Dysphagia not only severely affects patients’ quality of life but also significantly increases the incidence of complications and mortality risk. In recent years， neuromodulation technologies have provided breakthrough therapeutic strategies for swallowing rehabilitation by targeting peripheral and central neural circuits. This article systematically reviews the key technologies and recent advances in this field： for peripheral stimulation， it highlights pharyngeal electrical stimulation and vagus nerve stimulation； for central modulation， it focuses on the applications of repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These neuromodulation techniques exert their therapeutic effects through multiple mechanisms， including regulating neural plasticity and improving neuromuscular coordination. Future development should focus on the integration of multimodal technologies and optimization of personalized treatment strategies to promote the establishment of a precise rehabilitation system for dysphagia.
As one of the most common complications after stroke， dysphagia has a prevalence rate of 56.6%， which seriously affects the nutritional metabolic balance and quality of life of patients. Xanthan gum， as a natural polysaccharide thickener， has demonstrated its unique clinical value in post-stroke dysphagia （PSD） intervention due to its unique shear-thinning properties. In this article， the rheological properties of xanthan gum and its effect on swallowing function are systematically reviewed， and its application value in PSD is discussed from three dimensions： improvement of swallowing dynamics， prevention of aspiration and pneumonia， and regulation of nutritional status. Combined with the research progress on novel xanthan gum-based materials and intelligent assessment technologies， the future directions for personalized thickening scheme design and multimodal combined intervention is proposed to provide new insights for PSD intervention strategies.
Objective To explore the impact of intermittent nasogastric tube feeding on the quality of life of patients with dysphagia after radiotherapy for nasopharyngeal carcinoma in the short term. Methods Patients with dysphagia after radiotherapy for nasopharyngeal carcinoma who visited the Department of Rehabilitation Medicine of the Third Affiliated Hospital of Sun Yat-sen University from July 2022 to May 2025 were selected. At the time of visit， they were fed through a continuously indwelling nasogastric tube and were evaluated as suitable for intermittent nasogastric tube feeding. Three time points were selected for assessment： before the nasogastric tube was removed （T0）， the third day after intermittent nasogastric tube feeding （T1）， and the seventh day after intermittent nasogastric tube feeding （T2）. The Functional Oral Intake Scale （FOIS） was used to assess the severity of dysphagia， and the Chinese version of the Swallowing Quality of Life Scale （SWAL-QOL） was used for questionnaire survey and scoring. Changes in the quality of life related to swallowing at the three assessment time points were observed， and stratified analysis was conducted based on age， gender， and severity of dysphagia to compare the differences and changes in the quality of life of patients with different individual characteristics. Results There was no statistically significant difference in FOIS grades among the three assessment time points （P > 0.05）. In terms of the quality of life related to swallowing， there were statistically significant differences in the scores of the four dimensions of psychological burden， swallowing symptoms， social interaction， and fatigue and sleep （all P < 0.05）. Further pairwise comparisons showed that in the dimensions of psychological burden， social interaction， and fatigue and sleep， the differences in scores between T0 and T1， and between T0 and T2 were statistically significant （all P < 0.016 7）； in the dimension of swallowing symptoms， the differences in scores between T0 and T1， between T0 and T2， and between T1 and T2 were all statistically significant （all P < 0.016 7）. There were no statistically significant differences in the scores of the five dimensions of eating time， food choice， language communication， fear of eating， and mental health among the three assessment time points. Further subgroup analyses were conducted based on age， gender， and FOIS grades. The results showed that there was no statistically significant interaction effect between subgroup and time in the scores of each dimension （P > 0.05）； in the four dimensions of psychological burden， swallowing symptoms， social interaction， and fatigue and sleep， the time effect was statistically significant （P <0.001）， and the scores increased over time. In the gender subgroup analysis， the scores in the dimensions of swallowing symptoms and mental health were significantly different between the groups （P = 0.035， 0.011）， with higher scores in the male group than in the female group； in the subgroup analyses based on age and FOIS grades， there was no statistically significant group effect （P > 0.05）. Conclusion Short-term observation shows that there are differences in the quality of life among patients with dysphagia after radiotherapy for nasopharyngeal carcinoma under the two feeding methods， and intermittent nasogastric tube feeding can improve the quality of life of patients.
