Quantifying Bolus Residue and Its Risks in Children: A Videofluoroscopic Study

2021 ◽  
pp. 1-10
Author(s):  
Isuru Dharmarathna ◽  
Anna Miles ◽  
Jacqui Allen
Keyword(s):  
Strong Association ◽  
Standard Protocol ◽  
Intrarater Reliability ◽  
Clearance Ratio ◽  
Pharyngeal Residue ◽  
Specialized Software ◽  
Pharyngeal Transit ◽  
Pharyngeal Constriction ◽  
Over Time ◽  
Binary Observation

Purpose Postswallow residue is a clinical sign of swallow impairment and has shown a strong association with aspiration. Videofluoroscopy (videofluoroscopic study of swallowing [VFSS]) is commonly used to visualize oropharyngeal swallowing and to identify pharyngeal residue. However, subjective binary observation (present or absent) fails to provide important information on volume or location and lacks objectivity and reproducibility. Reliable judgment of changes in residue over time and with treatment is therefore challenging. We aimed to (a) determine the reliability of quantifying pharyngeal residue in children using the bolus clearance ratio (BCR), (b) determine associations between BCR and other timing and displacement measures of oropharyngeal swallowing, and (c) explore the association between BCR and penetration–aspiration in children. Method In this single-center retrospective observational study, we obtained a set of quantitative and descriptive VFSS measures from 553 children (0–21 years old) using a standard protocol. VFSS data were recorded at 30 frames per second for quantitative analysis using specialized software. Results Good interrater (ICC = .86, 95% CI [.74, .961], p < .001) and excellent intrarater reliability was achieved for BCR (ICC = .97, 95% CI [.91, 1.000], p = 001). Significant correlations between BCR and pharyngeal constriction ratio and total pharyngeal transit time were reported ( p < .05). Using binomial logistic regression modeling, we found BCR was predictive of penetration–aspiration in children, χ 2 (13) = 58.093, p < .001, 64.9%. Children with BCR of ≥ 0.1 were 4 times more likely to aspirate. Conclusion BCR is a reliable, clinically useful measure to quantify postswallow residue in children, which can be used to identify and treat children with swallow impairments, as well as to measure outcomes of intervention.

MO265LONGITUDINAL CHANGE IN PROTEINURIA AND KIDNEY OUTCOMES IN C3 GLOMERULOPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Fernando Caravaca-Fontán ◽  
Elena Goicoechea de Jorge ◽  
Manuel Praga
Keyword(s):  
Kidney Failure ◽  
Cox Model ◽  
Strong Association ◽  
Fold Increase ◽  
Joint Modeling ◽  
Longitudinal Change ◽  
C3 Glomerulopathy ◽  
Dynamic Prediction ◽  
Over Time

Abstract Background and Aims The association between a change in proteinuria over time and its impact in kidney prognosis has not been analyzed in C3 glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure. Method Retrospective, multicenter observational cohort study in 35 nephrology departments belonging to the GLOSEN group. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modeling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure. Results The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13–41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (HR: 0.79; 95%CI:0.56–0.97; p&lt;0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up. Conclusion The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.

scholarly journals On the Physiology of Normal Swallowing as Revealed by Magnetic Resonance Imaging in Real Time

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Arno Olthoff ◽  
Shuo Zhang ◽  
Renate Schweizer ◽  
Jens Frahm
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Real Time ◽  
Oral Contrast ◽  
Resonance Imaging ◽  
Start Time ◽  
Pineapple Juice ◽  
Normal Swallowing ◽  
Pharyngeal Transit ◽  
Pharyngeal Constriction

The aim of this study was to assess the physiology of normal swallowing using recent advances in real-time magnetic resonance imaging (MRI). Therefore ten young healthy subjects underwent real-time MRI and flexible endoscopic evaluations of swallowing (FEES) with thickened pineapple juice as oral contrast bolus. MRI movies were recorded in sagittal, coronal, and axial orientations during successive swallows at about 25 frames per second. Intermeasurement variation was analyzed and comparisons between real-time MRI and FEES were performed. Twelve distinct swallowing events could be quantified by real-time MRI (start time, end time, and duration). These included five valve functions: oro-velar opening, velo-pharyngeal closure, glottal closure, epiglottic retroflexion, and esophageal opening; three bolus transports: oro-velar transit, pharyngeal delay, pharyngeal transit; and four additional events: laryngeal ascent, laryngeal descent, vallecular, and piriform sinus filling and pharyngeal constriction. Repetitive measurements confirmed the general reliability of the MRI method with only two significant differences for the start times of the velo-pharyngeal closure (t(8)=-2.4,P≤0.046) and laryngeal ascent (t(8)=-2.6,P≤0.031). The duration of the velo-pharyngeal closure was significantly longer in real-time MRI compared to FEES (t(8)=-3.3,P≤0.011). Real-time MRI emerges as a simple, robust, and reliable tool for obtaining comprehensive functional and anatomical information about the swallowing process.

