Objective:To seek any correlation between cortical activity and the swallowing of dysphagia patients with infratentorial stroke, and to observe any effect of three-needle acupuncture of the tongue on such activity.Methods:Thirty infratentorial stroke survivors with dysphagia were randomly divided into a tongue three-needle group and a sham acupuncture group, each of 15. Functional near-infrared spectroscopy was used to monitor changes in the concentration of oxygenated hemoglobin (ΔHbO 2) at rest, during acupuncture (or sham acupuncture), during real or sham electro-acupuncture, and at rest after the acupuncture or sham acupuncture treatment. The Modified Rankin Scale, a Penetration-Aspiration Scale (PAS), and the Functional Oral Intake Scale were employed to assess overall functional disability and the swallowing of both groups. Results:At rest the average ΔHbO 2 concentrations recorded in the left primary motor cortex, the left dorsolateral prefrontal cortex and the left premotor cortex in both groups were positively correlated with the PAS scores. During the acupuncture ΔHbO 2 concentration in the right inferior frontal gyrus and the left middle temporal gyrus increased significantly in the tongue three-needle group. It decreased significantly in the left somatosensory cortex and the left primary motor cortex. Conclusion:Three-needle acupuncture of the tongue induces changes in cortical activity in infratentorial stroke survivors with dysphagia, suggesting a potential technique for improving disordered swallowing.

Objective:To observe any effect of intermittent theta burst stimulation (iTBS) of the prefrontal lobe on dysphagia and impaired cognition, and to explore the neural mechanisms involved.Methods:Twenty-eight patients with dysphagia and mild cognitive impairment were randomly divided into an iTBS group of 16 and a control group of 11. The iTBS group received 20 minutes of iTBS (2 seconds on and 8 seconds off) of the right dorsal lateral prefrontal cortex (DLPFC) once daily for 2 weeks, with the intensity at 80% of the resting movement threshold of the right abductor pollicis brevis, while the control group was given sham iTBS. Before and after the treatment, both groups′ cognitive functioning was evaluated using the Montreal Cognitive Assessment Scale (MoCA), a trial marking test, a digit span test and a Stroop color word test. Video-fluoroscopy was used to record oral transmission times (OTTs), hyoid bone anterior displacement and hyoid bone upward displacement during swallowing. Resting-state functional magnetic resonance imaging measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo) and functional connectivity in the patients′ brains.Results:Before the treatment there was no significant difference in the average indices of cognition or swallowing function between the 2 groups. Afterward the average MoCA score had increased significantly in both groups, with the improvement in the iTBS group significantly greater than that of the controls. Average OTT had shortened significantly in both groups, with significantly greater improvement in the iTBS group. The magnetic resonance imaging showed that after iTBS treatment, local excitation indicators and functional connections in several brain regions had changed. ALFF and ReHo in the right anterior cuneus had increased, ReHo in the left middle temporal gyrus, the orbital region of the left inferior frontal gyrus and the left middle cingulate gyrus had decreased, and functional connectivity in the right DLPFC, the bilateral cuneus and the right middle cingulate gyrus had increased.Conclusions:Two weeks of intermittent TBS of the right DLPFC can improve the swallowing and cognition of persons with dysphagia. Functional reorganization of brain networks may be one of the neural mechanisms involved.

Objective:To investigate the present situation of delayed medical care for patients with senile cataract and analyze the influencing factors.Methods:Totally 636 senile cataract patients in Baoji Eye Hospital from January to September, 2017 were recruited. They were investigated using the current status of medical delay questionnaire.Results:The detection rate of delayed medical care for elderly patients with cataract was 36.95%(235/650). Logistic analysis demonstrated that significant influencing factors for patient delay included age, place of residence, educational level, hypertension, diabetes, medical insurance, distance and time for place of residence to the nearest medical unit for elderly cataract patients ( P<0.05) . Conclusion:There are widespread medical delays in elderly cataract patients in Baoji City. We should strengthen health education for elderly cataract patients, provide social support, and develop targeted measures to promote timely medical treatment, reduce blindness and increase quality of life.

Objective: To evaluate the motility of the esophagus while swallowing of brainstem stroke survivors. Methods: Eighteen patients and 10 healthy subjects were included in the study. There was no significant difference in average age, gender, weight or body mass index between the two groups. All underwent high-resolution esophageal manometry to assess esophageal motility while swallowing, and they were rated using the version 3.0 of the Chicago classification. Results: Fourteen of the 18 stroke survivors displayed abnormal esophageal dynamics (77.8%), compared with only 10.0% of the healthy control group, but that difference was not statistically significant. The typical abnormalities were a lack of contraction, high pressure contractile esophagus, gastroesophageal junction outflow obstruction and/or distal esophageal spasm. Compared with the control group, the average resting pressure of the patients′ upper esophageal sphincters (UESs) was significantly lower, while the UES residual pressure and integrated relaxation pressure of their lower esophageal sphincters (LESs) were higher and the average UES relaxation time was significantly shorter. No significant differences were found in the LES resting pressures, distal contractile integrals or the distal latency between the two groups. Conclusions Abnormal esophageal motility is highly prevalent in brainstem stroke survivors and due attention should be paid to it. High-resolution manometry can be used to assess this condition.

