Objective:To observe any differences in the brain′s functional responses during swallowing with healthy young, middle-aged and elderly individuals.Methods:Fifteen healthy young people formed the youth group, while 15 healthy middle-aged or elderly subjects were the middle-aged and elderly group. Both groups performed repeated swallowing tasks while being observed using functional near-infrared spectroscopy. The data were processed using NirSpark software, and brain activation was compared between the two groups.Results:Swallowing-related brain regions were all significantly activated in the youth group, while in the middle-aged and elderly group only the primary motor cortex (M1), primary somatosensory cortex (PSC), premotor and supplementary motor cortex (pSMC), and inferior central region on the left side showed significantly increased activation. Compared to the youth group, the middle-aged and elderly group exhibited significantly reduced activation in seven channels, including the right M1 and pSMC, the left M1, the pSMC, the PSC, the dorsolateral prefrontal cortex and frontal pole area.Conclusions:The middle-aged and elderly show significantly less activation in certain brain regions during swallowing compared with younger persons. That may be related to aging and its associated cognitive decline, as well as reduced motor and sensory abilities related to swallowing.

Objective:To explore the factors influencing the recovery of swallowing function after a brainstem hemorrhage and to construct a prediction model.Methods:Clinical data on 134 persons with dysphagia after a brainstem hemorrhage were collected retrospectively. According to their swallowing ability at discharge, the patients were divided into a swallowing recovery group and a non-recovery group. Univariate correlation analysis and multivariate logistic regression analysis were used to explore the independent factors influencing the recovery of swallowing function and to construct a prediction nomogram. The receiver operating characteristics (ROC) curves were evaluated to analyze the nomogram′s predictive value and those of the relevant influencing factors.Results:Sixty-two of the patients (46%) had recovered their swallowing function at discharge, while 72 (54%) had not. Univariate correlation analysis showed that there had been significant differences in tracheal intubation, NIHSS score, FOIS score, Barthel index and Glasgow coma scale (GCS )score between the two groups, on average. The multivariate logistic regressions showed that a low NIHSS score, a high FOIS score and a high GCS score were independent predictors of swallowing function recovery, so they were used in the prediction model. ROC curve analysis showed that the area under the curve (AUC) of the prediction model was 0.953 (95% CI: 0.902~0.982) with a sensitivity of 87% and a specificity of 93%. The model′s predictions were thus better than using an NIHSS score, GCS score or FOIS score alone. Conclusions:NIHSS score, GCS score and FOIS score can independently predict the recovery of swallowing function after a brainstem hemorrhage. A prediction model constructed using all three has good predictive power.

Objective:To observe any therapeutic effect of transcranial direct current stimulation (tDCS) combined with intermittent oroesophageal tube feeding (IOE) on dysphagia among ischemic stroke survivors.Methods:Eighty-four ischemic stroke survivors with dysphagia were randomized into an observation group and a control group, each of 42. In addition to conventional rehabilitation, swallowing training and IOE, the observation group received tDCS while the control group received sham stimulation. Before and after 14 days of this treatment, both groups′ swallowing, life quality and depression were evaluated using the Penetration Aspiration Scale (PAS), the Functional Oral Intake Scale (FOIS), the Dysphagia Handicap Index (DHI), and a 9-item patient health questionnaire (PHQ-9).Results:There were no significant differences between the two groups before the experiment in terms of their general data, their average PAS, FOIS, DHI or PHQ-9 scores, or the incidence of depression. After the treatment, significant improvement was observed in the above indicators among both groups, but with significantly better average PAS, FOIS, DHI [(51.25±6.78) vs. (44.78±5.75)] and PHQ-9 [(4.17±1.15) vs. (6.01±1.93)] scores and less depression (14.29% vs. 42.86%) in the observation group compared with the control group.Conclusions:Combining tDCS with IOE better improves swallowing function, depression, and life quality after an ischemic stroke.

