Objective:To evaluate the effectiveness of diaphragm ultrasound in predicting the success of extubation from tracheotomy in patients with acquired brain injury.Methods:A retrospective analysis was conducted on 51 brain-injured patients. They were divided into an extubation failure group and an extubation success group. The results of ultrasound examination of the diaphragm in the 2 groups were analyzed by univariate analysis, and the independent variables with significance were further subjected to multivariate logistic regression analysis. R software was applied to build the diaphragm indicators showing significant predictive power into a histogram model. The predictive value of this nomogram model was assessed using the receiver operating characteristics (ROC) curve.Results:The univariate analysis revealed significant differences between the two groups in terms of diaphragm excursion, diaphragm thickening fraction and diaphragm excursion-time index. The multivariate logistic regression analysis and the nomogram showed that those three variables are independent influencing factors predicting the success of decannulation. The areas under the ROC curves confirmed that finding.Conclusions:Diaphragm excursion, diaphragm thickening fraction and the diaphragm excursion-time index are useful independent predictors of the success of decannulation among brain injury patients.

Objective:To evaluate the effectiveness of diaphragm ultrasound in predicting the success of extubation from tracheotomy in patients with acquired brain injury.Methods:A retrospective analysis was conducted on 51 brain-injured patients. They were divided into an extubation failure group and an extubation success group. The results of ultrasound examination of the diaphragm in the 2 groups were analyzed by univariate analysis, and the independent variables with significance were further subjected to multivariate logistic regression analysis. R software was applied to build the diaphragm indicators showing significant predictive power into a histogram model. The predictive value of this nomogram model was assessed using the receiver operating characteristics (ROC) curve.Results:The univariate analysis revealed significant differences between the two groups in terms of diaphragm excursion, diaphragm thickening fraction and diaphragm excursion-time index. The multivariate logistic regression analysis and the nomogram showed that those three variables are independent influencing factors predicting the success of decannulation. The areas under the ROC curves confirmed that finding.Conclusions:Diaphragm excursion, diaphragm thickening fraction and the diaphragm excursion-time index are useful independent predictors of the success of decannulation among brain injury patients.

Objective:To explore the effect of swallowing fluids of different viscosities in different head positions on the surface electromyography (sEMG) of the suprahyoid muscles.Methods:Twenty healthy adults were asked to swallow 5ml of liquids with 5 different viscosities in 3 different head positions. sEMG signals were recorded from their suprahyoid muscles in real time. The interactions between viscosity, head position and suprahyoid muscle activation were determined using simple effect analysis.Results:Significant head position and viscosity effects were observed. In the head-turning-right or the right head-flexion position, the net amplitude values of the left suprahyoid muscles were significantly higher than those from the right side when swallowing fluid of the same viscosity. Meanwhile, the net amplitude values of the left suprahyoid muscles increased gradually and significantly from the neutral position to the head-turning-right and the right head-flexion positions. When swallowing fluid with a viscosity of 0 to 3, the net amplitude values of the right suprahyoid muscles in the right head-flexion position were significantly lower than in the neutral and right head-flexion positions. With a viscosity of 4 the values of the former were significantly higher than the latter. The net amplitude of the left superhyoid muscle group when swallowing zero-viscosity food in a head-turning-right position was significantly lower than that when swallowing food of viscosity 1 to 4. In the right head-flexion position, the net amplitude of the left superhyoid muscle group when swallowing zero-viscosity food was significantly lower than that when swallowing food of viscosity 2 to 4. When swallowing fluid of viscosity 1 it was also significantly lower than that when swallowing food of viscosity 3 to 4. In the same position, the net amplitude of the right suprhyoid muscle group when swallowing fluid of viscosity 4 was significantly higher than that with a viscosity of 0 to 1. At viscosity 3 it was significantly higher than with a viscosity of 1.Conclusion:Swallowing fluids of different viscosities in different head positions can affect the contraction of the suprahyoid muscles to different degrees.