Objective To screen evaluation indicators of the International Classification of Functioning， Disability and Health （ICF） Core Set for Dysphagia Assessment （ICF-DA）， with the aim of enhancing its clinical applicability. Methods A questionnaire comprising 64 candidate evaluation indicators was developed based on a literature review. The Delphi method was employed to conduct two rounds of expert surveys. The authority coefficient （Cr） was calculated to assess the reliability of expert opinions. The Spearman’s rank correlation coefficient （rs） was used to assess the consistency between individual expert scores and group scores， while Kendall’s Coefficient of Concordance （W） was used to assess overall expert agreement. A five-point Likert scale was used to rate the importance of each candidate indicator. Based on the results of the second-round questionnaire， the top two indicators in each category with a coefficient of variation （CV） less than 0.25 were selected as the final evaluation indicators for the ICF-DA. Results A total of 20 experts in dysphagia diagnosis and treatment completed both rounds of the survey. The Cr was 0.94， indicating high expert reliability. The rs value in the second round was 0.71， demonstrating good consistency between individual and group scores. Both rounds yielded statistically significant W value （P < 0.001）， with a higher W value in the second round， indicating improved overall expert agreement. Ultimately， 17 evaluation indicators were finalized. Conclusion The evaluation indicators for the ICF-DA developed using the Delphi method contribute to a comprehensive and multi-dimensional assessment of swallowing function in patients with dysphagia.
Objective To evaluate the effect of negative pressure suctioning via visual suction tube on the removal of oral secretions in patients with post-stroke dysphagia （PSD）. Methods Ninety-six patients with PSD were randomly divided into the treatment and control groups， with 48 patients in each group. In the treatment group， negative pressure suctioning was given via visual suction tube， while traditional suctioning via disposable suction tube was delivered in the control group. The effects of oral secretion removal， body temperature， blood oxygen saturation， heart rate， oral cleanliness， visual analog comfort， duration of negative pressure suction， oral mucosal damage， WBC， CRP， oral flora， and oral pH value were observed in both groups. Results No oral mucosal damage occurred in either group. Visual negative pressure suction significantly smoothed the heart rate， with a statistically significant difference between two groups （P < 0.05）. Intra-group comparation showed that blood oxygen saturation and oral cleanliness in patients with PSD were improved in two groups （all P < 0.01）. After corresponding interventions， compared with the control group， visual analog comfort was enhanced and the duration of negative pressure suction was shortened in the treatment group， and oral cleanliness was also improved（all P < 0.05）. Following respective interventions， oral flora and oral pH value in patients with PSD were improved in two groups （all P < 0.01）. After interventions， compared with the control group， WBC， CRP and oral flora were decreased （all P < 0.05）， and oral pH value was increased in the treatment group （P < 0.000 1）. Negative pressure suctioning via visual suction tube exerted better effect on removing oral secretions in patients with PSD. Conclusions Negative pressure suctioning of oral secretions can improve blood oxygen saturation and smooth heart rate. Negative pressure suctioning via visual suction tube can effectively eliminate oral secretions， improve patient comfort， shorten the duration of negative pressure suctioning， reduce WBC， CRP and oral flora， and increase oral pH value in PSD patients.
Sarcopenic dysphagia， a dysphagia caused by decreased skeletal muscle mass， has a high prevalence in the elderly population and can cause asphyxia， aspiration， malnutrition or other complications， seriously affecting the quality of life of patients. At present， the relevant research on this disease in China is still in its infancy， and a unified consensus on diagnosis and treatment has not yet been formed. Therefore， this article provides an overview of the concept， pathogenesis， and major risk factors for sarcopenic dysphagia， including nutritional deficiencies， physical inactivity， aging， cerebrovascular injury， poor oral environment， and peripheral nerve damage. Interventions were discussed， including adjusting eating posture， resistance training， nutritional interventions， neuromuscular electrical stimulation， pharmacotherapy， and multidisciplinary intervention strategies. The aim of this study is to provide a theoretical basis for the early prevention and intervention of sarcopenic dysphagia， and to provide a reference for future research and clinical practice.
