Objective:To explore the incidence and severity of esophageal clearance impairment in stroke survivors with dysphagia, the clinical characteristics of patients with abnormal esophageal clearance, and their relationship with swallowing physiology, penetration and aspiration.Methods:Clinical data were collected describing 174 stroke survivors whose swallowing had been studied videofluoroscopically. In each selected case there was a good anterior-posterior view of esophageal clearance. Their anterior-posterior and lateral imaging results while swallowing 5ml of high-consistency food were analyzed. The esophageal clearance item of the modified barium swallow impairment profile was then used to rate each subject′s esophageal clearance and each physiological component of swallowing in the oral and pharyngeal phases. The Rosenbek penetration aspiration scale was employed evaluate the safety of their swallowing.Results:Seventy of the patients (40.2%) displayed abnormal esophageal clearance, and more than half of the 70 (43 patients, 24.7%) showed mid- to distal esophageal retention. Those with abnormal esophageal clearance had a higher average age and more severe overall impairment in the pharyngeal phase of swallowing. Esophageal clearance was not, however, significantly correlated with swallowing physiology in the oral phase or with penetration or aspiration grade. There were, however, significant positive correlations with laryngeal elevation, anterior hyoid excursion, pharyngeal stripping waves, pharynx contraction, upper esophageal sphincter opening, tongue base retraction and pharyx residue.Conclusion:Stroke survivors with dysphagia may display abnormal esophageal clearance. The risk is closely related to age and the severity of the dysphagia. Abnormal physiology during the pharyngeal phase of swallowing and reduced pharyngeal stripping may predict abnormal esophageal clearance. Swallowing assessment can be made more comprehensiveness and systematic by incorporating anterior-posterior videography in routine barium swallowing studies.

Objective To analyze the educational characteristics of physical therapy in universities of United States, and provide reference for the international development of rehabilitation therapy education in China.Methods Based on the data collected from the official websites of three universities in the United States and the databases at home and abroad, combined with the author's learning experience, the characteristics of physical therapy education in universities of United States in detail was analyzed.Results Characteristics of physical therapy education in universities of United States had strict accreditation system, course objectives oriented by practicing competence, comprehensive curriculum plan, educational concept of student-centered, high level of teaching informatization, diversified teaching and learning evaluation system, which conformed to the goal of rehabilitation competency of World Health Organization.Conclusion Physical therapy education in United States has remarkable characteristics and a well-developed system, which has certain reference value for China.

Objective:To explore the effect of swallowing different viscosities and volumes on the swallowing of dysphagic stroke survivors, and also penetration and aspiration.Methods:A total of 59 stroke survivors with dysphagia were evaluated using videofluoroscopy while completing the Chinese version of the volume viscosity swallow test. They were required to swallow 3, 5 and 10ml of food of medium, low, zero and high viscosity. Modified barium swallowing impairment profiles (MBSImPs) and the Rosenbek penetration aspiration scale were used for quantitative analysis.Results:Tongue control, initiation of the pharyngeal swallow and larynx closure showed the worst performance when swallowing zero-viscosity food. Oral residue performance was poor when swallowing large volumes and pharyngeal peristalsis was poor with small volumes. The risk of penetration and aspiration was greater with low-viscosity, large-volume swallowing tasks. There was a significant positive correlation between the penetration aspiration grade and total pharyngeal score. Larynx closure was especially strongly correlated with the penetration aspiration grade.Conclusions:The characteristics of physiological swallowing are closely related to the viscosity and volume of the material being swallowed. The risk of penetration and aspiration is greater with large volumes of low-viscosity food.

