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Context: Sport-related dystonia is a rare form of activity-specific dystonia that can severely impair an athlete's ability to perform. Due to a lack of data on the condition, it is difficult to diagnose and often overlooked, and no gold standard treatment has yet been defined. Case Presentation: We present a rare and challenging case of sport-related dystonia that affected a 24-year-old male professional soccer player. The patient presented with severe rigidity and dystonia of the right lower-extremity, particularly the ankle and foot. The symptoms set on >1 year prior to the presentation to our outpatient clinic. He began to complain of stiffness and difficulty moving his lower limbs, especially his right leg, initially when playing soccer, but then also when walking normally. On presentation, he was unable to run and walked with difficulty, supporting his body weight only on the outside of his right foot. He also reported a motor trick and reverse motor trick involving the oral musculature in order to move his lower limb more freely. Management and Outcomes: An integrated rehabilitation approach based on postural rehabilitation, neuromuscular rehabilitation, and dental intervention was used to successfully treat this condition. The approach included: (1) postural rehabilitation with the Mézières-Bertelè method to reduce muscular stiffness, (2) neuromuscular re-education with Tai Chi exercises and electromyography-guided biofeedback, and (3) dental intervention and swallowing rehabilitation to limit impaired oral habits (due to the relationship between his impaired lower limb movements and motor tricks of the oral musculature). After 7 months of integrated rehabilitation, the patient returned to professional soccer. Conclusions: This case report highlights the potential efficacy of an integrative rehabilitation approach for sports dystonia, particularly in cases where traditional treatments may not be effective. Such an approach could be considered a valuable option in the management of this rare, but debilitating, condition in athletes. Further research is needed to assess the effectiveness of this approach in larger populations. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the relationship between physical activity (PA) levels and short-term changes in skeletal muscle characteristics in patients with subacute hemiparetic stroke. Materials and Methods: This prospective observational study included 76 patients with stroke who received inpatient care in a convalescent rehabilitation ward. The PA level was measured as the duration of daily total PA (≥ 1.5 metabolic equivalents) using a triaxial accelerometer for 7 days after admission. The outcomes were changes in the quadriceps muscle quality and quantity on the affected and unaffected sides, as assessed by ultrasonography at admission and 1 month after admission. Results: Multiple regression analysis indicated that the duration of total PA was significantly associated with a percentage change in quadriceps muscle quality (p = 0.011) and quantity (p = 0.012) on the affected side. However, no significant relationship was observed between the muscle quality and quantity on the unaffected side. Conclusions: The results revealed that PA was associated with changes in the quadriceps muscle quality and quantity on the affected side in patients with subacute hemiparetic stroke. These findings highlight the importance of promoting PA in stroke rehabilitation to improve muscle properties and functional outcomes. IMPLICATIONS FOR REHABILITATION: Improving skeletal muscle quality and quantity is an important goal in post-stroke rehabilitation. We investigated physical activity and post-stroke changes in muscle properties. Physical activity is related to changes in muscle quantity and quality on the affected side. Promoting physical activity is essential for improving muscle quantity and quality on the affected side. [ABSTRACT FROM AUTHOR]

Respiratory–swallowing coordination (RSC) is well established as an essential airway‐protective mechanism. Previous studies have used nasal airflow and/or kinematic rib cage and abdominal measures to assess respiration surrounding swallowing, meaning that the direct influence of oral respiration on RSC remains unknown. This study used a partitioned oronasal facemask to compare respiratory phase patterns measured using isolated nasal airflow with those measured using combined oronasal airflow during non‐ingestive and ingestive swallowing tasks. Twenty‐four healthy individuals with no respiratory or swallowing disorders were assessed at rest and during cued dry, 10 mL water, continuous drinking and cracker swallowing tasks. Respiratory phase patterns were determined for discrete swallows using the nasal and combined oronasal channels separately. There was variable agreement between respiratory phase patterns according to the nasal and oronasal channels across swallowing conditions. The frequency of exhale–swallow–exhale, inhale–swallow–exhale and exhale–swallow–inhale patterns increased by 2%–3% each with the addition of oral flow data to nasal data, whereas the prevalence of inhale–swallow–inhale and ambiguous patterns decreased. This suggests that estimates of respiratory phase patterns are altered minimally by inclusion of oral respiratory estimates in a healthy sample. There were several additional findings of note, including lower within‐participant, within‐session trial consistency (test–retest reliability) than expected, suggesting high variability in respiratory phase patterns across trials. Additionally, data showed evidence of swallowing non‐respiratory flow at the beginning and end of the respiratory–swallowing pause, moving in both inward and outward directions, potentially expanding current understanding of swallowing non‐respiratory flow. Further in‐depth physiological investigations are required to improve understanding of these findings. [ABSTRACT FROM AUTHOR]

Ticagrelor is a key antiplatelet agent used to prevent thrombotic events in patients with acute coronary syndrome. This open‐label, 2‐period, crossover Phase I study assessed the pharmacokinetics and bioequivalence of a generic ticagrelor 90‐mg formulation compared to the innovator product under fasting conditions. Twenty‐eight healthy White adults participated in the study. Each participant received a single dose of either the test or reference formulation, followed by a 7‐day washout period before switching to the alternate formulation. Plasma concentrations of ticagrelor were measured using a validated high‐performance liquid chromatography‐tandem mass spectrometry method. Statistical analysis of primary pharmacokinetic parameters, including maximum concentration and area under the plasma concentration‐time curve from time 0 to the last quantifiable concentration, showed bioequivalence with test/reference ratios of 110.9% and 107.1%, respectively, and 90% confidence intervals within the 80%‐125% regulatory range. Treatment‐emergent adverse events, such as headache, dysphagia, and dizziness, were moderate and transient and resolved promptly, with no significant difference in incidence between the formulations. These results confirm that the generic ticagrelor formulation is bioequivalent to the innovator product, supporting its use as an interchangeable option in clinical practice. [ABSTRACT FROM AUTHOR]

Background Objective(s) Methods Results Conclusion Swallowing is a complex function that requires precise coordination between different muscles. Weakness in submental muscles can lead to complications such as pharyngeal residue and aspiration. Therefore, exercise interventions targeting these muscles, such as the Head‐Lift Exercise (HLE), are clinically important but pose challenges.This study aimed to compare the myoelectric activity of submental muscles during traditional Head‐Lift Exercise (HLE), Tongue‐Press Exercise (TPE) and Head Extension Tongue‐Press Exercise (HETPE), providing potential alternatives to HLE.Thirty healthy volunteers (22 females and 8 males, mean age 25.63 ± 5.27 years) participated in this cross‐sectional study. Surface electromyography (sEMG) recorded activity of the submental muscles bilaterally during HLE, TPE and HETPE. Participants performed each manoeuvre for 14 s, repeated three times in a counterbalanced order. Statistical analyses assessed differences in mean, maximum and median frequency of the sEMG signals among manoeuvres using repeated‐measures analysis of variance (RM‐ANOVA). The experienced irritation levels by participants during manoeuvres were also compared by the Friedman test.HETPE exhibited significantly higher maximum sEMG activity compared to HLE and TPE (p < .05). Mean sEMG activity was significantly increased during HETPE compared to TPE. Median frequency was significantly lower during HETPE compared to the two other exercises, indicating greater muscle fatigue. Participants reported similar levels of irritation for HLE and HETPE, and significantly lower levels during TPE.These results indicate that HETPE is effective in activating and strengthening submental muscles, potentially serving as a viable alternative to HLE without added difficulty. Further research is recommended to assess the long‐term impacts on swallowing physiology in patients with dysphagia. [ABSTRACT FROM AUTHOR]

