Pilot study of a neurophysiological dysphagia therapy for neurological patients

OBJECTIVE: To investigate the success of a neurophysiological dysphagia therapy in patients with neurological disorders. DESIGN: A pre- and post-intervention group study. SETTING: Acute rehabilitation unit. SUBJECTS: Ten patients (swallowing rate <1/5 minutes, Frühreha-Barthel Index <-150, tracheostomy as a result of a swallowing disorder) with dysphagia as a result of a head injury or cerebral haemorrhage. INTERVENTIONS: Therapy was given based on facio-oral tract therapy for three weeks (15 sessions of 1 hour each). MEASURES: The general scales used were the Frühreha-Barthel Index and Coma Remission Scale. Measures of swallowing rate, alertness and swallowing ability were undertaken before, during and after the treatment sessions and at intervals of 30 minutes for 2 hours after the treatment sessions. RESULTS: On the treatment days, the therapy did not lead to an increase in swallowing rate, but did lead to a significant increase in alertness. After completion of a single treatment session, there was a statistically significant decrease in alertness and swallowing rate for 90 minutes. An increase in alertness (Frühreha-Barthel Index and Coma Remission Scale), swallowing ability (measured using an endoscopic examination) and protection of the respiratory tract was observed over the entire therapy period. CONCLUSION: Facio-oral tract therapy led to a statistically significant increase in alertness during the treatment session and, over the entire therapy period, to an increase in swallowing rate, alertness and swallowing ability. The decrease in alertness following therapy sessions must be taken into account in planning rehabilitative measures. Further studies on larger populations as well as studies currently in progress should further elucidate the strategies employed to rehabilitate dysphagic patients.     

Feasibility and reliability of strain and strain rate measurement in neonates by optimizing the analysis parameters settings

The optimal combination of region-of-interest (ROI) size and strain length (SL) allowing two-segment strain and strain rate analyses in term neonates was investigated. The impact of different ROI sizes and SLs on the strain and strain rate beat-to-beat variation (BBV) was assessed in 80 good-quality tissue velocity images. Both BBVs decreased with increased ROI length and with increased SL (p < 0.05). There were no significant differences in the BBVs for ROI width 2, 3 and 4 mm (p > 0.05). Among the combinations eligible for two segment analysis, the lowest BBVs were found using SL 10 mm, ROI length 1 mm and ROI width 3 mm. Using this combination, the mean difference between the single-cycle value and two-cycle compound value for peak systolic strain rate was 6.2%, peak systolic strain was 2.9% and end systolic strain was 3.2% of the two-cycle compound mean values. Hence, strain and strain rate measurement in tissue velocity images in neonates is feasible and reliable.     

Mediastinitis after coronary artery bypass grafting increases the incidence of left internal mammary artery obstruction

Mediastinitis after coronary artery bypass grafting (CABG) gives a longstanding chronic inflammation and has a detrimental negative effect on long‐term survival. For this reason, we aimed to study the effect of mediastinitis on graft patency after CABG. The epidemiologic design was of an exposed (mediastinitis, n = 41) versus non‐exposed (non‐mediastinitis, controls, n = 41) cohort with two endpoints: (i) obstruction of saphenous vein grafts (SVG) and (ii) obstruction of the internal mammary artery (IMA) grafts. The graft patency was evaluated with coronary CT‐angiography examination at a median follow‐up of 2·7 years. The number of occluded SVG in the mediastinitis group was 18·9% versus 15·5% in the control group. Using generalized estimating equations model with exchangeable matrix, and confounding effect of ischaemic time and patients age, we found no significant association between presence of mediastinitis and SVG obstruction [rate ratio (RR) = 0·96, 95% CI (0·52–2·67), P = 0·697]. The number of occluded IMA grafts was 10·5% in the mediastinitis group and 2·4% in the control group. Using the Poisson regression model, we estimated RR = 5·48, 95% CI (1·43–21·0) and P = 0·013. There was a significant association between mediastinitis and IMA graft obstruction, when controlling for the confounding effect of ischaemic time, body mass index, presence of diabetes mellitus and the number of diseased vessels. Presence of mediastinitis increases the risk of IMA graft obstruction. This may confirm the importance of inflammation as a major contributor to the pathogenesis of atherosclerosis and explain the negative effect of mediastinitis on a long‐term survival.     

