Correlation between the parameters of quadrilateral vowel and dysphonia severity in patients with traumatic brain injury.

Dysarthria and dysphonia are common in patients with traumatic brain injury (TBI). Multiple factors may contribute to TBI-induced dysarthria, including poor vocalization, articulation, respiration, and/or resonance. Many patients suffer from dysarthria that persists after the onset of TBI, with negative effects on their quality of life. This study aimed to investigate the relationship between vowel quadrilateral parameters and Dysphoria Severity Index (DSI), which objectively reflects vocal function We retrospectively enrolled TBI patients diagnosed using computer tomography. Participants had dysarthria and dysphonia and underwent acoustic analysis. Praat software was used to measure vowel space area (VSA), formant centralization ratio (FCR), and the second formant (F2) ratio. For the 4 corner vowels (/a/,/u/,/i/, and/ae/), the resonance frequency of the vocal folds was measured and is shown as 2-dimensional coordinates for the formant parameters. Pear-son correlation and multiple linear regression analyses were performed between the variables. VSA showed a significant positive correlation with DSI/a/ ( R  = 0.221) and DSI/i/ ( R  = 0.026). FCR showed a significant negative correlation with DSI/u/ and DSI/i/. The F2 ratio showed a significant positive correlation with DSI/u/ and DSI/ae/. In the multiple linear regression analysis, VSA was found to be a significant predictor of DSI/a/ (ß = 0.221, P  = .030, R 2  = 0.139). F2 ratio (ß = 0.275, P  = .0.015) and FCR (ß = -0.218, P  = .029) was a significant predictor of DSI/u/ (R 2  = 0.203). FCR was a significant predictor of DSI/i/ (ß = -0.260, P  = .010, R 2  = 0.158). F2 ratio was a significant predictor of DSI/ae/ (ß = 0.254, P  = .013, R 2  = 0.154). Vowel quadrilateral parameters, such as VSA, FCR, and F2 ratio, may be associated with dysphonia severity in TBI patients.

Assessing the effect of transcranial magnetic stimulation on peak cough flow in patients with supratentorial cerebral infarction: A retrospective cohort study.

Respiratory dysfunction following supratentorial cerebral infarction leads to pneumonia and is a major cause of mortality. Decreased voluntary cough function impairs the ability to clear mucus or secretions from the airways and increases the risk of aspiration pneumonia. Peak cough flow (PCF) is one of the objective tools for evaluating voluntary cough function. Repetitive transcranial magnetic stimulation (rTMS) could be applied to the respiratory motor cortex to improve respiratory function. Little is known about the effect of rTMS on PCF in patients with supratentorial cerebral infarction during the subacute period. This study aimed to determine whether rTMS treatment could improve PCF in patients with supratentorial cerebral infarction. We retrospectively recruited patients with subacute supratentorial cerebral infarction who underwent a PCF test. The rTMS group received a combination of rTMS treatment for 2 weeks and conventional rehabilitation for 4 weeks. However, the control group underwent only conventional rehabilitation for 4 weeks. PCF tests were performed before and after treatment and the results were compared between the 2 groups. In total, 145 patients with supratentorial cerebral infarctions were recruited. The PCF parameters before and after treatment increased in both the rTMS and control groups. However, the rTMS group showed a greater increase in PCF values compared with the control group. In patients with supratentorial cerebral infarction, the combination of conventional rehabilitation and rTMS in the subacute period may be helpful in improving voluntary cough function compared with conventional rehabilitation alone.

Association between vitamin B12 status and heart rate variability in patients with ischemic stroke.

Autonomic dysfunction is common in patients with ischemic stroke. An ischemic stroke may induce abnormalities in autonomic tone, resulting in poor heart rate regulation and an increased risk of severe cardiac arrest and sudden death. Heart rate variability (HRV) is a reliable index for evaluating autonomic dysfunction. Vitamin B12 deficiency is frequent among older adults and is a known risk factor for ischemic stroke. As vitamin B12 deficiency affects the peripheral nerves and the central nervous system, it can lead to autonomic dysfunction. However, no study has been published on the correlation between HRV and vitamin B12 status in patients with ischemic stroke. This study aimed to investigate the relationship between HRV and vitamin B12 status and to determine whether the serum vitamin B12 level can be a predictor of HRV parameters. This retrospective study enrolled patients with ischemic stroke between January 2015 and December 2022. The patients underwent serum vitamin B12 level measurements and 24-h Holter monitoring. Pearson correlation analysis was used to investigate the correlation between serum vitamin B12 levels and HRV parameters. The impact of serum vitamin B12 status on HRV parameters was determined using multiple linear regression analysis. A total of 87 patients with ischemic stroke were included in this study. HRV parameters were significantly correlated with serum vitamin B12 status in the frequency domain. In multiple linear regression analysis, the serum vitamin B12 status was a significant predictor of HRV parameters. HRV parameters may be correlated with serum vitamin B12 status in patients with ischemic stroke. Therefore, the serum vitamin B12 status may be a significant predictor of autonomic dysfunction. Our results may provide objective evidence for the impact of serum vitamin B12 status on autonomic dysfunction in patients with ischemic stroke.