Objective: To systematically evaluate the efficacy and safety of CT-guided percutaneous lung puncture biopsy versus ultrasound-guided percutaneous lung puncture biopsy. Methods: Relevant domestic and foreign related databases such as PubMed, Web of Science, Cochrane Library, OVID, China Biology Medicine, VIP, Wanfang and CNKI databases were searched, the randomized controlled trial about the applications of CT-guided and ultrasound-guided percutaneous lung puncture biopsy were collected. After extracting the relevant data, a Meta-analysis was performed using RevMan 5.2 and Stata softwares. Results: Ten studies met the inclusion criteria, with a total sample size of 1 158 cases, of which 635 were CT-guided puncture biopsy and 523 were ultrasound-guided puncture biopsy. Meta-analysis showed that the difference of the success rate between the CT-guided group and the ultrasound-guided group was not statistically significant [97.48% (619/635) vs. 96.56% (505/523), RR= 1.01, 95% CI 0.99-1.03, P= 0.360]; the puncture diagnosis rate in the CT-guided group was lower than in the ultrasound-guided group, and the difference was statistically significant [92.44% (619/635) vs. 96.56% (505/523), RR= 0.97, 95% CI 0.94-0.99, P= 0.007]. The total incidence of complications after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [14.49% (92/635) vs. 9.56% (50/523), RR= 1.56, 95% CI 1.11-2.19, P= 0.010]; the incidence of pneumothorax after puncture in the CT-guided group was higher than that in the ultrasound-guided group, and the difference was statistically significant [11.50%(73/635) vs. 6.31% (33/523), RR= 1.77, 95% CI 1.17-2.68, P= 0.007]; the difference of the incidence of bleeding after puncture between the CT-guided group and the ultrasound-guided group was not statistically significant [2.99% (19/635) vs. 3.25% (17/523), RR= 1.08, 95% CI 0.59-1.98, P= 0.800]. Conclusions Both CT-guided and ultrasound-guided percutaneous lung puncture biopsy have good clinical diagnostic value. However, for the intrapulmonary masses shown by ultrasound, the ultrasound-guided lung puncture biopsy has a shorter operation time, lower cost, and higher safety.

Objective:To investigate the effect of botulinum neurotoxin type A (BoNT/A) on Nav1.3 sodium channels and the function of sodium current in neuropathic pain.Methods:Eighteen adult rats had a spared nerve injury (SNI) induced and then were randomly divided into a saline group and a BoNT/A group, each of 9. Another 9 rats formed a fake operation group, Five days after the SNI, BoNT/A (7U/kg or 15U/kg) or saline was subcutaneously administered into the plantar surface of a hindpaw. On the 3rd, 7th and 14th day after the injection, the SNI rats′ paw withdrawal threshold was measured. On the 7th and 14th day the expression of Nav1.3 protein in dorsal root ganglion (DRG) neurons was examined using western blotting, while any change in the functional tetrodotoxin-sensitive (TTX-S) current was recorded using the patch clamp technique.Results:Administration of BoNT/A at either 7U/kg or 15U/kg significantly increased the SNI-induced mechanical allodynia. The expression of Nav1.3 protein in DRG neurons increased significantly after the SNI, but had decreased significantly by the 7th and 14th day after the administration of BoNT/A. BoNT/A significantly decreased the current density in TTX-S sodium channels in DRG neurons following SNI.Conclusion:Administration of BoTN/A affects the expression of Nav1.3 protein and functional TTX-S current, relieving neuropathic pain.

Objective To observe the effects of dual-task motor training on motor and balance function for stroke patients. Methods From January, 2016 to June, 2017, 30 patients with stroke were assigned randomly into control group (n = 15) and treatment group (n = 15). Both groups accepted routine physical therapy, the control group accepted anti-gravity treadmill training, while the treatment group accepted dual-task training with anti-gravity treadmill, for four weeks. They were measured with balance training and evaluation system, and assessed with Fugl-Meyer Assessment-lower extremity (FMA-L), Berg Balance Scale (BBS) and modified Barthel Index (MBI), before and after treatment. Results The range of swaying on X axial (Rx) and Y axial (Ry), as well as rectangle area (RecArea) decreased after treatment in the treatment group (t > 4.719, P < 0.001), while RecArea decreased in the control group (t = 5.069, P < 0.001). Ry and RecArea were less in the treatment group than in the control group (t > 2.288, P < 0.05). The scores of FMA-L, BBS and MBI improved after treatment in both groups (t > 7.316, P < 0.001), and improved more in the treatment group than in the control group (t > 2.322, P < 0.05). Conclusion The dual-task training via anti-gravity treadmill may improve motor and balance function in stroke patients, and promote the activities of daily living.