Objective To study the effect of the trauscranial magnetic stimulation on the migration of phosphoprotein-enriched astrocytes-15kDa (PEA-15).Methods Third or fourth generation rat astrocytes cuhured in vitro were divided into a control group,a transfected group,a magnetic stimulation group and a transfected + magnetic stimulation group.The control group was undergone transfect of negative siRNA.In transfected group and the transfected + magnetic stimulation group the liposome in the astrocyte was transfected instantly with chemically synthesized PEA-15 siRNA,so as to interfere with the expression of PEA-15 protein.Magnetic stimulation was applied to both tranfected and transfected + magnetic stimulation groups 24 h after plating of astrocytes at 1 Hz and 60％ the maximal output of the stimulator.Cell scratch tests were used to assess the astrocytes' migration,and Western blotting was applied to detect the expression of PEA-15 and protein phosphorylation.Results Compared with the control group,the expression of PEA-15 protein decreased significantly in the transfected groups.The cell migration in the transfected group,the magnetic stimulation group,and the transfected + magnetic stimulation group was significantly greater than in the control group.Compared with the control group,the phosphorylation of PEA-15 increased significantly in the magnetic stimulation group.Conclusion When PEA-15 expression is interfered with,the migration of astrocytes increases significantly.Magnetic stimulation may promote the migration of astrocytes by enhancing PEA-15 phosphorylation.

Objective To examine the effect of the inter-stimulus interval (ISI) in magnetic stimulation (MS) on astrocyte migration and its related mechanism.Methods Cultured astrocytes were treated with intermittent MS with intervals of 1,5 and 10 seconds.The PEA-15 inhibitor BisI (10 μmol/ml) and the ERK1/2 inhibitor U0126 (10 μmol/ml) were administered and cell migration assays evaluated the astrocytes' migration.The expression of phosphorylated ERK1/2 and PEA-15 was detected using Western blotting.Results The 1 second interval significantly facilitated astrocyte migration,the phosphorylation of PEA-15 and ERK1/2,and the expression of MMP-9 (browse matrix metalloproteinase-9).The addition of Bis I significantly reduced the production of phosphorylated ERK1/2 and MMP-9,as well as astrocyte migration induced by MS.In addition,pretreatment with U0126 also significantly decreased the astrocyte migration induced by MS.Conclusion 1s-ISI MS can induce PEA-15 activation and subsequently lead to ERK1/2 phosphorylation and upregulation of MMP-9,which may contribute to the migration of astrocytes.

Objective To investigate the clinical pathological characteristics,immunohistochemistry,diagnosis and differential diagnosis,treatment and prognosis of malignant melanoma.Methods The data of 5 cases were reviewed.Results Out of 5 patients,1 patient was female and 4 were males,aged 48 from 92 years (mean age of 67.2 years).Tumors originated from different sites,such as nose,skin and esophagus.Microscopically,the tumor cells were various in morphology from spindle,epithelioid,nevus alike cells to foam alike cells,arranged in nests,stripes or loose nets.Immunohistochemical stain showed positive expressions in S-100,HMB45 in some extent,Melan-A or Vimentin,individually expression CD56 and CgA.However,the levels of CK,EMA,CEA,Desmin,NSE,LCA,CD3,CD20,SMA,MyoD 1,Myogenin and Syn were negatively expressed.Braf and C-kit gene tests were applied in all cases,however,only one case was detected with Braf gene V600E mutation.No case was found with C-kit gene mutations.Conclusion Malignant melanoma is a kind of highly invasive tumor,which is characterized by highly changed morphology and easily misdiagnosis or missed diagnosis.Immunohistochemistry and genetic testing are of great significance in diagnosis and targeted therapy.

Objective To investigate the clinical pathological characteristics,immunohistochemistry,diagnosis and differential diagnosis,treatment and prognosis of malignant melanoma.Methods The data of 5 cases were reviewed.Results Out of 5 patients,1 patient was female and 4 were males,aged 48 from 92 years (mean age of 67.2 years).Tumors originated from different sites,such as nose,skin and esophagus.Microscopically,the tumor cells were various in morphology from spindle,epithelioid,nevus alike cells to foam alike cells,arranged in nests,stripes or loose nets.Immunohistochemical stain showed positive expressions in S-100,HMB45 in some extent,Melan-A or Vimentin,individually expression CD56 and CgA.However,the levels of CK,EMA,CEA,Desmin,NSE,LCA,CD3,CD20,SMA,MyoD 1,Myogenin and Syn were negatively expressed.Braf and C-kit gene tests were applied in all cases,however,only one case was detected with Braf gene V600E mutation.No case was found with C-kit gene mutations.Conclusion Malignant melanoma is a kind of highly invasive tumor,which is characterized by highly changed morphology and easily misdiagnosis or missed diagnosis.Immunohistochemistry and genetic testing are of great significance in diagnosis and targeted therapy.