Nutritional Biomarkers as Predictors of Dysphonia Severity in Patients with Ischemic Stroke.

Dysphonia and malnutrition are major problems in patients who have suffered an ischemic stroke. Tools to assess dysphonia severity include the dysphonia severity index (DSI) and maximum phonation time (MPT). This study aimed to investigate whether the nutritional biomarkers transferrin, albumin, and prealbumin could be predictors of dysphonia severity. A retrospective analysis was conducted between January 2018 and October 2022. A total of 180 patients who had suffered an ischemic stroke were included. Serum transferrin, albumin, and prealbumin levels were significantly correlated with DSI and MPT levels. In a multiple regression analysis, prealbumin and transferrin were significant predictors of DSI, whereas only prealbumin was a significant predictor of MPT. Serum transferrin, albumin, and prealbumin levels in patients who have suffered an ischemic stroke may correlate with dysphonia severity as assessed using DSI and MPT. These results may provide objective evidence that nutritional biomarkers affect dysphonia severity.

Serum vitamin D levels and peak cough flow in patients with subacute ischemic stroke.

Aspiration pneumonia is a major, potentially fatal complication after ischemic stroke. Decreased coughing function is a significant risk factor for aspiration in ischemic stroke survivors. Peak cough flow (PCF) is a useful tool for assessing cough function. Vitamin D deficiency is frequent after ischemic stroke and is linked to a variety of muscle functions and physical activities. There has been no investigation of the correlation between vitamin D levels and PCF in ischemic stroke survivors. This study aimed to examine the relationship between serum vitamin D levels and PCF in patients with ischemic stroke. Patients with ischemic stroke who underwent PCF evaluation and serum vitamin D level measurements within 1 month of onset were retrospectively recruited. The association between PCF parameters and serum vitamin D levels was also analyzed. In total, 142 patients with ischemic stroke were included. PCF parameters and serum vitamin D levels were found to be significantly correlated. Moreover, serum vitamin D levels were shown to be a significant predictor of PCF parameters. Serum vitamin D levels were related to PCF parameters in patients with ischemic stroke. In addition, serum vitamin D level may serve as a predictor of coughing function in patients with ischemic stroke.

Vitamin D level in relation to phonetic function among subacute stroke patients.

There are many stroke patients with decreased phonation ability. Vitamin D is associated with weakness in muscle power and a decreased function of activity and is often accompanied by a deficiency of serum vitamin D in stroke patients. This study was conducted to evaluate the correlation between serum vitamin D level and phonetic function in subacute stroke patients. Among subacute stroke patients, patients with dysphonia were retrospectively recruited. Phonation function was assessed by acoustic analysis using the dysphonia severity index (DSI) and maximum phonation time for 4 corner vowels/a/,/i/,/u/, and/ae/. As a statistical method, the relationships of vitamin D levels with the maximum phonation time and DSI were evaluated using Pearson's correlation analysis and linear regression analysis. A total of 32 stroke patients with dysphonia were assessed. A positive correlation was found between vitamin D levels and the DSI of /a/, /u/, /i/, and/ae/. The DSI of/u/ was significantly lower in the group with vitamin D deficiency. Vitamin D level was associated with phonation function and its deficiency may be a factor in predicting phonation severity in stroke patients.

Effects of Compression Stockings on Body Balance in Hemiplegic Patients with Subacute Stroke.