Fluid therapy is a fundamental part of supportive therapy in critical care. However, it is also a suspected risk for endothelial glycocalyx degradation which is associated with poor clinical outcomes. This secondary analysis of RESPONSE randomized trial compares the effect of follow-up strategy (FU) on endothelial biomarkers to that of 500 ml crystalloid fluid bolus (FB) in oliguric, hemodynamically optimized intensive care unit (ICU) patients. 130 adult subjects were enrolled in two Finnish ICUs from January 2017 to November 2020. Blood and urine samples of 63 patients in FU group and 67 patients in FB group were collected before and after the intervention and analyzed using enzyme-linked immunosorbent assays. Single fluid bolus, given after median of 3887 ml (interquartile range 2842; 5359 ml) resuscitation fluids in the preceding 24 h, increased plasma hyaluronan concentration compared to the follow-up strategy (difference in medians 29.2 ng/ml with 95% CI [14.5ng/ml; 55.5ng/ml], P < 0.001). No treatment effect was detected in the plasma levels of syndecan-1, , angiopoietin-2, angiopoietin receptors Tie2 and Tie1, or in soluble thrombomodulin in the adjusted median regression analysis. The increase in hyaluronan was independent of its simultaneous renal clearance but correlated moderately with the increase in endothelium-specific Tie1. The follow-up strategy did not show consistent endothelium-sparing effect but protected against hyaluronan increase. The mechanisms and consequences of hyaluronan fluctuations need further clarification. Trial registration: clinicaltrials.gov, NCT02860572. Registered 1 August 2016, https://www.clinicaltrials.gov/study/NCT02860572?term=NCT02860572&rank=1 [ABSTRACT FROM AUTHOR]

Background Methods Key Results Conclusions & Inferences Although swallowing impairment is prevalent following lung transplantation, baseline respiratory and swallowing characteristics are often overlooked. Respiratory disease processes may predispose lung transplant candidates to altered respiratory‐swallow patterning and swallowing impairment.This cross‐sectional study included patients referred for a Modified Barium Swallow Study during lung transplant evaluation. Swallowing impairment was measured using the Modified Barium Swallow Impairment Profile and Penetration‐Aspiration Scale. Respiratory plethysmographic signals synchronized with videofluoroscopy were analyzed to determine phase patterning, pause duration, and rate. Mixed‐effects logistic regression was used to identify linkages between respiratory and swallowing measures.Fifty patients were included and demonstrated delayed swallow initiation (49/50), oral residue (37/50), incomplete pharyngoesophageal segment opening (35/50), and esophageal retention (43/50). Airway invasion occurred infrequently (10/50). Atypical respiratory patterning was significantly associated with impairment in pharyngeal swallow initiation (OR [95% CI] = 1.76 [1.16, 2.68], p = 0.009), laryngeal elevation (OR [95% CI] = 1.45 [1.01, 2.07], p = 0.044), and laryngeal vestibular closure (OR [95% CI] = 2.57 [1.48, 4.46], p < 0.001). Increased pause duration was associated with impaired initiation (OR [95% CI] = 2.24 [1.20, 4.16], p = 0.011), laryngeal elevation (OR [95% CI] = 1.18 [1.03, 1.36], p = 0.018), laryngeal closure (OR [95% CI] = 1.28 [1.9, 1.50], p = 0.003), and tongue base retraction (OR [95% CI] = 1.33 [1.13, 1.56], p < 0.001).Patients undergoing evaluation for lung transplant demonstrated impaired swallowing and phase patterning. Preliminary findings implicate the need for further evaluation of respiratory‐swallow coordination and its potential role in swallowing impairment before and after lung transplantation. [ABSTRACT FROM AUTHOR]

Background and Aims: Analysis of mean nocturnal baseline impedance (MNBI) and post‐reflux swallow‐induced peristaltic wave index (PSPWi) have been proposed to increase the diagnostic yield of pH‐impedance studies in reflux disease. However, routine use of these indices in clinical studies is yet to be established, particularly with PSPWi, which requires laborious manual analysis. Our study aimed to assess the utility of MNBI and PSPWi and their potential for future incorporation into clinical practice. Methods: pH‐impedance recordings from consecutive patients referred to the Motility Laboratory at Royal Adelaide Hospital for evaluation of gastro‐oesophageal reflux disease (GORD) were prospectively collected and manually analysed. Baseline demographic characteristics, symptoms, acid exposure time (AET), number of reflux episodes, and MNBI and PSPWi were collected. Results: Eighty‐nine patients were included in the study (age 50 ± 17 years, 35 males). MNBI and PSPWi inversely correlated with AET (R = −0.678, P < 0.0001 and R = −0.460, P < 0.0001 respectively) and with reflux episodes (R = −0.391, P = 0.0002 and R = −0.305, P = 0.0037 respectively). In patients with a negative pH study, but with typical reflux symptoms, 4/30 (13%) had pathologic MNBI and PSPWi. There was a positive correlation between MNBI and PSPWi values (R = 0.525, P < 0.0001). Performing analysis of PSPWi was substantially more laborious than MNBI. Conclusion: MNBI and PSPWi are both useful adjuncts in the diagnosis of reflux disease, although in our cohort MNBI showed stronger correlation with AET with less time to analyse. The role of these indices remains to be further explored, particularly in patients with inconclusive AET and in those with positive compared to negative symptom association. [ABSTRACT FROM AUTHOR]

Background: Caustic ingestions are relatively uncommon, but remain a significant source of morbidity. Patients with caustic injury often undergo an urgent EGD, although it is not clear if an EGD is routinely needed in an asymptomatic patient. The study has two primary objectives; 1) to determine the utility of routine EGD in asymptomatic suicidal caustic ingestions; 2) to determine if asymptomatic unintentional acidic ingestions can be managed with observation alone, similar to basic ingestions. Methods: This retrospective study, which took place at 14 hospitals in three countries evaluated all patients who presented with a caustic ingestion between 2014–2020. The presence of symptoms and esophageal injury, demographic information, pH of ingested substance, reason for the ingestion, and outcome were recorded. Results: 409 patients were identified; 203 (46.9%) were male. The median (IQR) age was 18 (4–31) years; overall range 10 months to 78 years. Suicidal ingestions accounted for 155 (37.9%) of cases. Dysphagia or dysphonia were more likely in those with significant esophageal injury compared to those without (59.3% vs. 12.6% respectively; OR 10.1; 95% CI 4.43–23.1). Among 27 patients with significant esophageal injury, 48% were found in suicidal patients, compared with 51.9% in non-suicidal patients (p = NS). On multivariate regression, there was no difference in the rate of significant esophageal injury among suicidal vs. non suicidal patients (aOR 1.55; p = 0.45, 95% CI 0.45–5.33). Most ingestions involved basic substances (332/409; 81.2%). Unknown or mixed ingestions accounted for 25 (6.11%) of the ingestions. Significant esophageal burns were found in 6/52 (11.5%) of acid ingestions, compared with 21/332 (6.3%) of basic ingestions. Of the 42 cases of acidic ingestions without dysphagia or odynophagia, 2 (4.8%; 0.58–16.1%) had significant esophageal burns, compared with 9 (3.2%; 95% CI 1.4–5.9%) of the 284 basic ingestions; p = 0.64). On multivariate logistic regression, patients with acidic ingestions were not more likely to experience a significant burn (aOR 1.7; p = 0.11, 95% CI 0.9–3.1) compared to those with basic ingestions. No patient with significant esophageal burns was asymptomatic. Conclusion: In this study, there was no statistical differences in the rates of significant burns between acidic and basic caustic ingestions. There were no significant esophageal injuries noted among asymptomatic patients. [ABSTRACT FROM AUTHOR]

Background: Low‐intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high‐intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. Objective: We aimed to explore the effects of high‐intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. Methods: Twenty‐eight healthy adults were divided into two groups. Participants performed high‐intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. Results: Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five‐time chair stand test, whereas the single training group did not. Conclusion: This study revealed that high‐intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. Clinical Trial Registration Number: UMIN000046724; https://upload.umin.ac.jp/cgi‐open‐bin/ctr/index.cgi?ctrno=UMIN000046724. [ABSTRACT FROM AUTHOR]

Background: The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS‐Children (TOMASS‐C) is the paediatric version of TOMASS. Objective: The present study aimed to establish normative data for TOMASS‐C using a validated regional commercial cracker among healthy individuals aged between 6–20 years of India. Methods: 327 healthy individuals between 6–20 years were recruited in a cross‐sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6–7, 8–9, 10–13, 14–17 and 18–20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated. Results: All parameters of TOMASS‐C had moderate to good (0.6–0.85) test–retest reliability and moderate to excellent (0.69–0.99) inter‐rater reliability at p >.000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p >.05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p >.05. Conclusion: TOMASS‐C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6–20 years offers much‐needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties. [ABSTRACT FROM AUTHOR]

