Objective:To observe any effects of contralateral repeated transcranial magnetic stimulation (rTMS) of the swallowing motor cortex on the swallowing and brainstem auditory evoked potentials (BAEPs) of stroke survivors with dysphagia.Methods:A total of 83 stroke survivors with dysphagia were randomly divided into an ipsilesional stimulation group ( n=22), a contralesional stimulation group ( n=21), a bilateral stimulation group ( n=20), and a control group ( n=20). In addition to their conventional dysphagia training, those in the three stimulation groups received 3Hz rTMS while the control group was given fake stimulation. The treatment was administered daily for 20 minutes, 6 days a week, for 5 consecutive weeks. Before and after the treatment, swallowing function was assessed videofluoroscopically and using the Dysphagia Outcome and Severity Scale (DOSS). The oral and pharyngeal stages of swallowing were evaluated using the videofluoroscopic dysphagia scale (VDS). Brain stem conduction was assessed using BAEPs. Results:After treatment the average DOSS scores of all 4 groups were significantly better than before the treatment. The average DOSS scores of the contralesional and bilateral sti-mulation groups were then significantly better than those of the other two groups. The sub-item and total VDS scores of all 4 groups had decreased significantly, but the average score of the bilateral stimulation group was significantly lower than the control group′s average. Ipsilesional stimulation significantly improved the VDS sub-item scores for the triggering of pharyngeal swallowing, laryngeal elevation, and pharyngeal transit time compared with the control group. In the contralesional stimulation group the average total score and the VDS sub-item scores for apraxia, premature bolus loss, oral transit times, the triggering of pharyngeal swallowing, vallecular residue, laryngeal elevation, coating on the pharyngeal wall, and pharyngeal transit time were significantly lower than those of the control group, on average. After the treatment the latencies of BAEP waves I, III and V and the I-III, III-V and I-V interpeak intervals had decreased significantly in all four groups, but the average latencies and intervals of the bilateral and contralesional groups were significantly shorter than those of the control group. The latencies and intervals of the bilateral stimulation group were then significantly shorter than those in the ipsilesional stimulation group on average. The average latency of wave V in the bilateral stimulation group (6.53±0.73ms) was significantly shorter than that in the contralesional stimulation group after the treatment.Conclusion:Bilateral rTMS over the swallowing motor cortex combined with conventional dysphagia training can significantly improve the swallowing of dysphagic stroke survivors.

Objective:To evaluate the clinical significance of neoadjuvant immunotherapy combined with chemotherapy in the treatment of larynx preservation in locally advanced hypopharyngeal squamous cell carcinoma. Methods:Patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were eligible. All received 2 cycles of pembrolizumab combined with docetaxel and platinum neoadjuvant induction therapy. After two cycles, the efficacy was evaluated, followed by radical chemoradiotherapy or surgery and adjuvant chemoradiotherapy according to the efficacy. The primary endpoints were objective response rate（ORR） ，larynx-preservation（LP） rate at 3 months post-treatment and the adverse reactions during neoadjuvant therapy. Results:From December 2021 to December 2022, 10 patients with locally advanced HPSCC（cT3-T4aN0-N3M0） were enrolled. After 2 cycles of the neoadjuvant therapy, 2 patients achieved complete response（CR）, 7 patients achieved partial response（PR）, 1 patient was stable disease（SD）, objective response rate（ORR） was 90%, and disease control rate（DCR） was 100%. 5 patients received radical chemoradiotherapy, 5 patients received surgery and adjuvant chemoradiotherapy, four of them received partial laryngectomy and partial hypopharyngeal resection surgery, and one of them received total laryngectomy and partial hypopharyngeal resection surgery. All patients were able to withstand adverse reactions of neoadjuvant therapy and successfully completed the whole treatment of HPSCC without grade 3-4 treatment-related adverse reactions. There was no recurrence or metastasis during 3-18 months of follow-up. 1 patient died of severe pneumonia 3 months after the completion of radical chemoradiotherapy. At 3 months after treatment, the larynx-preservation rate was 80%. Conclusion:Neoadjuvant immunotherapy combined with chemotherapy has good short-term efficacy and the adverse reactions were tolerable. It can improve the larynx-preservation rate of patients with locally advanced HPSCC, thus improving the prognosis and quality of life of patients.
Humans ; Squamous Cell Carcinoma of Head and Neck/etiology* ; Neoadjuvant Therapy ; Quality of Life ; Cisplatin ; Treatment Outcome ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Larynx ; Head and Neck Neoplasms ; Immunotherapy

