Facilitation of oral sensitivity by electrical stimulation of the faucial pillars

Dysphagia is common in neurological disease. However, our understanding of swallowing and its central nervous control is limited. Sensory information plays a vital role in the initiation of the swallowing reflex and is often reduced in stroke patients. We hypothesized that the sensitivity threshold of the anterior faucial pillar could be facilitated by either electrical stimulation (ES) or taste and smell information. The sensitivity threshold was measured by ES in the anterior faucial pillar region. The measurement was repeated 5 min after baseline. Thirty minutes after baseline, the participants underwent a test for taste and smell. Immediately after the test, the ES was repeated. Thirty healthy volunteers with a mean age of 27 ± 5.1 participated in the trial. Mean sensitivity threshold at baseline was 1.9 ± 0.59 mA. The values 5 min after baseline (1.74 ± 0.56 mA, p = 0.027) and 30 min after baseline (1.67 ± 0.58 mA, p = 0.011) were significantly lower compared to the baseline, but there was no difference between the latter (p = 0.321). After 5 min, a potentially facilitating effect was found on oral sensitivity by ES of the faucial pillar area. Thirty minutes later, this effect was still present.Trial registration Clinicaltrials.gov, NCT03240965. Registered 7th August 2017—https://clinicaltrials.gov/ct2/show/NCT03240965.

Facilitation of Oral Sensitivity by Electrical Stimulation of the Faucial Pillars

BackgroundDysphagia is common in neurological disease. However, our understanding of swallowing and its central nervous control is limited. Sensory information plays a vital role in the initiation of the swallowing reflex and is often reduced in stroke patients. We hypothesized that the sensitivity threshold of the anterior faucial pillar could be facilitated by either electrical stimulation (ES) or taste and smell information.MethodsThe sensitivity threshold was measured by ES in the anterior faucial pillar region. The measurement was repeated 5 minutes after baseline. Thirty minutes after baseline, the participants underwent a test for taste and smell. Immediately after the test, the ES was repeated. ResultsThirty healthy volunteers with a mean age of 27±5.1 participated in the trial. Mean sensitivity threshold at baseline was 1.9mA ± 0.59mA. The values 5 minutes after baseline (1.74mA ± 0.56mA, p=0.027) and 30 minutes after baseline (1.67mA ± 0.58mA, p=0.011) were significantly lower compared to the baseline, but there was no difference between the latter (p=0.321).Conclusion After 5 minutes, a potentially facilitating effect was found on oral sensitivity by ES of the faucial pillar area. Thirty minutes later, this effect was still present.

Association Between the Swallowing Reflex and the Development of Aspiration Pneumonia in Patients with Dysphagia Admitted to Long-term Care Wards -A Prospective Cohort Study of 60 Days-

ObjectiveTo investigate the association between the simple swallowing provocation test (SSPT) and development of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards.DesignThe study design was a prospective cohort study. Subjects were followed for 60 days from admission.SettingLTC wards.ParticipantsStudy subjects were patients with dysphagia aged 65 years or older who were admitted to LTC wards between August 2018 and August 2019. In total, 39 subjects were included in the analysis (20 males, 19 females; mean age 83.8 ± 8.5 years). Subjects were divided into two groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow coma scale, body mass index, geriatric nutritional risk index, the mann assessment of swallowing ability, food intake level scale, functional independence measure, and oral health assessment tool.InterventionsNot applicable.Main Outcome MeasureThe outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 ml.ResultsThe incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The phi coefficient was −0.43, the risk ratio was 2.29, and the 95% confidence interval (95%CI) was 1.14 to 4.58. The predictive factor for aspiration pneumonia was SSPT: 0.4 ml (95% CI: 1.57–26.03).ConclusionsOur findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards.

Comparison of Use of Isoflurane or Sevoflurane for Anaesthesia Induced by Mask in Calves

Background: Inhalation anaesthesia is an effective and reliable general anaesthesia method for inactivity, analgesia, and unconsciousness in extensive surgical procedures. Although widely used, especially in small animals, there are very few studies investigated the reliability and superiority of inhalation anaesthesia in surgical procedures for ruminants. This study intended to evaluate the anaesthetic effects of isoflurane and sevoflurane in different surgical cases with endotracheal intubation following the induction of anaesthesia using a calve-specific facemask, which is not yet a routine option in cattle.Materials, Methods & Results: The study was conducted on 14 calves, from new-born up to 3 months-old, that undergoing various surgical operations. The animals were divided into isoflurane and sevoflurane groups, and each group contained 7 animals. In all cases, atropine (0.04 mg/kg was administered intramusculer as premedication before 15 min from anaesthesia induction. For induction, the anaesthetic agent was given at an inspiratory concentration of 3-5% in the isoflurane group and at an inspiratory concentration of 5 - 7% in the sevoflurane group during 5 min via mask at 15min after atropine administration. In both groups, endotracheal intubation was performed (about 1-3 min) after of general anaesthesia symptoms starting. At 5min after induction, anaesthesia was continued at 1.5 - 3% in the isoflurane group and at 2.5 - 4% in the sevoflurane group during operation. The animals were monitored during anaesthesia and, anaesthetic effect, reaction of the calve, pronounced side effects, Heart Rate (HR), Systolic Arterial Blood Pressure (SABP), Diastolic Arterial Blood Pressure (DABP), Mean Arterial Blood Pressure (MABP), Respiration Rate (RR), Pulse Rate (PR), Arterial Oxygen Saturation (SpO2) were recorded at before anaesthesia, the premedication period, 5, 15, 30, 45, 60, 75 and 90min of anaesthesia. During anaesthesia, from the clinical parameters, mucosal capillary refilling time was evaluated by applying finger pressure to the oral mucosa. Mucous membrane color was determined by observing the oral mucosa. The time for palpebral reflex and swallowing reflex disappearance was measured and processed into individual forms. Anaesthesia induction and reanimation times were determined and recorded in the forms. After the operation, the return of the swallowing reflex and the time to stand up were recorded. During the operation, urination, defecation, salivation, vomiting, animal reactions, the shape and duration of the reamination period were recorded. In the isoflurane group anaesthesia induction was 3.71 ± 0.28 min, head movements started and came to the sterno- abdominal position at 4.57 ± 0.36 min, got up at 8.71 ± 0.42 min without assistance, meanwhile. In sevoflurane group, anaesthesia induction was 2.57 ± 0.20 min, head movements started and came to the sterno- abdominal position at 3.86 ± 0.40 min, the time to stand up was determined as 6.43 ± 0.29 min. During anaesthesia, HR, SABP, DABP, MABP, RR, PR, SpO2 findings were within physiological acceptable limits in 2 groups. In terms of indicators, there were no obvious differences in either group. The results revealed no significant difference between groups during anaesthesia.Discussion: The isoflurane and sevoflurane anaesthesia used in this study provided an adequate anaesthetic effect in calves characterized by adequate analgesia and muscle relaxation without any complications. The results of our study revealed that there was no significant difference between isoflurane and sevoflurane in calves. Both anaesthetic agents can be used safely for general anaesthesia in calves.