Objective To examine the molecular mechanism involved in astrocyte migration induced by magnetic stimulation (MS),and the role of high mobility group box 1 (HMGB1) in migration.Methods Astrocytes were isolated from the cortical tissues of 2-3 day old Sprague-Dawley rats and divided into a stimulus group given MS and a control group without MS.The stimulus group was further divided into an experimental group and a control group,with the former pre-stimulated with 10 μmol/ml U0126 for 30 minutes and no pre-stimulation for the latter.The cells in the experimental group were also randomly divided into siRNA and HMGB1-siRNA transfection groups to examine the role of HMGB1 in astrocyte migration induced by MS.The SiRNA group was transfected with HMGB1 siRNA.Western blotting was used to detect any effect of MS on HMGB1 and extracellular signal-regulated kinase1/2 (ERK1/2).The migration of astrocytes was detected using the scratch assay.Results MS (10 Hz) can promote the phosphorylation of ERK,increase the migration of astrocytes and the expression of HMGB1.After the U0126 treatment and transfection with HMGB1 siRNA,the effects of MS on expression of HMGB1 and migration of astrocytes decreased significantly.Conclusions Magnetic stimulation-mediated migration of astrocytes via activation of the ERK pathway phosphorylation and autocrine of HMGB1.

Objective To observe the surface electromyographic characteristics of the bilateral submen-tal muscles in dysphagia secondary to unilateral brainstem stroke. Methods A total of 25 subjects were recrui-ted. There were 8 stroke patients with dysphagia secondary to a left brainstem stroke and 7 stroke patients with dysphagia secondary to a right brainstem stroke. There were also 10 healthy controls matched in age and gender. The duration and peak amplitude of the submental muscle when swallowing 5 ml of warm water were recorded u-sing a surface electromyograph. Results The average amplitude of the left submental muscle in patients with a left brainstem stroke was significantly longer than that of those with a right brainstem stroke, but no significant differences in average duration were observed. Conversely, the amplitude of the right submental muscle in pa-tients with a right brainstem stroke was significantly longer than that of those with left brainstem stroke, but again there were no significant differences in duration. No significant differences were observed among the healthy con-trols. The amplitude and duration of both the affected and healthy sides of the patients were of course significantly longer or stronger than those of the healthy controls. Conclusion The swallowing function of the bilateral sub-mental muscles may be impaired among unilateral stroke survivors with dysphagia. The damage on the affected side is more severe than on the opposite side.

Objective To observe the effect of low-frequency, repetitive transcranial magnetic stimulation ( rTMS) at different frequencies on the cognitive function of traumatic brain injury patients with a history of epilepsy. Methods Sixty traumatic brain injury patients were randomly divided into a 0. 5 Hz group, a 1. 0 Hz group and a control group, each of 20. In addition to routine drug therapy and cognition training, the control group was given fake stimulation, the 0.5 Hz group was treated with 0.5 Hz rTMS, and the 1.0 Hz group was provided with 1.0 Hz rTMS for 4 weeks, eleven times per week. Before and after treatment, the cognitive function of all three groups was assessed using the Montreal cognitive assessment ( MOCA) , the Rivermead behavior memory test ( RBMT) and a symbol can-cellation test. The number of patients reporting headache or epilepsy during the treatment period was also counted. Results During the treatment, there was no headache case in any of the groups, and no significant difference was found in the occurrence of seizures. After the treatment, all of the measurements in all 3 groups had improved signifi-cantly. The average MOCA and RBMT scores in the 1.0 Hz group were all significantly better than those in the control group, but there was no significant difference between the 0.5 Hz group and the control group. The symbol cancella-tion test efficiency of the 1. 0 Hz group was not significantly better than that of the 0. 5 Hz and control groups. Conclusions Repeated 1.0 Hz transcranial magnetic stimulation can significantly improve cognition after traumatic brain injury among patients with a history of epilepsy without increasing the risk of seizures.