Background: Dysphagia may delay the functional recovery and substantially affects the quality of life after stroke, mainly if left untreated. Electrical stimulation has been reported as a treatment for pharyngeal dysphagia in recent studies, but the therapeutic effect of neuromuscular electrical stimulation (VitalStim) therapy lacks convincing supporting evidence and needs further clinical investigation. Methods: A total of 135 subjects were randomly divided into 3 groups: traditional swallowing therapy (n = 45), VitalStim therapy (n = 45), and VitalStim therapy plus traditional swallowing therapy (n = 45). The traditional swallowing therapy included basic training and direct food intake training. Electrical stimulation was applied by an occupational therapist, using a modified handheld battery-powered electrical stimulator (VitalStim Dual Channel Unit and electrodes, Chattanooga Group, Hixson, Tennessee). The surface electromyography (sEMG), standardized swallowing assessment (SSA), videofluoroscopic swallowing study (VFSS), and visual analog scale (VAS) were used to assess swallowing function before and 4 weeks after the treatment. Results: A total of 118 subjects with dysphagia completed the study, 40 in the traditional swallowing group and VitalStim therapy group and 38 in the VitalStim and traditional swallowing therapy group. There were significant differences in sEMG values and SSA and VFSS scores in each group after the treatment (P < .001). After 4-week treatment, sEMG value (917.1; standard deviation [SD], 91.2), SSA value (21.8; SD, 3.5), oral transit time (0.4; SD, 0.1), and pharyngeal transit time (0.8; SD, 0.1) were significantly improved in the VitalStim and traditional swallowing therapy group than in the other 2 groups (P < .001). Conclusions: Data suggest that VitalStim therapy coupled with traditional swallowing therapy may be beneficial for poststroke dysphagia.

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BackgroundWe aimed to determine the risk conferred by metabolic syndrome (METS) and diabetes mellitus (DM) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial.Methods and ResultsIn total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society (CDS) and International Diabetes Foundation (IDF) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS, 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke (P=0.82 for interaction in the fully adjusted model of CDS) was observed. Using the METS (IDF) criteria demonstrated similar results.ConclusionsConcurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

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In conventional in vitro fertilization (IVF), complete failure of fertilization occurs in 5% to 15% of treatments. Although the causes may be unclear, sperm defects appear to be the major contributor. However, a convincing test is not yet available that can predict the risk of fertilization failure. In this study, we found that germinal angiotensin-converting enzyme (gACE) (also called testicular ACE) was undetectable in sperm from patients who had total fertilization failure (TFF) and lower fertilization rates (LFRs) by IVF based on Western blot and indirect immunofluorescence analyses. Additionally, almost all of the patients without gACE on sperm (23 of 25) manifested a TT genotype of the rs4316 single-nucleotide polymorphism of ACE. Overall, our results indicate that the absence of gACE expression is responsible for TFF and LFRs by IVF. The rs4316 polymorphism of ACE might be associated with infertility in those patients. We conclude that sperm lacking gACE may be recognized before commencing IVF and that the patients may be directed instead to consider intracytoplasmic sperm injection.