Motor imagery can be classified in several ways, and assessed with various measures. There is a set of program to perform the motor imagery therapy. There are many reasearches about the effects of motor imagery for upper limbs rehabilitation in patients after stroke. Task-based and resting-state functional MRI explore the activation of various areas and functional linkages in cerebral network.

AIM To speculate the hypoglycemic mechanism for rats with type 2 diabetes by exploring the therapeutic effects of leaf aqueous extract from Cyclocarya paliurus on liver insulin receptor (InsR) and insulin receptor substrate 2 (IRS-2).METHODS The diabetic rat model was established through intraperitoneal injection of streptozotocin and fed with high-fat diet.The moleled rats were equally assigned into the control group and leaf aqueous extract from Cyclocarya paliurus group (extract group).After the test extract was orally administrated for four weeks,body weight,urine output,food intake,water intake and fasting blood-glucose (FBG) were measured,and the levels of serum insulin,InsR and IRS-2 mRNA in liver tissue were investigated in rats.RESULTS Compared with the control group,the extract group showed a reduction in urine output,food intake,water intake,FBG and insulin levels.Meanwhile,the rats' body weights in extract group were presented a trend to increase.The gene expressions of InsR and IRS-2 in liver tissue were up-regulated.Moreover,the insulin sensitivity was improved.CONCLUSION The leaf aqueous extract from Cyclocarya paliurus can reduce FBS,improve insulin sensitivity,which may be associated with the increase of InsR and IRS-2 gene expression in liver tissue.

Objective To study the effect of bilateral arm training on cortical reorganization in cerebral infarction patients using blood oxygen level-dependent functional MRI (BOLD-fMRI).Methods Fourteen cerebral infarction subjects with moderate to severe upper limb impairment participated in this randomized and single-blinded training study.Subjects in the bilateral arm training group (n =7) practiced bilateral symmetrical or opposite activities,while the control group (n =7) performed conventional,mainly unilateral,arm training.Those in both groups received fMRI scans before and after the training with passive elbow movement as the task in the imaging.Results Both groups had significant improvements in their average scores on the Fugl-Meyer upper extremity assessment and in their modified Barthel index scores after the treatment,and there were no significant differences between the two groups.Brain activation had increased in both groups after the treatment,especially in the bilateral training group.After the treatment,the first motor area (M 1),the first somatosensory area and the supplementary motor area on both sides were activated in the bilateral training group.Moreover,for patients in the bilateral training group with injuries of moderate severity,the M1 of the opposite side tended to be activated,while for those more severely injured the same side had a tendency to be activated.Conclusion Convalescing subcortical infarction patients with moderate to severe upper limb impairment benefit from bilateral arm training in terms of motor activity and performing activities in daily life.It may be related to the normalization of inhibition between the hemispheres of the bilateral cerebral cortex and the reconnection of ipsilateral corticospinal pathways.

Objective To observe the effect of kinesthetic imagery and visual imagery on upper limb rehabilitation among stroke survivors.Methods Forty-five hemiplegic stroke survivors were randomly assigned into a kinesthetic imagery training group (n=14),a visual imagery training group (n=15) or a control group (n=16).In addition to conventional rehabilitation,patients in the kinesthetic and visual imagery training groups were given 30 minutes of the appropriate imagery training once a day,five days per week for four weeks,while the control group relaxed or received health education for the same time.Before and after the 4-week intervention,the upper limb section of the Fugl-Meyer assessment (FMA-UE) and the modified Barthel index (MBI) were used to evaluate the motor function of the subjects' upper limb and their ability in the activities of daily living respectively.Results Before the intervention,there were no significant differences in the average FMA-UE and MBI scores among the 3 groups.After the intervention there was no significant difference between the average FMA-UE and MBI scores of the two training groups,but both were significantly better than the control group's averages.Conclusion Either kinesthetic or visual imagery training can improve the upper limb function of stroke survivors and their abihty in the activities of daily living.Their effectiveness is not significantly different.