Background: High‐density surface electromyography (HD‐sEMG) has enabled non‐invasive analysis of motor unit (MU) activity and recruitment, but its application to swallowing‐related muscles is limited. Objective: We aimed to investigate the utility of HD‐sEMG for quantitatively evaluating the MU recruitment characteristics of the suprahyoid muscles during tongue elevation. Methods: We measured the sEMG activity of the suprahyoid muscles of healthy participants during tongue elevation using HD‐sEMG. Maximum voluntary contraction (MVC) was measured, followed by data collection during sustained and ramp‐up tasks to capture suprahyoid muscle activity. Changes in the temporal/spatial MU recruitment patterns within individual suprahyoid muscles were analysed. Results: This study enrolled 16 healthy young adults (mean age: 27.8 ± 5.3 years; eight males and eight females). Increasing muscle force corresponded to a decrease in modified entropy and correlation coefficient and an increase in the coefficient of variation. No significant differences were observed between male and female participants. Conclusion: The results of this study, consistent with those observed in other muscles, such as the vastus lateralis muscle, suggest that HD‐sEMG is a valuable and reliable tool for quantitatively evaluating MU recruitment in the suprahyoid muscles. This measurement technique holds promise for novel assessments of swallowing function. [ABSTRACT FROM AUTHOR]

The mechanism behind normal swallowing is complex and multifactorial. Due to the close proximity of the pathways of swallowing and respiration, precise coordination between these functions is vital in order to avoid entry of material into the airway and to ensure optimal health and nutrition in general. Swallowing can be divided into three stages: oral, pharyngeal and oesophageal, and although initiation of the swallow is often under voluntary control, swallowing is also triggered frequently throughout the day as a reflex action due to the presence of saliva in the oropharynx. Dysphagia is a symptom frequently encountered by clinicians and its causes are vast and varied. A thorough understanding of the physiology of swallowing remains necessary to conduct a full assessment and instigate appropriate treatment for these patients in whom dysphagia is often debilitating and may significantly affect their quality of life. We present an account of the physiology of swallowing, illustrated with clinical examples. [ABSTRACT FROM AUTHOR]

• A link between consciousness state and decannulation has been suggested. • 144 patients with prolonged disorders of consciousness after severe acquired brain injury. • Almost all decannulated patients improved their consciousness before decannulation. • No decannulated patient had unresponsive wakefulness syndrome. • Consciousness may influence swallowing skills involved in decannulation. To prospectively investigate the evolution of the consciousness state and the cannula-weaning progression in patients with prolonged disorders of consciousness. Nonconcurrent cohort study. A rehabilitation unit. Adult patients (N=144) with prolonged disorders of consciousness after a severe acquired brain injury admitted between June 2020 and September 2022. Not applicable. Consciousness state was assessed by repeated Coma Recovery Scale-Revised (CRS-R) questionnaire administration at admission and weekly afterward. The dates of the first improvement of consciousness state and the achievement of decannulation were recorded. Decannulation followed an internal protocol of multiprofessional rehabilitation. One hundred forty-four patients were included: age, 69 years; 64 (44.4%) with hemorrhagic etiology; time post onset, 40 days, CRS-R score at admission, 9, median length of stay, 90 days. Seventy-three (50.7%) patients were decannulated. They showed a significantly higher CRS-R (P <.001) and states of consciousness (P <.001) at admission, at the first improvement of the consciousness state (P =.003), and at discharge (P <.001); a lower severity in the Cumulative Illness Rating Scale at admission (P =.01); and a lower rate of pulmonary infections with recurrence (P =.021), compared with nondecannulated patients. Almost all decannulated patients (97.3%) improved their consciousness before decannulation. Consciousness states at decannulation were as follows: unresponsive wakefulness syndrome, 0 (0%); minimally conscious state (MCS) minus, 4 (5.5%); MCS plus, 7 (9.6%); and emergence from MCS, 62 (84.9%). Kaplan-Meier analysis showed a significant divergence between the curves with a higher probability of decannulation in patients who improved consciousness (P <.001). This study showed that the presence of signs of consciousness, even subtle, is a necessary condition for decannulation, suggesting that consciousness may influence some of the components implied in the decannulation process. [ABSTRACT FROM AUTHOR]

Objective: To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results. Methods: This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments. Results: Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%). Conclusion: FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion. [ABSTRACT FROM AUTHOR]

Summary Dysphagia and difficulty swallowing, lead to a heightened risk of respiratory disorders and malnutrition. This study aimed to assess the physicochemical and sensory properties of a branched‐chain amino acids‐fortified perilla mousse (PM) and its retorted version (RPM) to determine their suitability for dysphagia patients. PM and RPM were evaluated for texture, colour, free amino acids content, sensory acceptance, and the International Dysphagia Diet Standardisation Initiative (IDDSI) levels were determined. The results showed that PM and RPM met IDDSI Levels 3–4. RPM exhibited a redder, darker colour and a firmer texture compared with PM. Moreover, RPM showed no syneresis and maintained high viscoelasticity from 20 °C to 80 °C. Additionally, retort sterilisation increased essential amino acid levels in RPM, and it received high sensory acceptance. This mousse offers a promising option for dysphagia patients, providing enhanced nutritional value with ease of swallowing. Future research should explore the long‐term impacts on dysphagia management. [ABSTRACT FROM AUTHOR]

Carbonated drinks have been reported to increase muscle activity during swallowing compared with water. Older adults who habitually consume carbonated drinks may use their swallowing-related muscles to a greater extent, thereby preserving their swallowing function. This study investigated the relationship between habitual carbonated drink intake, amount of carbonated drink consumed, and subjective difficulty in swallowing in community-dwelling older adults. We administered a questionnaire to determine subjective difficulty in swallowing, nutritional status, presence of sarcopenia, and habitual intake of carbonated drinks. Statistical analysis of the subjective difficulty in swallowing was performed using logistic regression analysis with the presence or absence of suspected dysphagia, using the Eating Assessment Tool-10 as the dependent variable. The results showed that older age (odds ratio [OR]: 1.077; p = 0.011), nutritional status (OR: 0.807; p = 0.040), systemic sarcopenia (OR: 1.753, p < 0.001), and habitual intake of carbonated drinks (OR: 0.455; p = 0.039) were associated with subjective difficulty in swallowing. In conclusion, the daily habits of community-dwelling older adults impact their swallowing function. [ABSTRACT FROM AUTHOR]

Introduction: The increasing incidence of stroke globally has led to dysphagia becoming one of the most common complications in stroke patients, with significant impacts on patient outcomes. Accurate early screening for dysphagia is crucial to avoid complications and improve patient quality of life. Methods: Included studies involved stroke-diagnosed patients assessed for dysphagia using bedside screening tools. Data was sourced from Embase, PubMed, Web of Science, Scopus, and CINAHL, including publications up to 10 December 2023. The study employed both fixed-effect and randomeffects models to analyze sensitivity, specificity, positive predictive value (PPV), and Negative Predictive Value (NPV), each with 95% confidence intervals. The random-effects model was particularly utilized due to observed heterogeneity in study data. Results: From 6,979 records, 21 studies met the inclusion criteria, involving 3,314 participants from 10 countries. The analysis included six assessment tools: GUSS, MASA, V-VST, BSST, WST, and DNTA, compared against gold-standard methods VFSS and FEES. GUSS, MASA, and V-VST showed the highest reliability, with sensitivity and specificity rates of 92% and 85% for GUSS, 89% and 83% for MASA, respectively. Heterogeneity among studies was minimal, and publication bias was low, enhancing the credibility of the findings. Conclusion: Our network meta-analysis underscores the effectiveness of GUSS, MASA, and V-VST in dysphagia screening for stroke patients, with high sensitivity and specificity making them suitable for diverse clinical settings. BSST and WST, with lower diagnostic accuracy, require more selective use. Future research should integrate patient-specific outcomes and standardize methodologies to enhance dysphagia screening tools, ultimately improving patient care and reducing complications. [ABSTRACT FROM AUTHOR]