Objective:To analyze the factors influencing the prognoses of stroke survivors with pseudobulbar palsy (PBP) dysphagia and construct a prediction model.Methods:Data on two hundred and fifty-one stroke survivors with PBP dysphagia were collected and analyzed retrospectively. The subjects were divided into a good prognosis group ( n=164) and a poor prognosis group ( n=87) according to the results of Kubota water swallowing tests administered at discharge. Their clinical data were analyzed using univariate correlation analysis, and the statistically significant independent variables found were further analyzed using multivariate logistic regression to obtain the important predictors of prognosis. R software was then used to assemble the useful factors into a nomogram prediction model. The area under the receiver operating characteristics (ROC) curve was employed to verify the model′s predictive power. Results:According to the univariate correlation analysis, significant differences were found between the two groups′ average National Institutes of Health Stroke Scale (NIHSS) scores, mouth opening grades and ages. The multivariate logistic regression analysis showed that NIHSS score, mouth opening grade and age could be useful and independent predictors of poor prognosis. The ROC curve analysis showed that the area under the curve for the nomogram model was 0.727, with a sensitivity of 59.8% and a specificity of 81.6%, suggesting that the model had good predictive power and was properly calibrated.Conclusions:NIHSS score, mouth opening grade and age are independent predictors of prognosis for stroke patients with PBP dysphagia. The nomogram model constructed in this study is of great value in developing a prognosis for such patients, which is helpful in the prevention and treatment of post-stroke dysphagia.

Objective:To analyze the factors influencing the prognoses of stroke survivors with pseudobulbar palsy (PBP) dysphagia and construct a prediction model.Methods:Data on two hundred and fifty-one stroke survivors with PBP dysphagia were collected and analyzed retrospectively. The subjects were divided into a good prognosis group ( n=164) and a poor prognosis group ( n=87) according to the results of Kubota water swallowing tests administered at discharge. Their clinical data were analyzed using univariate correlation analysis, and the statistically significant independent variables found were further analyzed using multivariate logistic regression to obtain the important predictors of prognosis. R software was then used to assemble the useful factors into a nomogram prediction model. The area under the receiver operating characteristics (ROC) curve was employed to verify the model′s predictive power. Results:According to the univariate correlation analysis, significant differences were found between the two groups′ average National Institutes of Health Stroke Scale (NIHSS) scores, mouth opening grades and ages. The multivariate logistic regression analysis showed that NIHSS score, mouth opening grade and age could be useful and independent predictors of poor prognosis. The ROC curve analysis showed that the area under the curve for the nomogram model was 0.727, with a sensitivity of 59.8% and a specificity of 81.6%, suggesting that the model had good predictive power and was properly calibrated.Conclusions:NIHSS score, mouth opening grade and age are independent predictors of prognosis for stroke patients with PBP dysphagia. The nomogram model constructed in this study is of great value in developing a prognosis for such patients, which is helpful in the prevention and treatment of post-stroke dysphagia.

Objective:To observe any differences in the brain′s functional responses during swallowing with healthy young, middle-aged and elderly individuals.Methods:Fifteen healthy young people formed the youth group, while 15 healthy middle-aged or elderly subjects were the middle-aged and elderly group. Both groups performed repeated swallowing tasks while being observed using functional near-infrared spectroscopy. The data were processed using NirSpark software, and brain activation was compared between the two groups.Results:Swallowing-related brain regions were all significantly activated in the youth group, while in the middle-aged and elderly group only the primary motor cortex (M1), primary somatosensory cortex (PSC), premotor and supplementary motor cortex (pSMC), and inferior central region on the left side showed significantly increased activation. Compared to the youth group, the middle-aged and elderly group exhibited significantly reduced activation in seven channels, including the right M1 and pSMC, the left M1, the pSMC, the PSC, the dorsolateral prefrontal cortex and frontal pole area.Conclusions:The middle-aged and elderly show significantly less activation in certain brain regions during swallowing compared with younger persons. That may be related to aging and its associated cognitive decline, as well as reduced motor and sensory abilities related to swallowing.

Objective:To explore the factors influencing the recovery of swallowing function after a brainstem hemorrhage and to construct a prediction model.Methods:Clinical data on 134 persons with dysphagia after a brainstem hemorrhage were collected retrospectively. According to their swallowing ability at discharge, the patients were divided into a swallowing recovery group and a non-recovery group. Univariate correlation analysis and multivariate logistic regression analysis were used to explore the independent factors influencing the recovery of swallowing function and to construct a prediction nomogram. The receiver operating characteristics (ROC) curves were evaluated to analyze the nomogram′s predictive value and those of the relevant influencing factors.Results:Sixty-two of the patients (46%) had recovered their swallowing function at discharge, while 72 (54%) had not. Univariate correlation analysis showed that there had been significant differences in tracheal intubation, NIHSS score, FOIS score, Barthel index and Glasgow coma scale (GCS )score between the two groups, on average. The multivariate logistic regressions showed that a low NIHSS score, a high FOIS score and a high GCS score were independent predictors of swallowing function recovery, so they were used in the prediction model. ROC curve analysis showed that the area under the curve (AUC) of the prediction model was 0.953 (95% CI: 0.902~0.982) with a sensitivity of 87% and a specificity of 93%. The model′s predictions were thus better than using an NIHSS score, GCS score or FOIS score alone. Conclusions:NIHSS score, GCS score and FOIS score can independently predict the recovery of swallowing function after a brainstem hemorrhage. A prediction model constructed using all three has good predictive power.

