Objective To study the phonetic characteristics of patients with abnormal plosive consonant of functional articulation disorders (FAD) and the possible treatment approaches.Methods A total of patients of 4~26 years old with abnormal plosive consonant of FAD received speech assessment and the phonetic characteristics.Incorrect articulation patterns and forms of plosive consonant /b/,/p/,/d/,/t/,/g/ and /k/ were analysed.The targeted speech treatment was established to correct the erroneous places and types of pronunciation.Results The error rate of /t/ (82/87)was the highest,followed by /k/(77/87),/d/(67/87),/g/(60/87),/p/(59/87) and /b/(3/87) which was the lowest.The error rate of fricative was 65.52% as the highest among all the erroneous patterns,followed by unaspiration(63.22%),forward movement of the tongue(54.02%),distortion(33.33%),bilabial(32.18%),and backward movement of the tongue(18.39%).Seventy-one cases were completely cured,and 16 cases partially cured after 2 to 10 times of treatment.The number of incorrect words of plosives decreased to 4.03±2.71 after the speech therapy from 67.97±18.56 prior to that.The differences were statistically significant (t =34.301,P<0.001).Conclusion The articulation errors of plosives occur mainly on /t/,/k/,/d/,/g/and /p/,/b/.The incorrect types of pronunciation are fricatives,unaspiration,distortion and omission.The incorrect places of articulation are forward movement of the tongue,bilabial and backward movement of the tongue.The targeted speech therapy established according to the erroneous places and types of articulation is significantly effective.

Objective To investigate the effect of Santong electroacupuncture (EA) on mRNA and protein expression of p75 neurotroph-in receptor (p75NTR) in rats with spinal cord injury (SCI). Methods A total of 72 female Sprague-Dawley rats were randomly assigned to sham operation group (group A, n=8) and model group (n=64). In the model group, Allen's method was used to make SCI rats model, in which 48 survived model rats were further subdivided into model control group (group B, n=12), EA group (group C, n=12), inhibitor Nogo extra cellular peptide residues 1-40 (NEP1-40) group (group D, n=12) and EA+inhibitor NEP1-40 group (group E, n=12) according to de-sign proposal. The treatment groups were electroacupunctured on Dazhui (GV14) and Yaoyangguan (GV3), bilateral Ciliao (BL32) and Zu-sanli (ST36) with loose-tight wave, for 20 minutes every day. After 7 and 14 days of treatment, injured spinal cord tissue was extracted for detecting. The mRNA and protein expression of p75NTR was detected by real-time fluorescent quantitative PCR, in situ hybridization and Western blotting respectively. The hind limb motor function was assessed with Basso-Beattie-Bresnahan (BBB) score. Results The BBB score increased in the treatment groups compared with group B, and was higher in group E than in groups C and D (P<0.05), as well as on the 14th day than on the 7th day in all the treatment groups (t>2.623, P<0.05). The mRNA and protein expression of p75NTR in spinal cord tissues decreased in the treatment groups compared with group B (P<0.05), and no significant difference was found among the treatment groups (P>0.05). Conclusion Santong elerctroacupuncture treatment could improve the hind limb motor function, which may associate with inhibition of the mRNA and protein expression of p75NTR in rats after SCI.

Objective:To explore the real experience of elderly patients with esophageal fistula after esophageal covered stent placement.Methods:From July 2019 to April 2020, purpose sampling was used to selected 13 elderly patients with esophageal fistula who were revisited after esophageal covered stent placement in the Intervention Therapy Department of the First Affiliated Hospital of Zhengzhou University for the semi-structured interview. The Colaizzi 7-step analysis method was used to analyze the interview data, integrate, summarize and refine the theme.Results:The inner experience of self-care of elderly patients with esophageal fistula after esophageal covered stent placement were summarized into 4 themes: diversification of negative emotions (being worried about complications, financial pressure, low self-esteem and loneliness) ; poor compliance behavior outside the hospital; insufficient self-care ability; the single source of support (insufficient family support, desiring for social support) .Conclusions:Elderly patients with esophageal fistula after esophageal covered stent placement generally have a variety of negative emotions and lack effective guidance and family social support. Medical and nursing staff should strengthen the health education and psychological counseling of patients, and medical institutions should accelerate the training of elderly nursing personnel and establish a mature elderly nursing system.

