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.     

On the learning of addictive behavior: Sensation-seeking propensity predicts dopamine turnover in dorsal striatum

Brain Imaging and Behavior - We asked if sensation-seeking is linked to premorbid personality characteristics in patients with addictive disorders, or the characteristics follow the...     

Outcome of Patients with Esophageal Perforations: A Multicenter Study

Background

Recent studies have suggested that stent-grafting may improve the treatment outcome of patients with esophageal perforation, but evidence on this is still lacking.

Methods

Data on 194 patients who underwent conservative (43 patients), endoclip (4 patients) stent-grafting (63 patients) or surgical treatment (84 patients) for esophageal perforation were retrieved from nine medical centers.

Results

In-hospital/30-day mortality was 17.5 %. Three-year survival was 67.1 %. Age, coronary artery disease, and esophageal malignancy were independent predictors of early mortality. Chi squared automatic interaction detection analysis showed that patients without coronary artery disease, without esophageal malignancy and younger than 70 years had the lowest early mortality (4.1 %). Surgery was associated with slightly lower early mortality (conservative 23.3, endoclips 25.0 %, stent-grafting 19.0 %, surgery 13.1 %; p = 0.499). One center reported a series of more than 20 patients treated with stent-grafting which achieved an early mortality of 7.7 % (2/26 patients). Stent-grafting was associated with better survival with salvaged esophagus (conservative 76.7 %, endoclips 75.0 %, stent-grafting 77.8 %, surgery 56.0 %; p = 0.019). Propensity score adjusted analysis showed that stent-grafting achieved similar early mortality (p = 0.946), but significantly higher survival with salvaged esophagus than with surgical treatment (p = 0.001, OR 0.253, 95 % CI 0.110–0.585). Primary surgical repair was associated with somewhat lower early mortality (14.6 vs. 19.0 %; p = 0.561) and better survival with salvaged esophagus (85.4 vs. 77.8 %; p = 0.337) than stent-grafting.

Conclusions

Esophageal perforation was associated with a rather high mortality rate in this all-comers population. Stent-grafting failed to decrease operative mortality, but it improved survival with salvaged esophagus. The results of one of the centers indicate that increasing experience with this less invasive procedure may possibly improve the outcome of these patients.     

Influence of Different Alloying Strategies on the Mechanical Behavior of Tool Steel Produced by Laser-Powder Bed Fusion

Additive manufacturing is a high-potential technique that allows the production of components with almost no limitation in complexity. However, one of the main factors that still limits the laser-based additive manufacturing is a lack of processable alloys such as carbon martensitic hardenable tool steels, which are rarely investigated due to their susceptibility to cold cracking. Therefore, this study aimed to expand the variety of steels for laser powder bed fusion (L-PBF) by investigating an alternative alloying strategy for hot work tool steel powder. In this study, a comprehensive investigation was performed on the powder and L-PBF processed specimen properties and their correlation with the existing defects. Cubical specimens were created using the following two alloying strategies by means of L-PBF: conventional pre-alloyed gas-atomized powder and a mixture of gas-atomized powder with mechanically crushed pure elements and ferroalloys. The influence of the particle parameters such as morphology were correlated to the defect density and resulting quasi-static mechanical properties. Micromechanical behavior and damage evolution of the processed specimens were investigated using in situ computed tomography. It was shown that the properties of the L-PBF processed specimens obtained from the powder mixture performs equal or better compared to the specimens produced from conventional powder.