scholarly journals Will Women Executives Reduce Corruption? Marginalization and Network Inclusion

2020 ◽  
pp. 001041402097021
Author(s):  
Monika Bauhr ◽  
Nicholas Charron
Keyword(s):  
Gender Differences ◽  
Beneficial Effect ◽  
Women Executives ◽  
Regression Discontinuity ◽  
Strong Association ◽  
Municipal Elections ◽  
Women Mayors ◽  
Elected Office ◽  
Over Time

While recent studies find a strong association between the share of women in elected office and lower levels of corruption, we know less about if women in executive office cause reductions in corruption levels, and if such effects last over time. This study suggests that women mayors reduce corruption levels, but that the beneficial effect may be weakened over time. Using both regression discontinuity and first difference designs with newly collected data on French municipal elections combined with corruption risk data on close to all municipal contracts awarded between 2005 and 2016, we show that women mayors reduce corruption risks. However, newly elected women mayors drive the results, while gender differences are negligible in municipalities where women mayors are re elected. Our results can be interpreted as providing support for marginalization theories, but also suggest that the women that adapt to corrupt networks survive in office.

P14.85 Impact of the neuro-radiologist and neuro-surgeon in contouring with the neuro-oncologist on local relapse rates for brain metastases treated with stereotactic radiosurgery

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii54-ii54
Author(s):  
M Robinson ◽  
K Sayal ◽  
C Tunstall ◽  
S Padmanaban ◽  
R Watson ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Strong Association ◽  
Local Relapse ◽  
Initial Contour ◽  
Published Data ◽  
Recurrence Rates ◽  
Local Institution ◽  
The Impact ◽  
Free Rate ◽  
Over Time

Abstract BACKGROUND The audit evaluates the value of MDT, including neuro-radiologist and neuro-surgeon, review of contouring carried out by a clinical oncologist in stereotactic radiosurgery (SRS). MATERIAL AND METHODS A sequential audit was conducted of all patients receiving intracranial SRS at our local institution for the first 22 months of a new SRS service. Lesions were contoured first by clinical oncologist then reviewed/edited by the MDT. The initial contour was compared with final contour using Jaccard conformity and geographical miss indices. The dosimetric impact of a contouring change was assessed using plan metrics to both original and final contour. The impact of the contouring review on local relapse, overall survival and radio necrosis rate was evaluated with at least 24 months follow up (24–46 months). RESULTS 113 patients and 142 lesions treated over 22 months were identified. Mean JCI was 0.92 (0.32–1.00) and 38% needed significant editing (JCI&lt;0.95). Mean GMI was 0.03 (0.0–0.65) and 17% showed significant miss (GMI&gt;0.05). Resection cavities showed more changes, with lower JCI and higher GMI (p&lt;0.05). There was no significant improvement on JCI or GMI shown over time. Dosimetric analysis indicated a strong association of conformity metrics with PTV dose metrics; a 0.1 change in GTV conformity metric association with 6–17% change in dose to 95% of resulting PTV. Greater association was seen in resection cavity suggesting the geographical nature of a typical contouring error gives rise to greater potential change in dose. Clinical outcomes compared well with published series. Median survival was 20 months and local relapse free rate in the treated areas of 0.89 (0.8–0.94) at 40 months, and 0.9 (0.83–0.95) radio-necrosis free rate at 40 months with a median 17 months to developing radio-necrosis for those that did. CONCLUSION This work highlights that a MDT contour review adds significant value to SRS and the approach translates into reduced local recurrence rates at our local institution compared with previously published data. Radio-necrosis rates are below 10%. No improvement in clinical oncologist contouring over time was shown indicating a collaborative approach is needed regardless of experience of clinical oncologist. MDT input is recommended in particular in contouring of resection cavities.

