-1 mRNA can be induced by focal CIR in rats.

ObjectiveTo investigate the effects of Angelica sinensis on the expression of vascular endothelial growth factor (VEGF) Flt-1, Flk-1 mRNA after the brain ischemia-reperfusion injury in rats.MethodsWistar rats were randomly divided into the group A, group B and normal control group. The group A underwent middle cerebral artery occlusion (MCAO) for 2h by suture, group B underwent MCAO for 2h meanwhile received treatment with Angelica sinensis (5 g/kg). Immunohistochemistry and quantitative reverse transcription and polymerase chain reaction (RT-PCR) technique were used to examine the gene expression of VEGF.ResultsThe result of immunohistry revealed that VEGF in the group A and group B reached its peak at 24 h after reperfusion then declined gradually. The result of RT-PCR manifested that the gene expression of VEGF in the group A increased from 3 h after reperfusion and reached its peak at 6 h; in the group B reached its peak on the 3rd day. The expression of VEGF in the group B was significantly increased than group A at the same time point.ConclusionAngelica sinensis can enhance the expression of Flt-1, Flk-1 after transient interruption of cerebral blood flow in rats.

Objective To study the validity and reliability of Tengdao's swallowing standard for stroke pa-tients with dysphagia.Methods A total of 128 patients with postroke dysphagia took the swallowing test and then were divided into three sub-groups.Their scores on Tengdao's evaluation and their fluoroscopy results were analyzed using Spearman's correlation coefficient.Intra-class coefficients (ICCs)were used to examine the intra-rater and in-ter-rater reliability of Tengdao's evaluation.Results TenIgdao's evaluation possessed good validity and reliability.There was a high correlation between the scores in Tengdao's evaluation and fluoroscopy results. Conclusions Tengdao's evaluation is valid,reliable,simple and safe.It can be used in the clinic to evaluate the stroke patients with dysphagia.

Objective To investigate the effect of tumor necrosis factor (TNF)-α antagonists on liver function and reactivation of hepatitis B virus ( HBV ) in patients with inflammatory arthropathy with concurrent chronic HBV infection.Methods Patients with active rheumatoid arthritis (RA) and ankylosing spondylitis (AS) who were grouped according to serum HBV biomarkers were treated with TNF-α antagonist.The liver function and reactivation of HBV were monitored before and after anti-TNF-α therapy.Kruskal-Wallis one-way analysis of variance on ranks of continuous variables and x2 test or Fisher's exact test for categorical variables among 3 or more groups.Results Fifty patients were enrolled with 3 to 23 months of follow-up visit.The level of transaminases in chronic HBV infection group [n=11,AST (36±18) U/L,ALT (44±46) U/L] were significantly higher than that in past HBV exposure group [n=16,AST (22±6) U/L,ALT (17±9) U/L] or free of HBV infection group [n=23,AST (19±6) U/L,ALT (15±9) U/L](AST:x2=11.161,P＜0.01,ALT:x2=8.038,P＜0.01).One patient with elevated baseline HBV-DNA load was treated concomitantly with lamivudine and anti-TNF-α therapy,and the HBV-DNA load reduced about to normal 4 months later.Among the other 10 patients with normal baseline HBV-DNA load in chronic HBV infection group,one patient showed reactivation of HBV with elevated transaminases after anti-TNF-α therapy; another patient had only elevated transaminases without reactivation of HBV,and the transaminases returned to normal after withdrawal of antiTNF-α therapy,which suggested drug-induced liver injury.All patients in both past HBV exposure group and free of HBV infection group remained HBsAg negative after the therapy.Conclusion Patients with inflammatory arthropathy should be screened for HBV infection and check liver function before anti-TNF-α therapy,and carefully monitor the reactivation of HBV and liver function during treatment.Patients with concurrent chronic HBV infection should be treated conco-mitantly with anti-virus and anti-TNF-α therapy if they have elevated baseline HBV-DNA load (＞105 copies/ml,in particular) and good economic situation.

Objective To investigate the dynamic expression and significance of B cell lymphoma (Bcl) 6 in fibroblast-like synoviocytes (FLS) induced osteoclast differentiation and activation in rheumatoid arthritis (RA) patients.Methods RA-FLS were co-cultured with peripheral blood monocytes (PBMCs) from healthy volunteers in the medium containing M-CSF.Bcl6 protein and mRNA in osteoclasts and their precursors were determined by immunofluorescence and Real-time PCR at day 0,7,14 and 21,respectively.Osteoclasts were identified by tartrate-resistant acid phosphatase (TRAP) staining.Bone resorption activity of osteoclasts was determined by bone slices stained with toluidine blue.Kruskal-Wallis H and Bonferroni were used for statistical analysis.Results ① Immunofluorescence staining and TRAP staining showed that Bcl6 protein was mainly expressed in the nuclei of PBMCs.After co-cultured with RA-FLS for 7 days,some PBMCs differentiated into macrophages and a few differentiated to TRAP-positive multinucleated osteoclasts,and the total Bcl6 protein expression in osteoclasts and their precursors were increased.At day 14,the total Bcl6 protein expression was increased further.At day 21,the Bcl6 protein expression in nuclei of osteoclasts was decreased while PBMCs were differentiated into osteoclasts,and total Bcl6 protein expression was decreased.②Real-time PCR showed that Bcl6 mRNA expression in osteoclasts and their precursors at day 7 tended to increase than that at day 0 (x2=3.429,P＞0.05).At day 14 after co-cultured with RA-FLS,Bcl6 mRNA expression in osteoclasts and their precursors was significantly higher than that at day 0 (x2=5.333,P=0.045).At day 21,the expression of Bcl6 mRNA was significantly lower than that at day 14 (x2=6.023,P=0.038).Conclusion Bcl6 may be involved in osteoclast differentiation and activation,and may play a role in the inflammatory status in the process of differentiation from PBMCs to macrophages.Further studies are needed to establish the mechanisms.

To investigate the effects of VitalStim therapy coupled with conventional swallowing training on recovery of post-stroke dysphagia, a total of 120 patients with post-stroke dysphagia were randomly and evenly divided into three groups: conventional swallowing therapy group, VitalStim therapy group, and VitalStim therapy plus conventional swallowing therapy group. Prior to and after the treatment, signals of surface electromyography (sEMG) of swallowing muscles were detected, swallowing function was evaluated by using the Standardized Swallowing Assessment (SSA) and Videofluoroscopic Swallowing Study (VFSS) tests, and swallowing-related quality of life (SWAL-QOL) was evaluated using the SWAL-QOL questionnaire. There were significant differences in sEMG value, SSA, VFSS, and SWAL-QOL scores in each group between prior to and after treatment. After 4-week treatment, sEMG value, SSA, VFSS and SWAL-QOL scores were significantly greater in the VitalStim therapy plus conventional swallowing training group than in the conventional swallowing training group and VitalStim therapy group, but no significant difference existed between conventional swallowing therapy group and VitalStim therapy group. It was concluded that VitalStim therapy coupled with conventional swallowing training was conducive to recovery of post-stroke dysphagia.

This paper, on top of its introduction of the concept of medical ethics counseling, analyzed the necessity of establishing a medical ethics consultation system in China.By reviewing the development of the medical ethics counseling system in other countries, the authors, in view of China′s medical practice, put forward specific recommendations on establishing a medical ethics counseling system in China.Issues on the construction of organ donation ethics counseling system in China were also discussed in focus.