Despite swallowing being a frequently performed daily function, it is highly complex. For a safe swallow to occur, muscles within the head, neck, and thorax need to contract in a concerted pattern, controlled by several swallowing centers at multiple levels of the central nervous system, including the midbrain, cerebral cortex, and cerebellum in addition to five cranial nerves. Dysphagia, or difficulty swallowing, is caused by a long list of pathologic processes and diseases, which can interfere with various stages along the swallowing sensorimotor pathway. When present, dysphagia leads to increased mortality, morbidity, hospital length of stay, and reduced quality of life. Current dysphagia management approaches, such as altering the texture and consistency of foods and fluids and teaching patients rehabilitative exercises, have been broadly unchanged for many years and, in the case of texture modification, are of uncertain effectiveness. However, evidence is emerging in support of new medication-based and neuromodulatory treatment approaches. Regarding medication-based therapies, most research has focused on capsaicinoids, which studies have shown are able to improve swallowing in patients with post-stroke dysphagia. Separately, albeit convergently, in the field of neuromodulation, there is a growing and positive evidential base behind three non-invasive brain stimulation techniques: repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (TDCS), and pharyngeal electrical stimulation (PES). Should some or all of these emerging therapies fulfill their promise, dysphagia-related patient outcomes may be improved. This paper describes the current state of our understanding regarding new medication and neuromodulation-based neurogenic oropharyngeal dysphagia treatments. [ABSTRACT FROM AUTHOR]

Dysphagia, a common result of other medical conditions, is caused by malfunctions in swallowing physiology resulting in difficulty eating and drinking. The Modified Barium Swallow Study (MBSS), the most commonly used diagnostic tool for evaluating dysphagia, can be assessed using the Modified Barium Swallow Impairment Profile (MBSImP™). The MBSImP assessment tool consists of a hierarchical grouped data structure with multiple domains, a set of components within each domain which characterize specific swallowing physiologies, and a set of tasks scored on a discrete scale within each component. We lack sophisticated approaches to extract patterns of physiologic swallowing impairment from the MBSImP task scores within a component while still recognizing the nested structure of components within a domain. We propose a Bayesian hierarchical profile regression model, which uses a Bayesian profile regression model in conjunction with a hierarchical Dirichlet process mixture model to (1) cluster subjects into impairment profile patterns while respecting the hierarchical grouped data structure of the MBSImP, and (2) simultaneously determine associations between latent profile cluster membership for all components and the outcome of dysphagia severity. We apply our approach to a cohort of patients referred for an MBSS and assessed using the MBSImP. Our research results can be used to inform appropriate intervention strategies, and provide tools for clinicians to make better multidimensional management and treatment decisions for patients with dysphagia. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsNeurogenic dysphagia causes complications such as malnutrition, dehydration, and aspiration pneumonia. Therefore, early detection with clinically valid tools is essential. This study aimed to investigate the Eating Assessment Tool-10 (EAT-10) ability to detect swallowing efficiency at three different consistencies in neurogenic dysphagia.One hundred twelve patients with neurogenic dysphagia (74 males and 38 females, mean ± SD age 61.83 ± 9.72 years) were included in the study. A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was performed in the clinic following EAT-10 to assess swallowing efficacy at International Dysphagia Diet Standardization Initiative (IDDSI) consistencies of 0, 3, and 7. The swallowing efficiency of the patients was assessed using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Area under the curve, sensitivity, and specificity values were calculated to evaluate the ability of EAT-10 to discriminate between participants with and without residue and between participants with and without moderate-to-severe residue.The EAT-10 significantly detected participants with and without residues for three IDDSI consistent: for IDDSI 0 residue in the vallecula and pyriform sinus (cutoff score ≥ 14, p < 0.001), for IDDSI 3 residue in the vallecula and pyriform sinus (cutoff score ≥ 13, p < 0.001), for IDDSI 7 residue in the vallecula and pyriform sinus (respectively, cutoff score ≥ 13, cutoff score ≥ 14, p < 0.001). Additionally, the EAT-10 significantly detected those with and without moderate-to-severe residue.The EAT-10, frequently used in swallowing clinics, can determine swallowing efficiency in individuals with neurogenic dysphagia. Additionally, it has the power to detect moderate-to-severe pharyngeal residue. [ABSTRACT FROM AUTHOR]

Background: Hyoid bone is attached to the mandible, tongue, larynx, temporal bone, and cervical spine via different types of muscles or ligaments. The tongue, mandible, and hyoid system play a crucial role in swallowing function. This within subject study aimed to evaluate the impact of mandibular implant overdentures on the displacement of the hyoid bones during the swallowing process. Methods: Twenty five healthy edentulous subjects were selected for participating in the study. New complete dentures were constructed for all the participants. Subsequently two dental implants were inserted in the canine regions of the participant's mandibular arch. In order to retain the mandibular prosthesis in place, ball attachments were incorporated into the mandibular dentures to convert them into implant overdentures. Using 10 ml of thin liquid bolus, videofluoroscopy swallowing examination was performed in three different oral conditions: without complete dentures (WCD), with complete denture (CDs), and with a mandibular implant overdenture (IODs). ANOVA with Bonferroni test was used to analyze the data in order to determine how the hyoid displacement varied throughout different oral conditions. Results: Compared to complete dentures, mandibular implant overdentures showed a significant decrease (P < 0.05) in both anterior hyoid displacement and duration of hyoid maximum anterior excursion (DOHMAE). However, there was a non-significant difference (P > 0.05) between the two oral circumstances in terms of superior hyoid displacement or duration for hyoid maximum elevation (DOHME). There is no penetration or aspiration for both complete denture and implant overdenture oral conditions. Conclusion: Implant retained overdentures have a positive effect on hyoid displacement during swallowing of thin liquid bolus consistency relative to conventional complete dentures. Trial registration: Retrospectively registered (NCT06187181) 02/1/2024. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of dysphagia worldwide are increasing yearly requiring a change in food texture to avoid malnutrition, dehydration, or sever complications. Riceberry porridges fortified with protein hydrolysate (1.5%), bio‐calcium (589 mg), and thickened with xanthan gum (XG) of varying concentrations (0%, 0.255, 0.50%, 0.75%, 1.0%, and 2.0%) showed suitability for use in enriching diets of these patients. Porridges were examined using specified tests from the International Dysphagia Diet Standardization Initiative (IDDSI) and National Dysphagia Diet (NDD), and coupled with rheological, textural analyses, in vitro swallowing simulator and sensory analysis performed by a trained panel. Porridges with 0%–0.25% and 0.50%–2.0% XG were classified as IDDSI level 3 and 4, respectively, and apparent viscosities of porridges showed samples with XG displayed shear thinning behavior beneficial for patients with dysphagia. Increasing XG concentrations increased the consistency coefficient and decreased the flow behavior index (p <.05) with positive correlation of XG concentration with textural properties including firmness, consistency, cohesiveness, adhesiveness, and stickiness values. The relationship between instrumental measurements, in vitro and in vivo swallowing behavior showed high correlations with regards to XG concentration (r =.995). The findings indicate Riceberry porridges containing XG have significantly improved textural properties over those without XG for patients with dysphagia. [ABSTRACT FROM AUTHOR]

This article provides a list of references to scientific articles on various topics related to personalized and precision medicine. The references cover subjects such as cardiovascular risk assessment, biomarkers for cancer, machine learning in healthcare, circadian rhythms, and personalized medicine. These articles can serve as a valuable resource for library patrons conducting research on these specific topics. [Extracted from the article]

Introduction: Bedside test are important tool for evaluating aspiration during swallowing. FEES that is functional endoscopic evaluation of swallowing is a gold standard method used in evaluation of dysphagia patients. Through this study we aim to assess the sensitivity and specificity of Bedside Clinical swallow evaluation in comparison with Fiberoptic Endoscopic Evaluation of Swallowing. Objective: To analyze which physiological examination amongst oro motor labial examination, lingual examination, gag reflex, coughs during or post swallow, change in voice quality and hyo-laryngeal excursion during swallow with semisolid and thin liquid consistency in the Bedside Clinical swallow evaluation is better indicator for presence or absence of aspiration. Methodology: 38 patients with different diagnostic entities were presented& included in the study for the assessment of swallowing difficulties as presence or absence of aspiration and possibility of weaning from nasogastric or Nasojejunal tube between March 2016 to October 2016. They were 32 (86%) males and 6 (14%) females. Aspiration correlates were assessed using bedside test (labial movement, lingual movement, gag reflex, strength of productive cough, hyo-laryngeal excursion, And post swallow changes in the quality of voice). FEES was then performed and sensitivity and specificity was compared. Result: Bedside test showed 84.62% sensitivity and 100% specificity in comparison to FEES. Gag and voice quality were noted to have significant difference with value of 0.009 and 0.033 respectively. Conclusion: Bedside tests can be considered as an important, easy, sensitive, and specific for the detection of aspiration. Combination of gag reflex and change of voice as parameters of aspiration compared with FEES showed high sensitivity and specificity. [ABSTRACT FROM AUTHOR]