Severe Telomeric Erosion In Ph-Negative Hematopoiesis After Successful CML Treatment: Association with Acquired Cytogenetic Lesions and Hematological Toxicity.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3375-3375
Author(s):  
Chiara Lobetti Bodoni ◽  
Ferrero Dario ◽  
Elisa Genuardi ◽  
Roberto Passera ◽  
Elisa Bernocco ◽  
...  
Keyword(s):  
Median Time ◽  
Conflicts Of Interest ◽  
Strong Association ◽  
Previous History ◽  
Hematological Toxicity ◽  
Control Group ◽  
Treatment Schedule ◽  
Telomere Shortening ◽  
Over Time ◽  
Telomere Erosion

Abstract Abstract 3375 Introduction. Telomere are effective sensors of cell integrity and their accelerated shortening is a marker of genetic and/or proliferative stress in several tissues including the hematopoietic compartment. Severe telomere attrition has been indeed observed in aplastic anemia and post-transplant setting. Little is currently known on the genetic integrity of Ph-negative hematopoietic cells (HCs) repopulating the bone marrow (BM) after successful chronic myeloid leukemia (CML) treatment. We thus decided to verify whether severe telomere shortening might occur in this setting and to assess whether its presence might correlate to genetic and functional impairment of Ph-negative hematopoiesis. Patients and methods. We investigated 81 CML patients with persistent (≥12 months) complete cytogenetic remission (CCyR). Median age was 62 years (23-88), M/F ratio was 1.5. Median time from diagnosis and CCyR were 4 years (1-18) and 3 years (1-12) respectively. 15 patients had acquired cytogenetic abnormalities (CA) (del7: 4 patients, +8: 5 patients, del5q: 2 patients, del or +Y: 2 patients, other CA: 2 patients). Telomere length (TL) analysis was performed by Southern Blotting on polymorphonucleates (PMN) and on monocyte-depleted PBMC (MD-PBMC) to monitor both the myeloid and lymphoid compartments. As control group we analyzed 76 age-matched healthy donors. Prospective follow-up monitoring of TL was performed on 56 CML patients with a median time of 22 months from the first determination (range 12–20). Results. PMN (but not MD-PBMC) from CML patients showed a major erosion of their telomeric DNA (median loss 1294 bp p<0.001). Correlations were sought by using a multivariate general linear model on the whole population (CML patients and controls) and then exclusively on the CML population. In the whole population a previous history of CML was a predictor of TL attrition together with age (both p <0.001). In the CML-only population we found no association between TL and sex, Sokal score, or treatment schedule. Most notably we found a correlation between TL attrition and presence of acquired CA (p=0.02, figure 1A), particularly in case of del7 and +8. Somehow more surprisingly we found an increased TL shortening among patients lacking complete molecular remission (CMolR) (p=0.001). The physiological correlation between age and TL persisted also among CML patients (p=0.003). Moreover we found an association between the presence of short telomeres and G≥2 hematological toxicity of any kind (p=0,005), anemia (p=0,007) and a trend with the presence of neutropenia (p=0,080). The association persisted also when G1-4 toxicities were considered (hematological toxicity of any kind p=0.030, anemia p=0.010). We than made a prospective assessment of the telomere dynamics over time performing a second TL determination after at least 12 months on 56 patients. The overall population showed further significant ongoing telomere shortening that was superior to the expected yearly loss for healthy subjects (median annual telomeric loss of 261 bp). We then performed a patient by patient analysis of TL dynamics over time. None of the patients had evidence of telomere recovery. Moreover even considering the maximal recorded interassay variability of 300 bp and the maximal physiological annual telomeric loss (50 bp), a non-physiological telomeric loss was observed in 17 patients (30% of CML population, median loss of 534 bp, range 1290-357 bp, figure 1C). Conclusions. i) Ph-negative HCs display severe telomeric loss, compared to healthy controls; ii) telomere erosion is more pronounced in patients with CA and without CMolR; iii) a strong association between shorter telomeres and hematological toxicity (particularly anemia) was observed; iv) telomere loss is persistent over time in the whole population. Moreover one third of them has a clear evidence of ongoing telomere erosion during the remission phase. Our results indicate that Ph-negative hematopoiesis emerging after successful CML treatment suffers from severe and ongoing telomeric stress whose biological and clinical consequences need to be carefully investigated. Disclosures: No relevant conflicts of interest to declare.

