Objective To study the effect of respiratory muscle weakness on the activity of swallowing-related muscle groups during swallowing in stroke patients with dysphagia by surface electromyography(sEMG),and to investigate the correlation between activity of swallowing-related muscle groups and respiratory muscle function.Methods A total of forty patients with dysphagia after stroke who met the inclusion criteria from December 2022 to October 2023 at Jiangsu Shengze Hospital of Nanjing Medical University were selected as the research group,and another 15 healthy individuals with matched data were selected as the control group.Maximum inspiratory pressure(MIP)and maximum expiratory pressure(MEP)of all subjects were assessed using a pulmonary function tester.The 40 stroke patients were divided into non-respiratory muscle weakness group(MIP≥70%and/or MEP≥70%of predicted values)of 15 patients and respiratory muscle weakness group(MIP<70%and MEP<70%of predicted values)of 25 patients based on the results of MEP and MIP tests.sEMG was used to collect the signals from the submental muscles and infra-hyoid muscles on both the healthy and affected sides of all subjects while swallowing 5 mL of water.The root mean square values and peak amplitudes were compared among the three groups and between the healthy and affected sides,and a correlation analysis was performed between the sEMG signals and respiratory muscle function in the study group.Results MIP and MEP of the respira-tory muscle weakness group were significantly lower than those of the non-respiratory muscle weakness group and the control group(P<0.05).The root mean square and peak amplitude of sEMG signals from submental muscles of the affected side in the respiratory muscle weakness group were significantly lower than those in the non-respiratory muscle weakness group and the control group(P<0.05),and the peak amplitude of sEMG signals from submental muscles of the healthy side in the respiratory muscle weakness group was significantly lower than that of the control group(P<0.05).The root mean square and peak amplitude of the sEMG sig-nals from the submental muscles on the affected side in the respiratory muscle weakness group were significantly lower than those on the healthy side(P<0.05).The root mean square and peak amplitude of the submental muscles on the affected side,and the peak amplitude of the submental muscles on the healthy side were significant and positively correlated with MIP(r=0.366,r=0.415,r=0.317,P<0.05).The root mean square and peak amplitude of the affected submental muscles,the healthy submental muscles and the affected infrahyoid muscles were positively correlated with MEP(r=0.534,r=0.595,r=0.332,r=0.455,r=0.323,r=0.375,P<0.05).Conclusion Patients with post-stroke dysphagia who have respiratory muscle weakness exhibit a significant decrease in the strength of the submental muscle group,and there is a correlation between swallowing-related muscle group activity and respiratory muscle function in stroke patients with dysphagia.

Background: The 4-Stage Balance test is one of the most commonly used tests to assess balance for older adults. Although it is generally accepted that the four positions (including side-by-side (SBSS), semi-tandem (STS), tandem (TS), and single-leg stance (SLS)) in this test are progressively more difficult, there are no studies comparing the balance parameters of the four positions in older adults to prove this result. The purpose of this study is to determine the difficulty of 4 positions in the 4-Stage Balance test and the effect of the dominant and non-dominant lower extremities on static balance among healthy older adults. Methods: A total of 115 community-dwelling healthy older adults were included. The postural parameters (including sway range standard deviation (SR), velocity of body sway (V), total sway area (TSA) and sway perimeter (TSP) of the center of pressure) were measured during 8 static postures (including SBSS, left STS, right STS, left TS, right TS, left SLS, right SLS and comfortable stance (CS)). Repeated measures ANOVA was used to analyze the postural parameters in 8 static postures. Results: The static balance stability of the five stances in older adults can be ranked in the following sequence: CS > SBSS/STS > TS > SLS. Moreover, changing foot placement in STS, TS and SLS tasks has no influence on stability. This study has been registered in China Clinical Trial Registry (ChiCTR2200065803). Conclusions: Our findings suggest that it is feasible to simplify the 4-Stage Balance test to a 3-Stage Balance test in the older adults.