Mirror neuron system （MNS） is a specialized group of neurons that can be activated both when an individual performs a specific action and when observing others perform similar actions. In recent years， rehabilitation interventions based on mirror neuron theory have demonstrated promising clinical potential in treating post-stroke dysphagia. In this article， the mechanisms of mirror neurons were systematically reviewed， with an emphasis upon exploring the therapeutic mechanisms and clinical efficacy of various MNS-based rehabilitation techniques including action observation therapy， motor imagery therapy， mirror therapy， virtual reality therapy， and brain-computer interface technology in the management of dysphagia. These findings aim to provide evidence-based medical support for optimizing rehabilitation protocols for post-stroke dysphagia.
Objective To evaluate the predictive value of the ratio of subpubic arch angle （SPA） to fetal head circumference （HC） （SPA/HC ratio） for the delivery mode of full-term pregnant women. Methods Clinical data of 363 pregnant women who received regular obstetric examination and vaginal trial of labor in Lingnan Hospital， the Third Affiliated Hospital of Sun Yat-sen University from July to December， 2023 were retrospectively analyzed. According to the delivery mode， they were divided into normal vaginal delivery group （n = 291） and cesarean delivery group （n = 72）. SPA and HC were measured by ultrasound after full-term pregnancy in all women. Mann-Whitney U test was used to compare SPA， HC and SPA/HC between two groups. The predictive values of SPA， HC and SPA/HC ratio for maternal delivery mode were assessed by Logistic regression analysis. The predictive efficiency of the model was evaluated by the receiver operating characteristic （ROC） curve. Results For 363 women with vaginal trial of labor， the average age was （30.33±4.40） years and the gestational age was （39.3±0.9） weeks. Compared with normal delivery group， the SPA was smaller and the HC was larger in the cesarean delivery group （both P < 0.001）. SPA yielded positive predictive value for normal delivery， with an area under the ROC curve （AUC） of 0.739 （95%CI 0.678-0.799）. HC had negative predictive value， with an AUC of 0.700 （95%CI 0.637-0.763）. SPA/HC yielded positive predictive value and the highest prediction efficiency， with an AUC of 0.817 （95%CI 0.763-0.871）. Conclusions SPA/HC ratio can effectively predict the delivery mode of full-term pregnant women. When SPA/HC ratio is less than 0.292， it is recommended to strengthen intrapartum fetal monitoring and prepare for emergency plan in advance.
Objective To establish and validate a standardized nursing assessment and management system for protein A immunoadsorption （IA） therapy in acute-stage autoimmune encephalitis （AE）， and to investigate its clinical efficacy and safety. Methods Through a case series analysis， data were retrospectively collected from 21 acute-phase AE patients who received protein A IA therapy between January 2022 and December 2024 （17 cases with anti-NMDAR antibody positivity， 2 with anti-GABABR antibody positivity， 1 with anti-IgLON5 antibody positivity， and 1 with anti-LGI1 antibody positivity）. All patients completed 5 to 10 sessions of IA therapy （median： 7 sessions）. Pre-and post-treatment scores on the modified Rankin Scale （mRS）， Glasgow Coma Scale （GCS）， Activities of Daily Living （ADL） scale， serum IgG levels， and serum antibody titers were statistically compared. Peri-procedural care was implemented based on the constructed standardized nursing assessment and management system， including： 1） Dynamic risk assessment （coagulation function， humoral immunity， neurological/mental status）； 2） Standardized operating procedures （blood flow/plasma separation parameter settings， transmembrane pressure monitoring）； 3） Complication warning and precision intervention strategies （hypotension， membrane rupture/hemolysis， psychiatric symptoms， etc.）； 4） Multi-dimensional infection prevention and control； 5） Nursing process optimization and quality control. Key nursing management effectiveness indicators were observed： pre-procedural assessment completion rate， assessment standardization compliance rate， incidence of hypotension， incidence of membrane rupture/hemolysis， infection rate， and unplanned extubation rate. Nursing-related indicators （adverse events and management outcomes） were recorded and analyzed. Results After treatment， patients showed reductions in serum IgG levels and antibody titers， along with neurological improvement： significant improvement in mRS， GCS， and ADL scores （all P < 0.001）. The nursing management system demonstrated high effectiveness： pre-procedural assessment completion rate was 100% （152/152）， assessment standardization compliance rate was 100% （152/152）， incidence of hypotension was 1.3% （2/152）， incidence of membrane rupture/hemolysis was 0.7% （1/152）， infection rate was 0.7% （1/152）， and unplanned extubation rate was 0% （0/152）， respectively. Peri-procedural nursing complications included hypotension （n = 2， given with fluid resuscitation/pressors）， membrane rupture （n = 1， treated with emergency blood return protocol）， psychiatric symptoms （n = 3， given with physical restraint and sedation management）， thrombocytopenia （n = 1， drug intervention + protection）， IgG decrease （n =2， given with intravenous immunoglobulin supplementation）， and respiratory infection （n = 1， given with anti-infection treatment+ isolation nursing）. All events were controlled with appropriate management， with no severe complications. Conclusions Protein A IA rapidly eliminates pathogenic antibodies and improves neurological deficits in AE patients. Its efficacy and safety are highly dependent on standardized nursing assessment and management system established in this study. This system effectively reduces treatment-related risks through dynamic risk assessment， precise complication prevention/management， and process optimization， providing effective evidence-based nursing practice for IA therapy in acute-phase AE patients.