Objective To analyze the effect of ultrasound-guided glucocorticoid injection on different pathologies of the shoulder retrospectively.Methods Clinical data were collected describing 75 patients with shoulder pain who received ultrasound-guided glucocorticoid injection and finished 3 month follow-ups in the rehabilitation clinic of the Third Affiliated Hospital of Sun Yat-sen University between April and September of 2017.The patients were divided into three groups based on their different injection sites:group 1 was injected at the subacromial bursa alone,group 2 was injected at both the subacromial bursa and the coracoid bursa,while group 3 was injected at the subacromial bursa and the long head of the tendon sheath of the biceps brachii.A shoulder pain and disability index (SPADI) was used to quantify the pain and disability of each patient before and after the injection.Results Significant improvement was observed in the average pain and disability scores of all groups at 1 week,1 month and 3 months after the injection.Moreover,significant and continuous improvement was observed in the average pain and disability scores of groups 1 and 3,as well as the average disability score of group 2 from right after the injection until the last follow-up.However,no significant differences were found in the average pain score between one and three months after the injection.There was no significant difference among the 3 groups in the average pain and disability scores before and immediately after the injection.Conclusion Ultrasound-guided glucocorticoid injection is effective and persistent for treating shoulder pain with different pathologies.

Objective: The purpose of the research was to draw up the questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly and to provide elderly people with a effective tool for evaluating the needs of medicine, pension, rehabilitation and care. Methods: The theoretical framework of the questionnaire was based on the qualitative interview results of 12 community elderly and community health care workers. A preliminary draft was formed through two rounds of expert consultation and a preliminary survey of 102 elderly people in 3 communities in Taian. Construct validity was used to evaluate the validity of the questionnaire, and Cronbach's alpha coefficient and split half reliability were used to evaluate the reliability of the questionnaire. Results: Sixteen experts were invited to conduct two rounds of consultation on 61 items of the questionnaire. The authoritative coefficient of experts was 0.881, and the positive coefficient of experts was 100%. In the first round, items I-CVI, S-CVI/UA and S-CVI/Ave were 0.68-1.00, 0.72 and 0.83, respectively. Seven items were modified, six items were deleted and three items were added. In the second round, one item was deleted and one item was added, and a questionnaire consisting of seven dimensions and 58 items was formed.7 common factors were extracted from exploratory factor analysis, and the cumulative contribution rate was 63.078%. Finally, 7 dimensions and 51 item questionnaires were formed. Each dimension is the community public health service and general services, health education, pension services, rehabilitation services, family beds, service charges The total Cronbach's alpha coefficient was 0.919, the Cronbach' s alpha coefficient of each dimension was 0.615-0.808, the retest reliability coefficient of the total questionnaire was 0.862.and the Guttman half coefficient is 0.865. The total questionnaire CVI was 0.85 and the item CVI was 0.80-1.00. Item analysis showed that the correlation coefficients of the 7 items were lower than 0.3, and the rest were all between 0.3~0.7, and were significantly correlated at P<0.05 level. Conclusion The questionnaire of the integrated services demand for medicine, pension, rehabilitation and care of community elderly had good reliability and validity, and it could be used to evaluate the needs of medicine, pension, rehabilitation and care in the elderly.

Objective: To explain the true experience of death anxiety in elderly inpatients with chronic diseases, and provide a theoretical basis for hospice care. Methods: The phenomenological study method was used to deeply interview the true feelings of death anxiety in 13 elderly inpatients with chronic diseases. Results: Through analysis, collation and refinement, the five themes of death anxiety, life regret, death attitude, death reminder and final decision power. Conclusions As clinical medical workers, we must always pay attention to the death anxiety of elderly inpatients with chronic diseases and strengthen the assessment of death anxiety. In particular, patients with cancer and patients at the end of life are provided with personalized care to remind them of the meaning of life and reduce the anxiety level of death.

Objective To explore the status and influencing factors of the integrated service needs of medicine, pension, rehabilitation and care of the community elderly in order to provide a theoretical basis for the construction of an old-age service model in line with the national conditions. Methods A total of 330 elderly people from three communities in Tai'an were selected and investigated by self-made questionnaire of the integrated services needs for medicine, pension, rehabilitation and care of community elderly. Results Nearly 83.54％(259/310) of the elderly had moderate and above pension needs, and the first three were rehabilitation services, family beds and community public health services. Age, educational level, self-rated health and number of chronic diseases were the influencing factors of the integrated service needs of medicine, pension, rehabilitation and care(t =2.374-4.844, all P<0.05). Conclusions The majority of elderly people have the moderate and above health care integration service demand, the elderly have the highest demand for rehabilitation services. Age, education, self-rated health status and the number of chronic diseases have different influence on the needs of the elderly;government, society, education and medical treatment institutions interdisciplinary multi linkage, and strengthen the professionals training of health, rehabilitation, health care, in order to explore the best old-age service model in line with national conditions.

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.

Objective To explore the effect of applying surface neuromuscular electrical stimulation (NMES) on the functioning of the upper esophageal sphincter (UES) using the high-resolution solid-state manometry.Methods Seventeen healthy volunteers were selected and given sham stimulation (SS),superior and inferior hyoid stimulation (SIHS),superior hyoid stimulation (SHS) or inferior hyoid stimulation (IHS) at a frequency of 80 Hz and the maximum tolerated level before swallowing.Any changes in the kinematics or biomechanics during swallowing and at rest were recorded using high-resolution solid-state manometry.One-factor repeated analysis of the measurement variance was used.Results A significant decrease in the duration of UES relaxation was observed in response to the electrical stimulation (compared with the sham stimulation).The UES's residual pressure showed a rising trend during electrical stimulation,especially in response to IHS,but the difference compared with SS was not significant.The UES's resting pressure during SIHS increased significantly compared with SS,but there was no significant difference between SHS and IHS in this respect.Conclusions Surface neuromuscular electrical stimulation applied to the neck can immediately change the functioning of the UES.NMES at the maximum tolerated intensity can reduce the duration of UES relaxation,which is important for dysphagia therapy and research.