BACKGROUND: In this study, innovative chocolate, citrus and mixture flavoured tofu‐based nutritionally customised, dysphagia‐oriented, comfortably consumed, appetising, one‐bite‐sized finger foods, oriented to malnutrition, sarcopenia and frailty prevention in older people were created by using 3D printing technology. Developed products were characterised by evaluating chemical composition and physical properties and performing sensory evaluation among geriatric clinic residents (≥60 years). RESULTS: The dietary composition of the developed foods was: 19–21 g (100 g)−1 protein, 6–8 g (100 g)−1 fibre, 8–9 g (100 g)−1 fat, 11 mg (100 g)−1 iron, 14 mg (100 g)−1 zinc, 70 μg (100 g)−1 selenium. Foods were also enriched with branched‐chain amino acids, such as leucine, isoleucine and valine. All formulated foods were classified as level 6 by International Dysphagia Diet Standardisation Initiative classification. Chocolate‐flavoured food was much harder (4914 g) with lower adhesiveness value (−33.6 g s), compared to the citrus‐ or mixture‐flavoured foods. Older people evaluated all finger foods as very easy handled by hand, soft, easy to swallow, having a moderate flavour intensity and a weak afterfeel. Despite the fact that the chocolate food was evaluated as having the highest hardness and gumminess values by the instrumental method, this difference was not noticeable to the evaluators. However 7% of the participants said that 3D printed foods were sticky to dentures. CONCLUSION: The results suggest that it is possible to create nutrient‐dense comfortably consumed 3D printed foods, oriented to malnutrition, sarcopenia and frailty prevention in older people. © 2024 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

A 41‐year‐old male presented with syncope whilst eating and was subsequently demonstrated to have recurrent symptomatic sinus pauses whilst swallowing. Following the exclusion of structural heart disease, he was diagnosed with swallow syncope, an uncommon variant of neurocardiogenic syncope. To avoid long‐term complications of a transvenous pacemaker, the case was managed with a leadless pacemaker which resulted in complete resolution of symptoms. [ABSTRACT FROM AUTHOR]

The therapeutic possibilities of endoscopy have rapidly increased in the last decades and now allow organ-sparing treatment of early upper gastrointestinal malignancy as well as an increasing number of options for symptom palliation. This review contains an overview of the interventional endoscopic procedures in upper gastrointestinal malignancies. It describes endoscopic treatment of early oesophageal and gastric cancers, and the palliative options in managing dysphagia and gastric outlet obstruction. It also provides an overview of the therapeutic possibilities of biliary endoscopy, such as retrograde stenting and radiofrequency biliary ablation. Endoscopic ultrasound-guided therapeutic options are discussed, including biliary drainage, gastrojejunostomy and coeliac axis block. To aid in clinical decision making, the procedures are described in the context of their indication, efficacy, risks and limitations. • Endoscopy now offers curative treatments for early oesophageal and gastric cancer. • Interventional endoscopy can offer effective symptom palliation for dysphagia, pain and jaundice. • Duodenal stents and EUS-guided interventions provide effective palliation in gastric obstruction. [ABSTRACT FROM AUTHOR]

Background: Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal‐abnormal ratings, objective measurements have been developed. We compared the inter‐rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Methods: Two blinded raters analyzed the subjective normal‐abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter‐rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. Results: In the pharyngeal findings, the subjective analysis inter‐rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter‐rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. Conclusions: The subjective analysis had moderate to strong inter‐rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter‐observer reproducibility and could thus improve the reliability of VFS diagnostics. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Background: Coordination among lip, cheek and tongue movements during swallowing in patients with mandibular prognathism remains unclear. Objectives: This study aimed to identify the temporal sequences of tongue pressure and maxillofacial muscle activities during swallowing in patients with mandibular prognathism and compared characteristics with those of healthy volunteers. Methods: Seven patients with mandibular prognathism (mandibular prognathism group) and 25 healthy volunteers with individual normal occlusion (control group) were recruited. Tongue pressures and masseter, orbicularis oris, mentalis and supra‐ and infrahyoid muscle activities while swallowing gel were measured simultaneously using a sensor sheet system with five measurement points and surface electromyography, respectively. Onset time, offset time and durations of tongue pressure and muscle activities were analysed. Results: In the mandibular prognathism group, tongue pressure was often produced first in more peripheral parts of the palate. Offset of tongue pressure in the posteromedian and peripheral parts of the palate and maxillofacial muscle activities except for orbicularis oris were delayed. Duration of tongue pressure in the anteromedian part of the palate was significantly shorter and durations of masseter, mentalis and suprahyoid muscle activities were significantly longer. Times to onset of orbicularis oris and suprahyoid muscle activities based on first onset of tongue pressure were significantly shorter. Conclusion: These results suggest that patients with mandibular prognathism may exhibit specific patterns of tongue pressure production and maxillofacial muscle activities during swallowing. [ABSTRACT FROM AUTHOR]

Background: There is growing interest in the development of objective methods for assessing lip‐closing function in children. Objective: To obtain normative data for healthy children in the developmental stages of lip closure function, we quantitatively evaluated oral movements associated with lip closure in children and adults using a composite sensor (CS). Methods: Twenty‐five normal children (11 boys, 14 girls) aged 8.8 ± 1.6 years and 25 young adults (13 men, 12 women) aged 27.4 ± 3.9 years were asked to perform test movements, maximal lip closure and swallowing of 3 mL of water. Lip‐closing pressure (LP), intraoral baro‐pressure (IP) and electromyographic (EMG) activity of the upper orbicularis oris muscle were simultaneously recorded using the CS. Results: EMG activity of the upper orbicularis oris muscle during closure was significantly greater in adults than in children. There were significant positive correlations between integral values of LP and EMG for closure in adults (r =.527, p =.008) but not in children, and significant positive correlations between integral values of LP and IP for swallowing in children (r =.508, p =.010) but not in adults. Conclusions: The CS may provide an effective tool for evaluating lip function in children acquiring oral function. For the combination of maxillary orbicularis oculus contraction and formation of intraoral negative pressure, EMG activity of the upper orbicularis oris muscle involvement in LP and IP involvement in LP may differ between children and adults. [ABSTRACT FROM AUTHOR]

Background: Modification of foods or liquids is commonly administered as part of dysphagia treatment. However, no consensus exists on the parameters for defining texture‐modified food for patients with dysphagia. Objectives: The aim of this study was to evaluate the effect of food/liquid material on swallowing physiology in patients with dysphagia and to discuss the optimal food choice for direct swallowing therapy. Materials and Methods: A total of 140 patients underwent a videofluoroscopic swallowing study using three test foods/liquids: 3 mL of mildly thick liquid (Thick liquid), jelly made of agar and polysaccharide [ABSTRACT FROM AUTHOR]

Background: It can be challenging to perform a second task at the same time as swallowing. Objective(s): The study aimed to investigate the effect of visual, auditory and motor dual‐tasking on swallowing and chewing function in healthy young adults. Method: Right‐handed healthy adults without any psychological and cognitive problems were included in the study. Swallowing was evaluated based on the dysphagia limit in different liquid textures such as water and nectar consistencies, and chewing was evaluated by the Test of Masticating and Swallowing Solids. For the second task, visual and auditory performance was assessed using reaction time, and the motor performance was assessed using a bilateral tapping task. Assessments were performed in two steps: baseline and dual‐task. For baseline, all evaluation methods were applied individually. After completing the baseline assessment, dual‐task assessment were carried out the following day. For dual‐task assessment, the swallowing and chewing tasks were performed simultaneously with visual, auditory and motor tasks. Results: Results showed a significant decrease in dysphagia limit in the nectar consistency, and significant increase in chewing time, visual reaction time and tapping rate (right–left) when compared to baseline and dual‐task conditions (χ2(3) = 9.61, p =.02; χ2(3) = 9.02, p =.02; χ2(3) = 28.09, p <.001; χ2(3) = 28.97, p <.001; χ2(3) = 21.56, p <.001, respectively). However, there were no differences in dysphagia limit in the water and auditory reaction time compared to baseline and dual‐task conditions (χ2(3) = 3.18, p =.36; χ2(3) = 2.56, p =.50, respectively). Conclusion: Results shedding light on how simultaneous dual tasks can influence swallowing and chewing. Dual‐tasking cause a decrease in both swallowing/chewing and the visual/motor performances. These results may provide valuable information for designing interventions or strategies aimed at improving or maintaining optimal swallowing and chewing during in various populations during daily life. [ABSTRACT FROM AUTHOR]