Objective To systematically evaluate the clinical efficacy of traditional Chinese medicine （TCM） based on liver regulation theory combined with anti-thyroid drugs in the treatment of hyperthyroidism， aiming to provide more sufficient evidence of evidence-based medicine for the application of TCM in hyperthyroidism. Methods Studies related to TCM treatment of hyperthyroidism based on liver regulation theory were retrieved from CNKI， Wanfang Database， Chongqing VIP Database， Chinese Biomedical Literature Database， Web of Science， PubMed， Cochrane Library and Embase until November 30， 2024. After screening the eligible studies， the quality of the studies was evaluated. Revman 5.4 software was used to systematically re-evaluate the efficacy. Results A total of 36 published studies were included， including 2 616 patients， 1 309 in the control group and 1 307 in the study group. Comparison of thyroid function improvement between two groups showed that TSH elevation in the study group was higher than that in the control group （I 2=93%，SMD=1.16，95% CI（0.81， 1.51）， P < 0.000 01）， and decreased FT3 （I 2=95%，SMD=-1.56，95%CI （-1.98， -1.14）， P < 0.000 01） and FT4 （I 2=96%，SMD=-1.78，95%CI （-2.25，-1.30）， P < 0.000 01） were better than those in the control group. In addition， the symptoms were more significantly mitigated in the study group （I 2=93%， SMD=-1.55， 95%CI （-1.95， 1.15）， P < 0.000 01）. The clinical response rate in the study group was higher than that in the control group （I 2=0%，RR=1.23， 95%CI （1.19， 1.27）， P < 0.000 01）. Conclusion TCM based on liver regulation theory combined with anti-thyroid drugs can better improve thyroid function， relieve clinical symptoms and improve clinical efficacy， which remains to be validated by large-scale， high-quality clinical research.
Neuromyelitis optica spectrum disorder （NMOSD） is a group of autoimmune-mediated inflammatory demyelinating disorders of the central nervous system， mainly involving the optic nerve and spinal cord. Pain is a common clinical symptom in the course of NMOSD， which severely affects the quality of life of patients. At present， clinical use of glucocorticoids， immunosuppressants， analgesics and other drugs can partially alleviate NMOSD complicated with pain. However， recurrence， aggravation or persistence of the pain， and low efficacy remain the challenges. Consequently， progress in clinical characteristics， pathogenesis and treatment of NMOSD-related pain was reviewed， aiming to provide reference for the clinical treatment and management.
Endometrial cancer （EC） is a common gynecological malignant tumor with relatively good prognosis. However， the progress in its epigenetic carcinogenic mechanisms and treatment regimens remains to be explored. In recent years， more and more studies have shown that the adenomatous polyposis coli （APC） gene can serve as a promising diagnostic and therapeutic biomarker. APC is a typical tumor-suppressor gene related to chromatin remodeling. Its mutations and functional abnormalities have been reported to be associated with the occurrence and therapeutic drug resistance of various types of EC. The carcinogenic mechanisms of EC may involve abnormalities in the Wnt pathway （a cell signaling pathway in organisms that regulates organogenesis， embryonic development， tissue homeostasis， and tumorigenesis）， environmental factors， genetic abnormalities， high estrogen levels， abnormal mismatch repair， and abnormal expression of DNA and microRNAs. Selecting corresponding treatment strategies based on its carcinogenic mechanisms may help improve the efficacy of EC treatment. In this article， the role of APC in the carcinogenesis of early-stage EC was mainly reviewed and its significance in EC treatment was summarized， providing novel perspective for relevant research.