Longitudinal change in proteinuria and kidney outcomes in C3 glomerulopathy

2021 ◽  
Author(s):  
Fernando Caravaca-Fontán ◽  
Montserrat Díaz-Encarnación ◽  
Virginia Cabello ◽  
Gema Ariceta ◽  
Luis F Quintana ◽  
...  
Keyword(s):  
Kidney Failure ◽  
Cox Model ◽  
Strong Association ◽  
Fold Increase ◽  
Longitudinal Change ◽  
C3 Glomerulopathy ◽  
Dynamic Prediction ◽  
Glomerular Diseases ◽  
Over Time

Abstract Introduction The association between a change in proteinuria over time and its impact on kidney prognosis has not been analysed in complement component 3 (C3) glomerulopathy. This study aims to investigate the association between the longitudinal change in proteinuria and the risk of kidney failure. Methods This was a retrospective, multicentre observational cohort study in 35 nephrology departments belonging to the Spanish Group for the Study of Glomerular Diseases. Patients diagnosed with C3 glomerulopathy between 1995 and 2020 were enrolled. A joint modelling of linear mixed-effects models was applied to assess the underlying trajectory of a repeatedly measured proteinuria, and a Cox model to evaluate the association of this trajectory with the risk of kidney failure. Results The study group consisted of 85 patients, 70 C3 glomerulonephritis and 15 dense deposit disease, with a median age of 26 years (range 13–41). During a median follow-up of 42 months, 25 patients reached kidney failure. The longitudinal change in proteinuria showed a strong association with the risk of this outcome, with a doubling of proteinuria levels resulting in a 2.5-fold increase of the risk. A second model showed that a ≥50% proteinuria reduction over time was significantly associated with a lower risk of kidney failure (hazard ratio 0.79; 95% confidence interval 0.56–0.97; P &lt; 0.001). This association was also found when the ≥50% proteinuria reduction was observed within the first 6 and 12 months of follow-up. Conclusions The longitudinal change in proteinuria is strongly associated with the risk of kidney failure. The change in proteinuria over time can provide clinicians a dynamic prediction of kidney outcomes.

Predictors of Post-concussive Symptoms in Young Children: InjuryversusNon-injury Related Factors

2016 ◽  
Vol 22 (8) ◽  
pp. 793-803 ◽  
Author(s):  
Coco O. Bernard ◽  
Jennie A. Ponsford ◽  
Audrey McKinlay ◽  
Dean McKenzie ◽  
David Krieser
Keyword(s):  
Young Children ◽  
Parental Stress ◽  
Longitudinal Design ◽  
Strong Association ◽  
Family Factors ◽  
Relative Influence ◽  
Post Injury ◽  
Related Factors ◽  
Prospective Longitudinal ◽  
Over Time

AbstractObjectives:A notable minority of children will experience persistent post-concussive symptoms (PCS) following mild traumatic brain injury (mTBI), likely maintained by a combination of injury and non-injury related factors. Adopting a prospective longitudinal design, this study aimed to investigate the relative influence of child, family, and injury factors on both acute and persistent PCS in young children.Methods:Participants were 101 children aged 2–12 who presented to an Emergency Department, with either mTBI or minor bodily trauma (control). PCS were assessed at time of injury, 1 week, and 1, 2, and 3 months post-injury. Predictors included injury and demographic variables, premorbid child behavior, sleep hygiene, and parental stress. Random effects ordinal logistic regression models were used to analyze the relative influence of these predictors on PCS at early (acute – 1 week) and late (1–3 month) post-injury phases.Results:Presence of mTBI was a stronger predictor of PCS in the early [odds ratio (OR)=18.2] compared with late (OR=7.3) post-injury phase. Older age at injury and pre-existing learning difficulties were significant predictors of PCS beyond 1 month post-injury. Family factors, including higher levels of parental stress, higher socio-economic status, and being of Anglo-Saxon descent, consistently predicted greater PCS.Conclusions:Injury characteristics were significantly associated with PCS for 3 months following mTBI but the association weakened over time. On the other hand, pre-existing child and family factors displayed an increasingly strong association with PCS over time. Follow-up for these “at-risk” children which also addresses family stress may minimize longer-term complications. (JINS, 2016,22, 793–803)

scholarly journals Quantitative Videofluoroscopic Analysis of Swallowing Physiology and Function in Individuals With Chronic Obstructive Pulmonary Disease