目的 探讨裸足状态(bare foot)、穿戴软式塑料踝足矫形器(sAFO)和硬式塑料踝足矫形器(hAFO)对老年脑卒中偏瘫病人静态和动态平衡、步态功能的影响.方法 共选取老年脑卒中偏瘫病人52例,男38例,女14例,分别在睁眼和闭眼2种方式下,采用Pro-Kin平衡评估训练仪评估bare foot、sAFO和hAFO 3种条件下的静态站立平衡功能,记录每种条件下双足最适距离站立以及主要测量参数,包括前后摆动幅度标准差、左右摆动幅度标准差、前后平均运动速度、左右平均运动速度、运动椭圆面积和运动长度.采用Tinetti平衡与步态量表(Tinetti Performance-Oriented Mobility Assessment,Tinetti POMA)评估老年脑卒中偏瘫病人在3种条件下的动态平衡和步态功能.结果 静态站立时,bare foot、sAFO、hAFO双足间最适距离分别为(15.46±4.65)cm、(17.87±5.5)cm、(18.43±5.45)cm.使用sAFO站立时,在睁眼状态下,左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05);在闭眼状态下,左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05).使用hAFO站立时,在睁眼状态下,前后摆动幅度标准差、左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05);在闭眼状态下,前后摆动幅度标准差、左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05).在睁眼状态下,使用hAFO站立时,左右摆动幅度标准差参数显著小于sAFO站立条件;在闭眼状态下,前后摆动幅度标准差显著小于sAFO条件(P<0.05).使用sAFO的Tinetti POMA、POMA-B、POMA-G评分显著高于bare foot条件(P<0.05);使用hAFO的Tinetti POMA、POMA-B评分显著高于bare foot条件(P<0.05);使用sAFO的Tinetti PO-MA、POMA-G评分显著高于hAFO条件(P<0.05).结论 sAFO和hAFO均能改善老年脑卒中偏瘫病人的静态和动态平衡功能,而且sAFO改善步态功能更有效.

BackgroundIntermittent theta burst stimulation (iTBS) is an effective stimulus for long-term potentiation (LTP)-like plasticity. However, iTBS-induced effects varied greatly between individuals. Ample evidence suggested that an initial decrease in local γ-aminobutyric acid (GABA) or enhancement in N-methyl-D-aspartate (NMDA) facilitation neurotransmission is of vital importance for allowing LTP-like plasticity to occur. Therefore, we aimed to investigate whether the individual level of GABA or NMDA receptor-mediated activity before stimulation is correlated with the after-effect in cortical excitability induced by iTBS.MethodsFifteen healthy volunteers were recruited for the present study. We measured short-interval intracortical inhibitory (SICI), long-interval intracortical inhibitory (LICI), and intracortical facilitation (ICF), which index GABAA receptor-, GABAB receptor-, and glutamate receptor-mediated activity, respectively, in the cortex before conducting iTBS. After iTBS intervention, the changes of motor-evoked potential (MEP) amplitude were taken as a measure for cortical excitability in response to iTBS protocol.ResultsThere was a significant negative correlation between the amount of SICI measured before iTBS and the after-effect of iTBS-induced LTP-like plasticity at the time points of 5, 10, and 15 min after inducing iTBS. A multiple linear regression model indicated that SICI was a good predictor of the after-effect in cortical excitability induced by iTBS at 5, 10, and 15 min following stimulation.ConclusionThe present study found that GABAA receptor-mediated activity measured before stimulation is negatively correlated with the after-effect of cortical excitability induced by iTBS. SICI, as the index of GABAA receptor-mediated activity measured before stimulation, might be a good predictor of iTBS-induced LTP-like plasticity for a period lasting 15 min following stimulation.

Objective To investigate the effectiveness of high-intensity laser therapy (HILT) on chronic refractory wounds.DesignRandomised controlled trial.Setting The outpatient wound care department of the Affiliated Jiangsu Shengze Hospital of Nanjing Medical University from August 2019 to June 2020.Participants Sixty patients were enrolled in this study and were randomised into control (n=30) and treatment (n=30) groups.Interventions and outcome measures The control group was treated only with conventional wound dressing, whereas the treatment group received irradiation with HILT in addition to standard wound care, such as debridement, wound irrigation with normal saline solution and application of dressing and sterile gauze. Patient scores on the Bates-Jensen Wound Assessment Tool (BWAT) and Pressure Ulcer Scale for Healing (PUSH) were evaluated before and after 1, 2 and 3 weeks of treatment.Results One patient was excluded from the control group, and a total of 59 subjects completed the trial. The BWAT scores significantly decreased in the treatment group compared with the control group at the end of 3-week treatment (difference=−3.6; 95% CI −6.3 to–0.8; p<0.01). Similarly, patients in treatment group showed a significant reduction of PUSH scores compared with the control group (difference=−5.3; 95% CI −8.1 to –2.6; p<0.01).Conclusions The therapeutic effects of HILT on chronic refractory wounds are significant and far more superior to those of conventional wound dressing.Trial registration number Chinese Clinical Trial Registry; ChiCTR1900023157. URL: http://www.chictr.org.cn/showproj.aspx?proj=38866