Objective: This cross-sectional study explores the serial multiple mediation of the correlation between internet addiction and depression by social support and sleep quality of college students during the COVID-19 epidemic. Methods: We enrolled 2,688 students from a certain university in Wuhu, China. Questionnaire measures of internet addiction, social support, sleep quality, depression and background characteristics were obtained. Results: The prevalence of depression, among 2,688 college students (median age [IQR]=20.49 [20.0, 21.0] years) was 30.6%. 32.4% of the students had the tendency of internet addiction, among which the proportion of mild, moderate and severe were 29.8%, 2.5% and 0.1%, respectively. In our normal internet users and internet addiction group, the incidence of depression was 22.6% and 47.2%, respectively. The findings indicated that internet addiction was directly related to college students’ depression and indirectly predicted students’ depression via the mediator of social support and sleep quality. The mediation effect of social support and sleep quality on the pathway from internet addiction to depression was 41.97% (direct effect: standardized estimate=0.177; total indirect effect: standardized estimate= 0.128). The proposed model fit the data well. Conclusion Social support and sleep quality may continuously mediate the link between internet addiction and depression. Therefore, the stronger the degree of internet addiction, the lower the individual’s sense of social support and the worse the quality of sleep, which will ultimately the higher the degree of depression. We recommend strengthening monitoring of internet use during the COVID-19 epidemic, increasing social support and improving sleep quality, so as to reduce the risk of depression for college students.

Objective: To analyze the school adaptation and behavioral performance of the first batch of students who return to school during the COVID-19 epidemic, and to provide a theoretical basis for further development of corresponding intervention measures. Methods: The method of cluster sampling was adopted to conduct anonymous questionnaire survey on the first batch of college students who have returned to a certain university. The survey contents included the basic information of the students, the adaptability of the school after returning to school and the corresponding behavior performance. Results: Male students reported high lever of satisfaction than female students on the dormitory environment health (t=10.28, P<0.01), but low satisfaction on school security and logistical support (t=2.26, P=0.02), rural students marked higher score than urban students for the school closed management system (t=2.82, P=0.01), in terns of school security, Logistics, the degree of school s attention to the epidemic prevention and epidemic prevention, non only-child gave high score than the only children; In terms of their own behavior, the rate of seek medical treatment immediately when they develop COVID-19 related symptoms (68.1%) was lower than that of others (81.3%)(χ 2=223.88，P<0.01)；In addition, the percentage of respondents who chose to report COVID-19 related symptoms (79.5%) was lower than that of others (88.7%)(χ 2=97.49，P<0.01). A total of 2 671 college students (98.9%) were able to wear masks every day and 2 457 (90.9%) chose to improve their diet to improve their immunity. Conclusion The first batch of college students who return to school have a high level of satisfaction on school management, and can take active measures to adapt to the life back to school and commit self-protection, however targeted measures to are still needed further strengthen students health education.

Objective: To understand the current situation and influencing factors of Internet addiction among college students after returning to school during the COVID-19 epidemic, and to provide scientific basis for timely intervention measures to adjust the risk factors of Internet addiction. Methods: A cluster sampling method was adopted to conduct a questionnaire survey among 2 700 college students who firstly returned to college using general condition questionnaire and Internet Addiction scale. Results: The detection rate of Internet addiction disorder was 32.4% among returning college students, moreover, the detection rate of Internet addiction in male students(36.0%) was higher than that in female students (31.2%) (χ 2=5.42,P<0.05). The degree of Internet addiction was negatively correlated with the physical health score (r-s=-0.20) and mental health score (r-s=-0.24) of college students (P<0.01). Multivariate Logistic regression analysis showed that compared with introversion, neutral (OR=0.67, 95%CI=0.55-0.82) and extroverted college students (OR=0.59, 95%CI=0.48-0.74) were protective factors for Internet addiction; compared with no exercise, physical exercise ≥3 times or more per week (exercise 3-4 times：OR=0.67, 95%CI=0.51-0.87; ≥5 times：OR=0.67, 95%CI=0.50-0.90) were the protective factors for Internet addiction among college students; family loss during the epidemic was a risk factor for Internet addiction among college students (OR=1.34, 95%CI=1.12-1.60); the risk of Internet addiction was 2.13 times higher for college students who actively sought psychological help than for those who did not seek psychological help (95%CI=1.14-3.96); college students who did not want to go back to school had 1.50 times the risk of Internet addiction as those who did (95%CI=1.26-1.77). Conclusion The current situation of college students online behaviors during COVID-19 is not optimistic, and should arouse sufficient attention from society and universities. In addition, college students returning to school should take more physical exercises and psychological counseling to detect and intervene in psychological problems in time, reduce their psychological burden, and enhance their psychological quality.