Objective To observe the effect of electro-acupuncture on Nogo /NgR signal pathway related factor gene expression in rats with spinal cord injury,so as to investigate the potential mechanism of elec-tro-acupuncture(EA)treatment for spinal cord injury.Methods The rats were randomly divided into model group,EA group,blocking agent group,EA +blocking agent group,and sham operation group. T10 spinal cord injury model was induced by the modified Allen’s impact method,and the BBB function score on day 1,7,and 14 in each group were obtained after treatment respectively.Spinal cord tissues were extracted on day 7 and 14,then Nogo-A,NgR and LINGO-1 protein expression in spinal cord tis-sues of rats were detected by Western blot.The mRNA expression of LINGO-1,NgR and Nogo-A were measured by real-time fluorescence quantitative PCR.Results After spinal cord injury,BBB scores of model rats was 0 on day 1;after 7 or 14 days of intervention,the BBB scores of each treatment group were significantly higher than those of model group(P <0.05),and the EA +blocking agent group was better than the EA group and blocking agent group(P <0.05).Compared with sham operation group at the same time point,the expression of each gene in model group significantly improved(P <0.05 ). Compared with the model group,the gene expression in each treatment group significantly decreased(P <0.05),at the same time,there was a significant difference in LINGO-1 gene expression between the EA+blocking agent group and the EA group(P <0.05).Conclusion Nogo /NgR signal pathway plays a key role in the process of nerve regeneration and repairment after spinal cord injury.Electro-acupuncture may be via inhibiting Nogo /NgR,LINGO-1 signal pathway to treat spinal cord injury in rats.

Objective To explore the effects of the mouth -muscle strengthening training on the phonetic in-telligibility (PI) of children with functional articulation disorders (FAD) .Methods A total of 80 children of 4 to 7 years old with FAD were randomly divided into the common group (n=40) and comprehensive group (n=40) .Both groups accepted routine speech training ,and the comprehensive group was given mouth muscles training additional-ly .All the children received the assessment of speech before the speech training and 3 months after the training .Re-sults Before the speech training ,the PIs of the common and comprehensive groups were 34 .54％ and 33 .52％ ,re-spectively .The differences between the 2 groups were not statistically significant (P> 0 .05) .After 3 months of speech training ,the PI in the common group increased to 77 .02 ± 4 .21％ from 34 .54 ± 7 .28％ of the baseline ,while in the comprehensive group ,the PI increased to 87 .54 ± 4 .31％ from 33 .52 ± 7 .46％ .In both groups ,the PIs after training were significantly higher than those of before the training respectively .The differences were statistically significant (P<0 .05) .The PIs in the comprehensive group were significantly higher than those of in the common group .The differences were statistically significant (t= -8 .862 ,P<0 .001) .Conclusion Strengthening the mouth muscles is beneficial to improve the PI of children with FAD .