Background: Cervical posture affects swallowing function through contractile and non‐contractile structures. Craniocervical flexor endurance training (CCFET), which focuses on the activation of deep cervical muscles, is used to ensure cervical posture stability. Objective: The aim of this study was to investigate the effect of CCFET on the suprahyoid muscles (SH), which play an important role in swallowing function. Methods: Eighty healthy individuals (52 female and 28 male, mean age 21.77 ± 1.81 years) were recruited and randomly assigned to groups that underwent either deep cervical flexor (DCF) training with a pressure biofeedback unit (CCFET group, n = 41) or no intervention (control group, n = 39). The intervention was applied for 4 weeks (five sessions per week). Static endurance and activation of DCF muscles (Craniocervical Flexion Test, CCFT), tragus–wall distance (TWD) for forward head posture and surface electromyographic (sEMG) activation of suprahyoid muscles were evaluated. Results: The endurance and activation of the DCF muscles were significantly increased in the CCFET group (p = <.001). In the CCFET group, TWD significantly lower than the control group (p = <.001) Peak SH amplitude and mean SH amplitude were lower in the CCFET group compared to the control group (p =.013, p =.003). Conclusion: The study shows that 4 weeks of CCFET reduced SH muscle activation, allowing the same work to be done with fewer motor units. CCFET can be included in rehabilitation programs as an additional method that has an effect on the muscles involved in swallowing by providing cervical motor control. [ABSTRACT FROM AUTHOR]

Background: Postextubation dysphagia (PED) is a common complication to endotracheal intubation in critically ill patients and may lead to pneumonia, prolonged ventilation, longer hospital stays, and increased mortality. Recognizing dysphagia is paramount to preventing adverse events. The aim of this study was to describe PED management by investigating practice in Danish intensive care units (ICUs) focusing on current practice in 2023 (screening, prevention, and treatment), perceived best practice (barriers and facilitators), and when possible, to compare practice in 2017 and 2023. Methods: Self‐reported, cross‐sectional survey of dysphagia practice in Danish ICUs administered from April to May 2023. In addition, data were compared with the 2017 Dysphagia in Intensive Care Evaluation study, when possible. Results: Only half of Danish ICUs reported to have a PED protocol, and less than half routinely screen patients for dysphagia after extubation. Most common screening methods were the oral mechanism examination, water test, and Facio‐oral tract therapy. Nurses and physicians often relied on an overall physical assessment of the patient. Best treatment methods were uniformly agreed to be patient positioning, modification of food and fluids, use of ergonomic utensils, and compensatory maneuvers. Key barriers to dysphagia management were lack of specialized staff, under‐recognition of dysphagia as a health issue, and lack of standardized protocols. Conclusion: Awareness of PED is increasing and identification, prevention, and treatment is slowly improving, but systematic implementation of protocols for dysphagia screening and treatment could enhance dysphagia management in Danish ICUs. [ABSTRACT FROM AUTHOR]

The hyoid bone displacement and rotation are critical kinematic events of the swallowing process in the assessment of videofluoroscopic swallow studies (VFSS). However, the quantitative analysis of such events requires frame-by-frame manual annotation, which is labor-intensive and time-consuming. Our work aims to develop a method of automatically tracking hyoid bone displacement and rotation in VFSS. We proposed a full high-resolution network, a deep learning architecture, to detect the anterior and posterior of the hyoid bone to identify its location and rotation. Meanwhile, the anterior-inferior corners of the C2 and C4 vertebrae were detected simultaneously to automatically establish a new coordinate system and eliminate the effect of posture change. The proposed model was developed by 59,468 VFSS frames collected from 1488 swallowing samples, and it achieved an average landmark localization error of 2.38 pixels (around 0.5% of the image with 448 × 448 pixels) and an average angle prediction error of 0.065 radians in predicting C2–C4 and hyoid bone angles. In addition, the displacement of the hyoid bone center was automatically tracked on a frame-by-frame analysis, achieving an average mean absolute error of 2.22 pixels and 2.78 pixels in the x-axis and y-axis, respectively. The results of this study support the effectiveness and accuracy of the proposed method in detecting hyoid bone displacement and rotation. Our study provided an automatic method of analyzing hyoid bone kinematics during VFSS, which could contribute to early diagnosis and effective disease management. [ABSTRACT FROM AUTHOR]

Aim: To explore the correlations between examination tolerance and anxiety, knowledge needs and examination cooperation in sedation‐free gastroscopy examinees. Design: Cross‐sectional survey using convenience sampling. Methods: A total of 170 healthy adults who underwent sedation‐free gastroenteroscopy were asked to complete a visual analogue scale (VAS) to rate their examination tolerance, the state anxiety questionnaire (S‐AI), a newly designed knowledge needs questionnaire and a cooperation questionnaire. Results: The VAS score was 4.47 ± 1.96, the state anxiety score was 39.46 ± 9.81, the total score for knowledge needs was 44.89 ± 11.02, and the average cooperation score was 2.47 ± 0.38. The VAS score during the examination positively correlated with the pretest state anxiety score and pretest knowledge needs score and negatively correlated with the examination cooperation score. The results of multiple linear regression analysis showed that after undergoing the examination for the first time, anxiety, body position and swallowing control were the main factors influencing the examination tolerance of sedation‐free gastroscopy examinees. Patient or Public Contribution: We would like to thank the staff and patients of the participating hospital for their assistance and cooperation in performing the current study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to discuss the feasibility of developing, and the challenges of implementing, a structured dysphagia program in a rural patient population with preliminary data. Method: The Dysphagia Pathway Program (DPP) is a standardized, prophylactic swallow therapy program for head and neck cancer patients initiated in 2019 as a multidisciplinary approach at Penn State Hershey Medical Center. An interrupted time series study was conducted comparing the swallow and nutritional status of patients pre- and postimplementation of the DPP. Data were analyzed using the chi-square test and linear mixed-effects models to determine statistical significance for categorical and continuous variables, respectively. Results: The DPP group included 52 patients, and the pre-implementation group included 109 patients. A higher percentage of patients in the DPP group tolerated a by mouth (PO)-only diet at the last day of treatment time point (p < .001). The DPP group showed similar changes in body mass index and albumin over time but had lower rates of gastrostomy tube placements (p = .002) compared to the pre-implementation group. The average adherence to speech and swallow therapy in the DPP group decreased over time. Conclusions: Although we encountered many obstacles in the development of the DPP, we found prophylactic swallow therapy to be feasible to implement and beneficial in our rural patient population. In this pilot study, our results demonstrated that prophylactic swallow therapy shows a favorable trend in swallowing and nutritional status. Future improvements include improving documentation of swallowing outcomes, patient adherence, and utilizing telehealth. [ABSTRACT FROM AUTHOR]

Purpose: Traditional health care decision-making models center on clinicians making decisions for patients/caregivers based on the best available research evidence. However, this diminishes patient/caregiver involvement in their care and hinders the ability to align care plans with patient values and preferences. Shared decision making is a potentially beneficial process to implement with individuals with amyotrophic lateral sclerosis (ALS) to provide more holistic, patient-centered dysarthria and dysphagia treatment. Shared decision making promotes active involvement by patients/caregivers by informing them of potential treatment options, understanding their values and preferences, and aligning their desires with treatment options to determine the most optimal individualized care plan. Conclusions: The benefits and barriers to incorporating shared decision making within ALS multidisciplinary clinics are discussed in this clinical focus article. Furthermore, a fictional case study example of how to apply shared decision making to dysarthria and dysphagia management of individuals with ALS is provided. [ABSTRACT FROM AUTHOR]