(1) Background: Stroke patients with hemiplegia have an increased risk of developing deep vein thrombosis (DVT). DVT increases the risk of life-threatening pulmonary embolism and is associated with poor prognosis. The early wearing of compression stockings can help prevent DVT. This study aimed to assess the impact of compression stockings on body balance in stroke patients with unilateral lower extremity muscle weakness; (2) Methods: Hemiplegic stroke patients in the subacute phase who were able to walk with assistance were recruited. The patients were divided into two groups: one group received rehabilitation treatment with compression stockings, and the other received treatment without compression stockings. The rehabilitation treatment involved hospitalization for 4 weeks, the Trunk Control Test (TCT), the Trunk Impairment Scale (TIS), and the Berg Balance Scale (BBS). The patients were evaluated before and 4 weeks after the start of treatment. The differences in BBS, TCT, and TIS before and after treatment between the two groups were compared; (3) Results: Altogether, 236 hemiplegic stroke patients were recruited. There was an improvement in body balance after treatment in both groups, and BBS, TCT, and TIS scores significantly increased in the group that received rehabilitation treatment with compression stockings; (4) Conclusions: In patients with hemiplegic stroke in the subacute period, rehabilitation while wearing compression stockings appears to improve body balance.

Nutritional Biomarkers and Heart Rate Variability in Patients with Subacute Stroke.

Malnutrition and autonomic dysfunction are associated with poor outcomes, mortality, and psychological problems after stroke. Relevant laboratory biomarkers include serum albumin, prealbumin, and transferrin. Heart rate variability (HRV), a noninvasive measurement, can objectively measure autonomic nervous system (ANS) function. The relationship between HRV and nutritional biomarkers in stroke patients has not been studied. This study aimed to examine the relationship between nutritional biomarkers and HRV parameters in stroke patients. We retrospectively recruited 426 patients with subacute stroke who were examined for nutritional biomarkers, such as serum albumin, prealbumin, and transferrin, and underwent 24 h ambulatory Holter electrocardiography. Patients were divided into groups according to their nutritional biomarker status. Differences in HRV parameters between nutritional biomarker-deficient and normal groups were assessed. Pearson's correlation and multiple regression analyses were used to verify the relationship between HRV parameters and nutritional biomarkers. HRV parameters were significantly lower in the nutritional biomarker-deficient groups. In addition, there was a significant association between HRV parameters and nutritional biomarkers. Serum albumin, prealbumin, and transferrin levels were associated with ANS function, as measured by HRV, and their deficiency may be a predictive factor for the severity of ANS dysfunction in stroke patients.

Destruction of Vowel Space Area in Patients with Dysphagia after Stroke.

Dysphagia is associated with dysarthria in stroke patients. Vowel space decreases in stroke patients with dysarthria; destruction of the vowel space is often observed. We determined the correlation of destruction of acoustic vowel space with dysphagia in stroke patients. Seventy-four individuals with dysphagia and dysarthria who had experienced stroke were enrolled. For /a/, /ae/, /i/, and /u/ vowels, we determined formant parameter (it reflects vocal tract resonance frequency as a two-dimensional coordinate point), formant centralization ratio (FCR), and quadrilateral vowel space area (VSA). Swallowing function was assessed using the videofluoroscopic dysphagia scale (VDS) during videofluoroscopic swallowing studies. Pearson's correlation and linear regression were used to determine the correlation between VSA, FCR, and VDS. Subgroups were created based on VSA; vowel space destruction groups were compared using ANOVA and Scheffe's test. VSA and FCR were negatively and positively correlated with VDS, respectively. Groups were separated based on mean and standard deviation of VSA. One-way ANOVA revealed significant differences in VDS, FCR, and age between the VSA groups and no significant differences in VDS between mild and moderate VSA reduction and vowel space destruction groups. VSA and FCR values correlated with swallowing function. Vowel space destruction has characteristics similar to VSA reduction at a moderate-to-severe degree and has utility as an indicator of dysphagia severity.

Elastic Dynamic Sling on Subluxation of Hemiplegic Shoulder in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial.

Background: Shoulder subluxation occurs in 17−64% of hemiplegic patients after stroke and develops mostly during the first three weeks of hemiplegia. A range of shoulder orthoses has been used in rehabilitation to prevent subluxation. However, there is little evidence of their efficacy. AIM: This study aimed to investigate whether there is a difference in the subluxation distance, pain, and functional level of the hemiplegic upper extremity among patients with two different shoulder orthoses. Design: This is a prospective, randomized controlled trial with intention-to-treat analysis. SETTING: Multicenter, rehabilitation medicine department of two university hospitals in South Korea. Population: Forty-one patients with subacute stroke with shoulder subluxation with greater than 0.5 finger width within 4 weeks of stroke were recruited between January 2016 and October 2021. Methods: The experimental group used an elastic dynamic sling while sitting and standing to support the affected arm for eight weeks. The control group used a Bobath sling while sitting and standing. The primary outcome was to assess the distance of the shoulder subluxation on radiography. The secondary outcomes were upper-extremity function, muscle power, activities of daily living, pain and spasticity. Result: The horizontal distance showed significant improvement in the elastic dynamic sling group, but there were no significant differences in the vertical distance between the elastic dynamic and Bobath sling groups. Both groups showed improvements in upper-extremity movements and independence in daily living after 4 and 8 weeks of using shoulder orthoses, and the differences within the groups were significant (p < 0.05). However, there were no significant differences in upper-extremity movements and independence in daily living between the two groups. Conclusions: The subluxation distance showed better results in the elastic dynamic sling, which has both proximal and distal parts, than in the Bobath sling, which holds only the proximal part. Both shoulder orthoses showed improvements in the modified Barthel index, upper-extremity function, and manual muscle testing.