Characteristics of patients frequently subjected to pharmacological and mechanical restraint—A register study in three Norwegian acute psychiatric wards

This retrospective study from three catchment-area-based acute psychiatric wards showed that of all the pharmacologically and mechanically restrained patients (n=373) 34 (9.1%) had been frequently restrained (6 or more times). These patients accounted for 39.2% of all restraint episodes during the two-year study period. Adjusted binary logistic regression analyses showed that the odds for being frequently restrained were 91% lower among patients above 50 years compared to those aged 18–29 years; a threefold increase (OR=3.1) for those admitted 3 times or more compared to patients with only one stay; and, finally, a threefold increase (OR=3.1) if the length of stay was 16 days or more compared to those admitted for 0–4 days. Among frequently restrained patients, males (n=15) had significantly longer stays than women (n=19), and 8 of the females had a diagnosis of personality disorder, compared to none among males. Our study showed that being frequently restrained was associated with long inpatient stay, many admissions and young age. Teasing out patient characteristics associated with the risk of being frequently restraint may contribute to reduce use of restraint by developing alternative interventions for these patients.     

Prevalence of cortical superficial siderosis in patients with cognitive impairment

Cortical superficial siderosis (cSS) is a magnetic resonance imaging marker of cerebral amyloid angiopathy (CAA) and can be its sole imaging sign. cSS has further been identified as a risk marker for future intracranial hemorrhage. Although uncommon in the general population, cSS may be much more prevalent in high risk populations for amyloid pathology. We aimed to determine the frequency of cSS in patients with cognitive impairment presenting to a memory clinic. We prospectively evaluated consecutive patients presenting to our memory clinic between April 2011 and April 2013. Subjects received neuropsychological testing using the Consortium to Establish a Registry for Alzheimer’s Disease battery (CERAD-NP). Two hundred and twelve patients with documented cognitive impairment further underwent a standardized 3T-MR-imaging protocol with T2*-weighted gradient-echo sequences for detection of cSS. Thirteen of 212 patients (6.1 %) displayed cSS. In seven of them (54 %) cSS was the only imaging sign of CAA. Patients with cSS did not differ from patients without cSS with regard to medical history, age or cardiovascular risk profile. Subjects with cSS performed worse in the mini-mental state examination (p = 0.001), showed more white matter hyperintensities (p = 0.005) and more often had microbleeds (p = 0.001) compared to those without cSS. cSS is common in patients with cognitive impairment. It is associated with lower cognitive scores, white matter hyperintensities and microbleeds and can be the only imaging sign for CAA in this patient group.     

Controlled release from a mechanically-stimulated thermosensitive self-heating composite hydrogel

Temperature has been extensively explored as a trigger to control the delivery of a payload from environment-sensitive polymers. The need for an external heat source only allows limited spatiotemporal control over the delivery process. We propose a new approach by using the dissipative properties of a hydrogel matrix as an internal heat source when the material is mechanically loaded. The system is comprised of a highly dissipative hydrogel matrix and thermo-sensitive nanoparticles that shrink upon an increase in temperature. Exposing the hydrogel to a cyclic mechanical loading for a period of 5 min leads to an increase of temperature of the nanoparticles. The concomitant decrease in the volume of the nanoparticles increases the permeability of the hydrogel network facilitating the release of its payload. As a proof-of-concept, we showed that the payload of the hydrogel is released after 5–8 min following the initiation of the mechanical loading. This delivery method would be particularly suited for the release of growth factor as it has been shown that cell receptor to growth factor is activated 5–20 min following a mechanical loading.