2020 ◽  
Vol 63 (11) ◽  
pp. 3643-3658
Author(s):  
Renata Mancopes ◽  
Melanie Peladeau-Pigeon ◽  
Emily Barrett ◽  
Andrea Guran ◽  
Sana Smaoui ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Upper Esophageal Sphincter ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Data Set ◽  
Obstructive Pulmonary Disease ◽  
Pharyngeal Residue ◽  
Pharyngeal Constriction

Purpose Dysphagia is a serious extra pulmonary manifestation of chronic obstructive pulmonary disease (COPD). However, the nature of abnormalities in swallowing physiology in COPD has yet to be clearly established. We explored the frequency of swallowing measures outside the healthy reference range in adults with COPD. Method Participants were 28 adults aged 41–79 years (18 men, 20 women) with stable COPD. Disease severity was classified as GOLD (Global Initiative For Chronic Obstructive Lung Disease) Stages 1 (4%), 2 (25%), 3 (53%), and 4 (18%). Participants underwent a videofluoroscopy and swallowed 20% w/v thin barium in, followed by 20% w/v mildly, moderately, and extremely thick barium prepared with a xanthan gum thickener. Blinded duplicate ratings of swallowing safety, efficiency, kinematics, and timing were performed according to the ASPEKT method (Analysis of Swallowing Physiology: Events, Kinematics and Timing). Comparison data for healthy adults aged < 60 years were extracted from an existing data set. Chi-square and Fisher's exact tests compared the frequencies of measures falling < 1 SD / > 1 SD from mean reference values (or < the first or > the third quartile for skewed parameters). Results Participants with COPD did not display greater frequencies of penetration–aspiration, but they were significantly more likely ( p < .05) to display incomplete laryngeal vestibule closure (LVC), longer time-to-LVC, and shorter LVC duration. They also displayed significantly higher frequencies of short upper esophageal sphincter opening, reduced pharyngeal constriction, and pharyngeal residue. Conclusion This analysis reveals differences in swallowing physiology in patients with stable COPD characterized by impaired safety related to the mechanism, timing, and duration of LVC and by impaired swallowing efficiency with increased pharyngeal residue related to poor pharyngeal constriction.

Bone Cancers

2017 ◽  
Author(s):  
Lisa Mirabello ◽  
Rochelle E. Curtis ◽  
Sharon A. Savage
Keyword(s):  
Risk Factors ◽  
Genetic Risk ◽  
Strong Association ◽  
Malignant Neoplasms ◽  
Older Individuals ◽  
Increased Risk ◽  
Primary Bone ◽  
Children And Young Adults ◽  
Therapeutic Radiation ◽  
Over Time

Cancers arising from bone or cartilage account for about 0.2% of malignant neoplasms. They are histologically heterogeneous with multiple rare subtypes. Osteosarcoma and Ewing sarcoma occur primarily in children and young adults, whereas other bone cancers occur in older individuals. As a group, bone cancers have few known environmental risk factors, the exception being a strong association between therapeutic radiation and increased risk of osteosarcoma. The genetic etiology is also better understood in osteosarcoma, although there have been limited studies in other types of bone cancers. This chapter reviews the worldwide incidence of more common types of primary bone cancers, patterns in survival over time, and the associated environmental and genetic risk factors.

scholarly journals Social Inequalities and Loneliness as Predictors of Ageing Well: A Trend Analysis Using Mixed Models

2020 ◽  
Vol 17 (15) ◽  
pp. 5314 ◽  
Author(s):  
Jens Klein ◽  
Olaf von dem Knesebeck ◽  
Daniel Lüdecke
Keyword(s):  
Physical Functioning ◽  
Mixed Models ◽  
Time Trends ◽  
Social Inequalities ◽  
Strong Association ◽  
Total Sample ◽  
Population Based ◽  
Ageing Population ◽  
Educational Inequalities ◽  
Over Time

Background: This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods: The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results: Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions: Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.

Sign in / Sign up

Export Citation Format

Share Document