Objective:To investigate the characteristics of cochleo-vestibular dysfunction in patients with profound sudden deafness, and the prognosis of inner ear hemorrhage.Methods:From January 2017 to December 2018, 92 inpatients with profound sudden sensorineural hearing loss were enrolled in the Department of Otorhinolaryngology, First Affiliated Hospital of Sun Yat-sen University. Our studied patients included 47 males and 45 females, aged 20-78 (39.3±6.1) years. According to the results of inner ear magnetic resonance imaging (MRI), the patients were divided into two groups: inner ear hemorrhage group and non-inner ear hemorrhage group. The clinical features, vestibular tests and audiological examination results during follow up were compared between the two groups. SPSS 22.0 software was used for statistical analysis.Results:The inner ear hemorrhage group consisted of 32 cases (34.8%, 32/92), all of whom complained of vertigo (100%, 32/32). Simultaneous vertigo attack and hearing loss occurred in 78.1% of this group (24/32). Neither semicircular canals function, nor cervical vestibular evoked myogenic potential (c-VEMP), nor ocular vestibular evoked myogenic potential (o-VEMP) in the affected side was normal (100%, 32/32). The rates of benign paroxysmal positional vertigo (BPPV) and disequilibrium were 37.5% (12/32) and 25.0% (8/32) respectively. Hearing improved in 28.1% (9/32) two weeks after treatment, and became stable at one month′s follow up. In 60 cases without inner ear hemorrhage, 58.3% of them (35/60) experienced vertigo, which occurred simultaneously with hearing loss in 21 patients (60%, 21/35). The abnormal rates of semicircular canals function, c-VEMP and o-VEMP were 71.6% (43/60), 78.3% (47/60) and 66.7% (40/60), respectively. The incidence of BPPV was 16.7% (10/60) and 8.3% (5/60) in cases with disequilibrium. Hearing improved in 58.3% (35/60) two week after treatment, and became stable at three months′ follow up. Significant difference was found in either vertigo rate, or simultaneous vertigo/hearing loss rate, or abnormal c-VEMP/o-VEMP rates, or accompanying BPPV, or disequilibrium rates between the two groups ( P<0.05 each). Moreover, we observed better hearing recovery in non-inner ear hemorrhage group in the two weeks, one month, three months and six months′ follow up, when compared with those in inner ear hemorrhage groups ( P<0.05 each). Conclusions:Inner ear hemorrhage is associated with more severe cochlea-vestibular lesion and poorer prognosis, in comparison to the non-inner ear hemorrhage,in patients with profound sudden sensorineural hearing loss.

Background: and Purpose We investigated the causal relationships between the gut microbiota (GM), stroke, and potential metabolite mediators using Mendelian randomization (MR). Methods: We leveraged the summary statistics of GM (n=18,340 in the MiBioGen consortium), blood metabolites (n=115,078 in the UK Biobank), and stroke (cases n=60,176 and controls n=1,310,725 in the Global Biobank Meta-Analysis Initiative) from the largest genome-wide association studies to date. We performed bidirectional MR analyses to explore the causal relationships between the GM and stroke, and two mediation analyses, two-step MR and multivariable MR, to discover potential mediating metabolites. Results: Ten taxa were causally associated with stroke, and stroke led to changes in 27 taxa. In the two-step MR, Bifidobacteriales order, Bifidobacteriaceae family, Desulfovibrio genus, apolipoprotein A1 (ApoA1), phospholipids in high-density lipoprotein (HDL_PL), and the ratio of apolipoprotein B to ApoA1 (ApoB/ApoA1) were causally associated with stroke (all P<0.044). The causal associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were validated using the weighted median method in an independent cohort. The three GM taxa were all positively associated with ApoA1 and HDL_PL, whereas Desulfovibrio genus was negatively associated with ApoB/ApoA1 (all P<0.010). Additionally, the causal associations between the three GM taxa and ApoA1 remained significant after correcting for the false discovery rate (all q-values <0.027). Multivariable MR showed that the associations between Bifidobacteriales order, Bifidobacteriaceae family and stroke were mediated by ApoA1 and HDL_PL, each accounting for 6.5% (P=0.028) and 4.6% (P=0.033); the association between Desulfovibrio genus and stroke was mediated by ApoA1, HDL_PL, and ApoB/ApoA1, with mediated proportions of 7.6% (P=0.019), 4.2% (P=0.035), and 9.1% (P=0.013), respectively. Conclusion The current MR study provides evidence supporting the causal relationships between several specific GM taxa and stroke and potential mediating metabolites.

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.