Suppression of the Swallowing Reflex during Rhythmic Jaw Movements Induced by Repetitive Electrical Stimulation of the Dorsomedial Part of the Central Amygdaloid Nucleus in Rats

A previous study indicated that the swallowing reflex is inhibited during rhythmic jaw movements induced by electrical stimulation of the anterior cortical masticatory area. Rhythmic jaw movements were induced by electrical stimulation of the central amygdaloid nucleus (CeA). The swallowing central pattern generator is the nucleus of the solitary tract (NTS) and the lateral reticular formation in the medulla. Morphological studies have reported that the CeA projects to the NTS and the lateral reticular formation. It is therefore likely that the CeA is related to the control of the swallowing reflex. The purpose of this study was to determine if rhythmic jaw movements driven by CeA had inhibitory roles in the swallowing reflex induced by electrical stimulation of the superior laryngeal nerve (SLN). Rats were anesthetised with urethane. The SLN was solely stimulated for 10 s, and the swallowing reflex was recorded (SLN stimulation before SLN + CeA stimulation). Next, the SLN and the CeA were electrically stimulated at the same time for 10 s, and the swallowing reflex was recorded during rhythmic jaw movements (SLN + CeA stimulation). Finally, the SLN was solely stimulated (SLN stimulation following SLN + CeA stimulation). The number of swallows was reduced during rhythmic jaw movements. The onset latency of the first swallow was significantly longer in the SLN + CeA stimulation than in the SLN stimulation before SLN + CeA stimulation and SLN stimulation following SLN + CeA stimulation. These results support the idea that the coordination of swallowing reflex with rhythmic jaw movements could be regulated by the CeA.

Machine learning analysis to automatically measure response time of pharyngeal swallowing reflex in videofluoroscopic swallowing study

To evaluate clinical features and determine rehabilitation strategies of dysphagia, it is crucial to measure the exact response time of the pharyngeal swallowing reflex in a videofluoroscopic swallowing study (VFSS). However, measuring the response time of the pharyngeal swallowing reflex is labor-intensive and particularly for inexperienced clinicians, it can be difficult to measure the brief instance of the pharyngeal swallowing reflex by VFSS. To accurately measure the response time of the swallowing reflex, we present a novel framework, able to detect quick events. In this study, we evaluated the usefulness of machine learning analysis of a VFSS video for automatic measurement of the response time of a swallowing reflex in a pharyngeal phase. In total, 207 pharyngeal swallowing event clips, extracted from raw VFSS videos, were annotated at the starting point and end point of the pharyngeal swallowing reflex by expert clinicians as ground-truth. To evaluate the performance and generalization ability of our model, fivefold cross-validation was performed. The average success rates of detection of the class “during the swallowing reflex” for the training and validation datasets were 98.2% and 97.5%, respectively. The average difference between the predicted detection and the ground-truth at the starting point and end point of the swallowing reflex was 0.210 and 0.056 s, respectively. Therefore, the response times during pharyngeal swallowing reflex are automatically detected by our novel framework. This framework can be a clinically useful tool for estimating the absence or delayed response time of the swallowing reflex in patients with dysphagia and improving poor inter-rater reliability of evaluation of response time of pharyngeal swallowing reflex between expert and unskilled clinicians.

Formulation and Evaluation of New Dosage Form of Calcium and Vitamin D

The aim of the research work was to develop a new dosage form (tablet in tablet) of calcium and vitamin D. In this research work vitamin D3 was used as vitamin D. This type of dosage form is very useful for elder people and children who have a week swallowing reflex. They have difficulty in swallowing tablets with water. In the present research work, pre-formulated and evaluated chewable tablets of calcium and vitamin D3 (from Formulation and Evaluation of Chewable Tablets of Calcium and Vitamin D) were taken and then moulded into a jelly like material under specified conditions of temperature and humidity and a new dosage form was developed which is sweet, flavored and chewable dosage form (tablet in tablet). The new dosage form was subjected to various tests for evaluation of the new dosage form.