This aim of this study is to characterize the nature and pathophysiology of dysphagia after ACDF surgery by precisely and comprehensively capturing within-subject changes on videofluoroscopy between preoperative and postoperative time points. 21 adults undergoing planned primary ACDF procedures were prospectively recruited and enrolled. Participants underwent standardized preoperative and six-week postoperative videofluoroscopic swallow studies. Videos were blindly rated using the Penetration-Aspiration Scale (PAS) and analysis of total pharyngeal residue (%C2-42), swallowing timing, kinematics, and anatomic change was completed. Linear mixed-effects modeling was used to explore the relationships between possible predictor variables and functional outcomes of interest that changed across timepoints. There was no change in PAS scores across timepoints. Total pharyngeal residue (%C2-C42) was increased postoperatively (p < 0.001). Our statistical model revealed significant main effects for timepoint (p = 0.002), maximum pharyngeal constriction area (MPCAN) (p < 0.001), and maximum thickness of posterior pharyngeal (PPWTMAX) (p = 0.004) on the expression of total pharyngeal residue. There were significant two-way interactions for timepoint and MPCAN (p = 0.028), timepoint and PPWTMAX (p = 0.005), and MPCAN and PPWTMAX (p = 0.010). Unsurprisingly, we found a significant three-way interaction between these three predictors (p = 0.027). Our findings suggest that in planned ACDF procedures without known complications, swallowing efficiency is more likely to be impaired than airway protection six weeks after surgery. The manifestation of impaired swallowing efficiency at this timepoint appears to be driven by a complex relationship between reduced pharyngeal constriction and increased prevertebral edema. [ABSTRACT FROM AUTHOR]

There have been many reports of normative pharyngeal swallowing pressures using high-resolution pharyngeal manometry, but there is a fair amount of between-subject variance in reported pressure parameters. The purpose of this study was to put forward normative pharyngeal high-resolution manometry measures across the lifespan and investigate the effects of age, size of system, and sex. High-resolution pharyngeal manometry was performed on 98 healthy adults (43 males) between the ages 21 and 89. Pressure duration, maxima, integral, and within-individual variability metrics were averaged over 10 swallows of 10-ml thin liquid. Multiple linear and logistic regressions with model fitting were used to examine how pharyngeal pressures relate to age, pharyngeal size, and sex. Age was associated with tongue base maximum pressure, tongue base maximum variability, and upper esophageal sphincter-integrated relaxation pressure (F3,92 = 6.69; p < 0.001; adjusted R2 = 0.15). Pharyngeal area during bolus hold was associated with velopharynx integral (F1,89 = 5.362; p = 0.02; adjusted R2 = 0.05), and there was no significant model relating pharyngeal pressures to C2–C4 length (p < 0.05). Sex differences were best described by tongue base integral and hypopharynx maximum variability (χ2 = 10.27; p = 0.006; pseudo R2 = 0.14). Normative data reveal the distribution of swallow pressure metrics which need to be accounted for when addressing dysphagia patients, the importance of pressure interactions in normal swallow, and address the relative stability of swallow metrics with normal aging. [ABSTRACT FROM AUTHOR]

Peak velocity, distance, and time of laryngeal elevation during swallowing were measured with a laryngeal motion measurement system in eight healthy young adult men in their 20 and 30 s (33.0 ± 4.3 years) and ten healthy older men in their 60 and 70 s (74.0 ± 3.9 years). The participants performed swallowing five times each for a total of eight conditions: two bolus types (saliva and water) and four swallowing methods (normal swallow, effortful swallow, super-supraglottic swallow, and Mendelsohn maneuver). When the bolus type was saliva, peak velocity and distance increased more for swallowing maneuvers (effortful swallow, super-supraglottic swallow, and Mendelsohn maneuver) than for normal swallow. On the other hand, when the bolus type was water, there was no difference in peak velocity or distance between normal swallow and swallowing maneuvers. In healthy older men, distance was greater with Mendelsohn maneuver than with normal swallow, and peak velocity was increased with swallowing maneuvers than with normal swallow. Healthy young adult men had increased peak velocity and distance with water rather than saliva. The increase in peak velocity and distance obtained by swallowing maneuvers was influenced by age and bolus, suggesting that the subjects and conditions used are important in terms of promoting safer oral intake. [ABSTRACT FROM AUTHOR]

Background: High-resolution manometry (HRM) can quantify swallowing pathophysiology to evaluate the status of the pharynx. Sequential 4-channel neuromuscular electrical stimulation (NMES) was recently developed based on the normal contractile sequences of swallowing-related muscles. This study aimed to examine the effects of sequential 4-channel NMES for compensatory application during swallowing and to observe the residual effects after the application of NMES using HRM. Results: Sequential 4-channel NMES significantly improved the HRM parameters, with respect to the maximal pressure and area of the velopharynx (VP), maximal pressure and area of the mesopharynx (MP), and upper esophageal sphincter (UES) activation and nadir duration. Furthermore, the improvement in the pressure and area variables of the VP and MP showed a tendency to maintain even when measured after NMES, but there are no significant differences. Conclusions: The present study suggests that the sequential 4-channel NMES application of the suprahyoid and infrahyoid muscles during swallowing improves the pressure, area, and time variables of the oropharynx, as measured by HRM, and it is likely that the effects may persist even after stimulation. Trial Registration Clinicaltrials.gov, registration number: NCT02718963 (initial release: 03/20/2016, actual study completion date: 06/24/2016, last release: 10/20/2020). [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Intraoperative hypotension is a risk factor for kidney, heart and cognitive postoperative complications. Literature suggests that the use of low‐dose peripheral norepinephrine (NOR) reduces organ dysfunction, yet its administration remains unstandardized. In this work we develop a pharmacokinetic (PK)/pharmacodynamic (PD) model of NOR and its effect on mean arterial pressure (MAP).From June 2018 to December 2021, we included patients scheduled for elective neurosurgery and requiring vasopressors for intraoperative hypotension management at Lariboisière Hospital, Paris. Low doses of NOR were administered peripherally, and successive arterial blood samples were collected to track its plasmatic concentration. We used a compartmental modelling approach for NOR PK. We developed and compared 2 models for NOR PD on MAP. Model comparison was done using Bayes information criteria. The resulting PK/PD model parameters were fitted over the entire population and linked to age, weight, height and sex.We included 29 patients (age 52 [46–64] years, 69% female). NOR median time to peak effect on MAP was 74 [53–94] s. After bolus administration, MAP increased by 24% (15–31%). A 2‐comparment model with depot best captured NOR PK. NOR PD effect on MAP was well represented by both Emax and Windkessel models, with better results for the former. We found that age, height and weight as well as history of smoking and hypertension were correlated with model parameters.We have developed a PK/PD model to accurately track norepinephrine plasma concentration and its effect on MAP over time, which could serve for target‐controlled infusion. [ABSTRACT FROM AUTHOR]

Background: In the livestock industry, Foreign Body Syndrome is a devastating disease condition. Feeding management, lacking of food discrimination, and eating chopped food increase the risk of swallowing sharp foreign bodies in bovine species. In addition to the honeycomb cells shape of the reticulum, the contractions of the reticular wall, gravid uterine pressure, and parturition efforts, foreign bodies can penetrate the reticular wall, causing cascade of problems including traumatic reticulitis, traumatic reticuloperitonitis, and traumatic pericarditis. The present study was carried out to evaluate the diagnostic significance of cardiac troponin I rapid test cassette and other cardiac biomarkers including serum cardiac troponin I (cTn I), creatine kinase-myocardial band (CK-MB), lactate dehydrogenase (LDH), and aspartate aminotransferase enzyme (AST), in confirmed cases of traumatic pericarditis (TP) and/or traumatic reticuleoperitonitis (TRP) in cattle and buffaloes. Methods: A total number of 30 animals (22 cattle and 8 buffaloes) with different signs such as anorexia, jugular distension, brisket edema, and signs of pain (reluctance to move, arching back, and abduction of the forelimbs) were included in the present study. Based on case history, clinical signs, ferroscopic, pericardiocentesis, radiographic and ultrasonographic examinations, TP were confirmed in cattle (n = 10) and buffaloes (n = 8) while TRP were confirmed only in cattle (n = 12). Additionally, 20 clinically healthy animals (n = 10 cattle and 10 buffaloes) were used as a control group. Blood samples were collected for determination of blood level of Tn-I, and activity of CK-MB, LDH, and AST. Results: The obtained results revealed a highly significant increase in serum cTn I in diseased cattle with TP and TRP (P = 0.00), while buffaloes with TP showed no significant changes in serum cTn I (P = 0.111). Both diseased cattle and buffaloes showed increased serum activities of CK-MB, AST, and LDH enzyme. On the other hand, cardiac troponin I rapid test cassette failed to detect cTn I in diseased animals. Conclusion: The study concluded that the cardiac troponin I rapid test cassette did not have a diagnostic significance and could not be used as a point-of-care under field condition for diagnosis of TP and TRP in large ruminants. However, the serum troponin I level is helpful in diagnosis of TP and TRP in cattle. Although cardiac biomarkers have some diagnostic values in TP and TRP, the traditional diagnostic methods (clinical, radiography and ultrasonography examinations) are crucial for thorough evaluation of TP/TRP cases in bovine. [ABSTRACT FROM AUTHOR]