Objective:To observe any therapeutic effect of transcranial direct current stimulation (tDCS) combined with intermittent oroesophageal tube feeding (IOE) on dysphagia among ischemic stroke survivors.Methods:Eighty-four ischemic stroke survivors with dysphagia were randomized into an observation group and a control group, each of 42. In addition to conventional rehabilitation, swallowing training and IOE, the observation group received tDCS while the control group received sham stimulation. Before and after 14 days of this treatment, both groups′ swallowing, life quality and depression were evaluated using the Penetration Aspiration Scale (PAS), the Functional Oral Intake Scale (FOIS), the Dysphagia Handicap Index (DHI), and a 9-item patient health questionnaire (PHQ-9).Results:There were no significant differences between the two groups before the experiment in terms of their general data, their average PAS, FOIS, DHI or PHQ-9 scores, or the incidence of depression. After the treatment, significant improvement was observed in the above indicators among both groups, but with significantly better average PAS, FOIS, DHI [(51.25±6.78) vs. (44.78±5.75)] and PHQ-9 [(4.17±1.15) vs. (6.01±1.93)] scores and less depression (14.29% vs. 42.86%) in the observation group compared with the control group.Conclusions:Combining tDCS with IOE better improves swallowing function, depression, and life quality after an ischemic stroke.

Objective:To observe the clinical efficacy of intermittent feeding through an oral to esophageal (IOE) tube for persons with a late-onset swallowing disorder after radiotherapy for nasopharyngeal carcinoma.Methods:Fifty-six patients with late-onset swallowing difficulties after radiotherapy for nasopharyngeal carcinoma were divided at random into an observation group and a control group, each of 28. In addition to conventional therapy, the controls were fed through an indwelling nasogastric tube (NGT) while an IOE tube was used in the observation group. The nutritional status of the two groups was compared after 20 hours and after 15 days of treatment. Depression, oral feeding ability, leakage and aspiration, and life quality were evaluated using patient health questionnaire-9 (PHQ-9), a functional oral feeding scale (FOIS), a leakage-aspiration scale (PAS), and a swallowing-quality of life (SWAL-QOL) evaluation. From the 3rd day after admission the daily amount fed was recorded.Results:At admission there were no significant differences between the two groups. After 15 days, however, there was significantly greater improvement observed in the average serum albumin, hemoglobin, serum total protein, serum prealbumin level, body mass index(BMI) and SWAL-QOL score of the experimental group compared to the control group, with significantly fewer members suffering from depression. From the 4th day after admission the observation group′s members ate a significantly larger proportion of the target feeding amount.Conclusion:IOE feeding can improve the nutritional status, psychological status, and life quality of persons with a late-onset swallowing disorder more effectively than NGT feeding, with a lower incidence of adverse events.

Objective:To observe any clinical effect of supplementing ultrasound stimulation with balloon-guided injection of botulinum toxin into the upper esophageal sphincter in the treatment of cricopharyngeal achalasia.Methods:Forty patients with cricopharyngeal achalasia were randomly divided into an observation group and a control group, each of 20. Both groups were given routine swallowing rehabilitation training, while the observation group additionally had botulinum toxin injected into the upper esophageal sphincter guided by ultrasound and with the aid of balloon dilation. Before the experiment and after 2 weeks, both groups were evaluated videofluoroscopically and flexible endoscopic evaluation of swallowing was performed. Moreover, 2 weeks before the treatment and 2, 4 and 24 weeks afterward, everyone′s eating, leakage and aspiration, and oral and pharyngeal secretions were assessed using the functional oral intake scale (FOIS), the penetration-aspiration scale (PAS), the fiberoptic endoscopic dysphagia severity scale (FEDSS) and the Murray secretion scale (MSS).Results:After 2 weeks the average PAS, FEDSS and MSS scores of both groups had improved significantly, but the observation group′s averages[3(2, 5), 3(2, 5) and 2(1, 2)] were significantly better than those of the control group. 2, 4 and 24 weeks after the experiment the average FOIS scores of both groups also showed significant improvement, with the observation group′s average[3(2, 4), 4(2, 6) and 6(3, 7)] again significantly better than that of the control group.Conclusions:A botulinum toxin injection into the upper esophageal sphincter can effectively improve the swallowing of persons with cricopharyngeal achalasia with adequate safety and significant long-term benefits. Therefore, such treatment is worthy of clinical promotion and application.