Objective: To investigate the sleep quality and influencing factors of the first batch of college students returning to school during COVID-19 epidemic, so as to provide scientific basis for taking corresponding measures. Methods: An anonymous self-administered questionnaire survey was conducted among the first batch of college students returning from a certain university by cluster sampling, which included general demographic characteristics, Trait Coping Style Questionnaire (TCSQ) and Pittsburgh Sleep Quality Index(PSQI). Results: The detection rate of sleep disorders was 19.33%(522/2 701). The mother s education level was high school or technical secondary school or below(OR=2.24, 95%CI=1.47-3.41), never eat breakfast(OR=3.25, 95%CI=1.86-5.68), families were damaged during the outbreak (OR=1.48, 95%CI=1.17-1.87) and negative coping (OR=1.15, 95%CI=1.12-1.17) were risk factors for sleep disorders(P<0.05). Compared to having a very poor relationship with parents, the relationship between parents was average(OR=0.23, 95%CI=0.06-0.89), better(OR=0.23, 95%CI=0.06-0.87), very good (OR=0.19, 95%CI=0.05-0.74) were protective factors for sleep disorders(P<0.05). Exercise once or twice a week during the epidemic(OR=0.76, 95%CI=0.58-1.00), positive coping (OR=0.93, 95%CI=0.91-0.96) were protective factors for sleep disorders(P<0.05). Conclusion In this COVID-19 epidemic, the sleep quality of returning college students was affected to different extent, and the relationship between parents, sports, mother s education, breakfast habits, and family damage during the COVID-19 were factors affecting their sleep quality. Targeted psychological intervention measures should be given to returning college students in the early stage.

Objective: The purpose of this study was to investigate the state of depression and anxiety and assciated factors of back to school college students during the outbreak of COVID-19, so as to provide theoretical basis for emotional counseling and psychological crisis intervention after long term school closure due to epidemic outbreak. Methods: Cluster sampling was used to select the first batch of 2 697 back to school students in a high vocational college. The survey content includes basic information questionnaire, Depression Self rating Scale (SDS) and Anxiety Self rating Scale(SAS). Results: The detection rate of depression and anxiety was 31.8% and 10.4% respectively. Multivariate Logistic regression analysis showed that the risk of depression in female college students was 1.28 times higher than that in male students. The risk of depression among college students with family loss experience caused by the outbreak of COVID-19 was 1.30 times that of those without family loss experience caused by the outbreak of COVID-19. Outgoing personality(OR=0.62), neutral (OR=0.55) and mild temper(OR=0.46), moderate frequency of physical exercise per week(1-2 times:OR=0.73, 3-4 times:OR=0.65) were protective effects for depression in college students.Low frequency of breakfast were the risk effects for depression in college. The risk of anxiety among college students who was the only child in the family was 1.61 times higher than that who was not the only child in the family. The risk of anxiety among college students with family loss experience caused by the outbreak of COVID-19 was 1.45 times higher than that college students without family loss experience caused by the outbreak of COVID-19. Neutral temper, mild temper and physical exercise 1-2 times a week were associated with lower level of anxiety in college students(OR=0.67,0.56,0.67). Breakfast skipping (OR=2.03) was associated with higher levvel of anxiety in college students. Conclusion During the outbreak of COVID-19, the first batch of back to school college students presented high level of depression. Colleges are suggested to promptly carry out effective emotional relief and psychological intervention for students, especially those whose family suffered in COVID-19, the only child in the family, with poor breakfast eating habits, as well as breakfast skipping and lack of physical exercise.