Introduction: Aspiration pneumonia, a leading cause of mortality, poses an urgent challenge in contemporary society. Neuromuscular electrical stimulation (NMES) has been commonly used in dysphagia rehabilitation. However, given that NMES at motor threshold targets only specific muscles, it carries a potential risk of further compromising functions related to swallowing, respiration, and airway protection. Considering that the swallow motor pattern is orchestrated by the entire swallow pattern generator (the neural mechanism governing a sequence of swallow actions), a rehabilitation approach that centrally facilitates the entire circuit through sensory nerve stimulation is desirable. In this context, we propose a novel stimulation method using surface electrodes placed on the back to promote swallowing. Methods: The efficacy of the proposed method in promoting swallowing was evaluated by electrically stimulating sensory nerves in the back or neck. Probabilistic stimulus was applied to either the back or neck of male and female rats. Swallows were evoked by an oral water stimulus, and electromyographic (EMG) activity of the mylohyoid, thyroarytenoid, and thyropharyngeus muscles served as the primary outcome measure. Results: Gaussian frequency stimulation applied to the skin surface of the thoracic back elicited significant increases in EMG amplitude of all three swallow-related muscles. Neck stimulation elicited a significant increase in EMG amplitude of the thyroarytenoid during swallow, but not the mylohyoid or thyropharyngeus muscles. Discussion: While the targeted thoracic spinal segments T9-T10 have been investigated for enhancing respiration, the promotion of swallowing through back stimulation has not been previously studied. Furthermore, this study introduces a new probabilistic stimulus based on Gaussian distribution. Probabilistic stimuli have been reported to excel in nerve stimulation in previous research. The results demonstrate that back stimulation effectively facilitated swallow more than neck stimulation and suggest potential applications for swallowing rehabilitation. [ABSTRACT FROM AUTHOR]

Introduction: The impact of the COVID-19 pandemic on head and neck cancer (HNC) has been suggested, but the causal relationship remains unclear. Methods: We explore this connection by utilizing the Mendelian randomization (MR) approach applied to publicly available genome-wide association study (GWAS) summary datasets for COVID-19 and HNC. The datasets included critical COVID-19 (13,769 cases, 1,072,442 controls), hospitalized COVID-19 (32,519 cases, 2,062,805 controls), SARS-CoV-2 infection (122,616 cases, 2,475,240 controls), and HNC (2,131 cases, 287,137 controls). Mechanistic underpinnings of the causal relationships identified by MR analysis were explored through functional annotation augmented by AI-based literature data mining. Results: Surprisingly, a genetic predisposition to contracting a milder form of COVID-19 substantially reduced the risks of developing HNC (OR: 0.52, 95% CI: 0.35-0.78, p = 1.42E-03), with no significant association between genetic liability to severe COVID-19 and the risk of HNC detected. Additionally, our findings highlighted 14 genes linked to SARS-CoV-2 infection, potentially playing a protective role in the context of HNC. These genes include OAS1, LOC107985887, BCL11A, DPP9, LOC107984685, LINC02326, MUC4, NXPE3, IFNAR2, LZTFL1, LOC105372437, NAPSA, LOC105376622, LOC107986082, and SLC6A20. Conclusion: Our study emphasizes the protective role of the genetic liability to milder COVID-19 in reducing the risk of HNC while refuting a causal relationship between severe COVID-19 and HNC. [ABSTRACT FROM AUTHOR]

BACKGROUND: Modification of food consistency and volume is a commonly used method of swallowing compensation in clinical practice. Dry swallowing is a commonly used method of evaluation. The hyoid muscles are very important in swallowing. The effects of dry swallowing and swallowing tasks of different consistencies and volumes on hyoid muscle activation levels are still unclear. OBJECTIVE: To explore the effects of simple dry swallowing and swallowing tasks of different consistencies and volumes on the hyoid muscles in healthy adults. METHODS: A total of 44 healthy adults were included from April to August 2019, including 19 males and 25 females, with an average age of (21.7±2.8) years. They randomly performed dry swallowing and swallowing tasks of different consistencies (the International Dysphagia Diet Standardisation Initiative (IDDSI) frame levels 0-4) and volumes (5, 10, 20 mL), and the surface electromyogram signals of the hyoid muscles during each swallowing task were recorded. After processing the raw surface electromyogram signals, the activation levels of the hyoid muscles were compared between dry swallowing and swallowing tasks of different consistency and volume. RESULTS AND CONCLUSION: The mean amplitude values of the suprahyoid muscles corresponding to swallowing tasks of 20 mL for levels 0-4, 10 mL for level 3, and 5 mL for level 4 were higher than those of dry swallowing (P < 0.05). The mean amplitude values of the suprahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than those of the 5-mL swallowing tasks of the corresponding consistencies, except for level 3 (P < 0.05). The mean amplitude values of the suprahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than those of the 10-mL swallowing tasks of the corresponding consistencies, except for levels 2 and 3 (P < 0.05). The mean amplitude values of the infrahyoid muscles corresponding to all swallowing tasks were higher than that of dry swallowing (P < 0.05). The mean amplitude values of the infrahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than that of the 5- and 10-mL swallowing tasks of the corresponding consistencies (P < 0.05). The mean amplitude values of the infrahyoid muscles corresponding to the 10-mL swallowing tasks of different consistencies were higher than those of the 5-mL swallowing tasks of the corresponding consistencies, except for level 3 (P < 0.05). To conclude, in healthy adults performing swallowing tasks of different volumes and consistencies, the level of activation of the hyoid muscles is less susceptible to IDDSI frame levels 0-4 consistency and more susceptible to volume. The higher volume indicates the higher activation level of the hyoid muscles. [ABSTRACT FROM AUTHOR]

Background: Inducible laryngeal obstruction (ILO) accounts for or contributes to dyspnea in a noteworthy proportion of treatment seeking populations including those misdiagnosed with asthma. Despite increasing awareness of the disorder, literature exploring patient experience is limited. The aim of this work is to report patient perspectives on ILO and the way in which it impacts quality of life. Methods: This qualitative study utilized methods detailed in the literature on grounded theory and phenomenological research to analyze interviews collected from participants diagnosed with ILO. Interviews were conducted, audio recorded, and transcribed. Transcriptions underwent content-analysis using Burnard's 14 step method [15], which included review of content codes across multiple raters until consensus regarding analyses was reached. Results: Twenty-six participants were included in the study. Most participants were female (92%). Ages ranged from 18–72 with a mean age of 45 for female participants and 37 for male participants. Without specific prompting to do so, all participants offered descriptions of the specific symptoms they experienced and the triggers for their symptoms. In the content analysis process, "descriptions of symptoms and triggers" was thus labeled a theme that was present in all interviews. Seven additional themes were shared consistently and judged to encapsulate the interview material. These themes were: 2) diagnosis and treatment, 3) emotional impact of ILO, 4) perception of health and prognosis, 5) ameliorating factors, 6) influence of ILO on lifestyle, 7) the physical impact of ILO, and 8), social consequences of ILO. In addition, 54 subthemes were identified. Conclusions: Patients appear to place particular emphasis on the emotional and psychosocial consequences of ILO as well as factors that ameliorate the condition. As such, future efforts to treat ILO and to collect outcomes measures should account for these aspects of the patient experience. [ABSTRACT FROM AUTHOR]