Objective:To observe the effect of observing good swallowing on the swallowing action of stroke survivors with dysphagia.Methods:Eighteen stroke survivors with dysphagia were randomly divided into a treatment group ( n=9) and a control group ( n=9). In addition to routine swallowing rehabilitation therapy, the treatment group was asked to simulate swallowing after watching a video of normal people′s swallowing action. They did so 5 times a week for 10 minutes, while the control group just watched landscape videos at the same time. The treatment lasted 8 weeks. Before and after the treatment, both groups were assessed using the eating assessment tool (EAT-10), the functional oral intake scale (FOIS) and the penetration and aspiration scale (PAS). Functional magnetic resonance imaging (fMRI) was also used to observe their swallowing action. Results:There was no significant difference between the two groups in any of the measurements before the treatment. After the 8 weeks of treatment the average EAT-10, FOIS and PAS scores of the treatment group were all significantly better than before the treatment and better than the control group′s averages at the time. fMRI showed significantly more areas activated in the precuneus, parietal lobe, posterior central gyrus, BA7, BA5, frontal lobe and paracentral lobule in the treatment group compared with before the intervention and also more than in the control group.Conclusions:Observing proper swallowing action can improve dysphagia and activation of the swallowing-related brain areas of stroke survivors.

Objective: To examine the status of self-harm, depression and anxiety and to analyze the relation of self-harm with depression and anxiety in college students. Methods: Totally 9 638 college students were randomly selected from five universities in Anhui province using stratified cluster sampling and were surveyed with basic demographic characteristics, Depression Self Rating Scale (SDS), Self-evaluation of Anxiety Scale (SAS) and self-harm behavior questionnaire. Results: The detection rate of self-harm among college students was 22.94%(2 211), boys (24.51%) were higher than girls(21.72%), the difference was statistically significant(χ2=10.46, P<0.05). The detection rate of depression was 28.57%(2 754). The detection rate of anxiety was 11.11%(1 071). The detection rate of self-harm in the depression group was 33.48%, which was significantly higher than those without depression group(18.72%)(χ2=242.22, P<0.01). The similar results were found in the anxiety analysis, students with anxiety showed higher detection rate in self-harm (48.74%) than those without anxiety (19.72%)(χ2=453.66, P<0.01). Both depression and anxiety were positively associated with self-harm behaviors(r=0.24, 0.27, P<0.01). Multivariate Logistic regression model found that after covariates controlled, depression(OR=1.48) and anxiety (OR=2.84) were positively associated with self-harm of college students(P<0.05). Conclusion Self-harm, depression and anxiety among college students in Anhui Province are at a high level, and a positive correlation between self-harm behaviors and depression and anxiety is observed. Attention should be paid to the mental health education of college students.

Objective:To observe the effect of applying repetitive transcranial magnetic stimulation (rTMS) on swallowing function and auditory evoked potentials in the brain-stems of stroke survivors with dysphagia.Methods:Sixty stroke survivors with dysphagia were randomly assigned to an observation group and a control group, each of 30. Both groups were given 30 minutes of routine swallowing training 6 times a week for 5 weeks, while the observation group was additionally provided with two-second bursts of rTMS on the left and right brain hemispheres alternately for 20 minutes daily. The frequency was 3.0Hz and the strength was 80% of the resting motor threshold (RMT), with an interval of 10 seconds between bursts. Before and after the treatment, both groups′ swallowing was assessed using the functional communication measure (FCM) and the modified Mann swallowing capacity evaluation scale (MMASA). Brainstem auditory evoked potentials (BAEP) were recorded to detect any changes in the peak latency (PL) and inter-peak latency (IPL). The clinical efficacy was also observed.Results:After the treatment, the average FCM results of both groups had improved significantly, but the observation group had improved significantly more. The average MMASA total scores and the average scores on all the sub-items had improved significantly more in the observation group except for the expressive speech disorder and anarthria scores. After the treatment, improvement was observed in respiration, anarthria, range of motion of the tongue muscles, strength of the tongue muscles, gag reflex and soft palate movement compared with before the intervention. Peak and inter-peak latencies had also improved significantly more in the observation than in the control group, on average.Conclusions:rTMS combined with conventional swallowing training can significantly improve the swallowing of dysphagic stroke survivors, and shorten the PL of the BAEP so as to better regulate deglutition.