Quantitative Measurement of Dysphonia Severity in Patients With Stroke With Unilateral Vocal Cord Palsy.

Unilateral vocal cord palsy (UVCP) is frequently observed in patients with stroke. This study aimed to evaluate the association between objective dysphonia severity and the classification of UVCP in patients with stroke by objectively and quantitatively measuring their phonetic function. We recruited patients with UVCP diagnosed using laryngoscopy after stroke. Subgroups were divided according to UVCP type, and the dysphonia severity index (DSI) and maximum phonation time (MPT) were measured to objectively evaluate dysphonia. The DSI and MPT were compared between subgroups using analysis of variance with Tukey's honest significant difference post hoc test. In total, 103 patients with stroke and UVCP were recruited. We found that a higher UVCP severity possibly had to do with lower DSI and MPT values. We objectively confirmed that phonetic function was worse in patients with stroke with higher UVCP severity, and the DSI and MPT tests can be helpful in determining the severity and need for additional evaluation.

Association of Depressive and Somatic Symptoms with Heart Rate Variability in Patients with Traumatic Brain Injury.

Depressive and somatic symptoms are common after traumatic brain injury (TBI). Depression after TBI can relate to worsened cognitive functioning, functional impairment, higher rates of suicide attempts, and larger health care costs. Heart rate variability (HRV) represents the activity of the autonomic nervous system (ANS), which regulates almost all vascular, visceral, and metabolic functions. Several studies show a correlation between HRV, depression, and somatic symptoms in other diseases. However, studies on autonomic dysfunction, depression, and somatic symptoms in TBI patients are lacking. This study investigated the association between reduced ANS function, depression, and somatic symptoms in TBI patients. We retrospectively recruited 136 TBI patients who underwent 24 h ambulatory Holter electrocardiography to measure autonomic dysfunction within 1 month of onset. Patients who used BDI and PHQ-15 to evaluate depressive and somatic symptoms were included. Using Pearson's correlation analysis and multiple linear regression, the association between HRV parameters and BDI and PHQ-15 was determined. The HRV parameters and BDI and PHQ-15 showed statistical significance. In addition, HRV was shown to be a significantly associated factor of BDI and PHQ-15. HRV was associated with depressive and somatic symptom severity in TBI patients. Additionally, autonomic dysfunction may serve as an associated factor of depressive and somatic symptoms in patients with TBI.

HLA-G 14bp Ins/Del Polymorphism in the 3'UTR Region and Acute Rejection in Kidney Transplant Recipients: An Updated Meta-Analysis.

Background and Objectives: Acute kidney injury (AKI) affects the survival rate of kidney transplant organs and patients. Acute rejection (AR) due to AKI may lead to kidney transplantation failure. It is known that there is a relationship between human leukocyte antigen-G (HLA-G), which is involved in immune regulation, and AR in transplant patients. Moreover, 14-bp insertion/deletion polymorphism in the 3' untranslated region (UTR) region of the HLA-G gene is known to affect HLA-G expression. However, its relationship to AR is still controversial. The aim of this study was to investigate whether HLA-G 14-bp insertion/deletion polymorphism contributed to the development of AR in kidney transplant patients using a meta-analysis. Materials and Methods: To perform our meta-analysis, eligible studies about HLA-G 14-bp insertion/deletion polymorphism and AR were searched in electronic databases until 1 June 2021. Finally, a total of 336 patients with AR and 952 patients without AR in relation to kidney transplantation were analyzed from a total of nine studies. Results: In our results, the Del allele and Ins/Del+Del/Del and Del/Del genotypes significantly increased susceptibility of AR in Asian populations [odds ratio (OR) = 2.359, 95% confidence interval (CI) = 1.568-3.550, p = 3.8 × 10-5; OR = 3.357, 95% CI = 1.769-6.370, p = 0.002; OR = 2.750, 95% CI = 1.354-5.587, p = 0.0052 in each model, respectively]. Conclusions: Evidence of the present results indicate that HLA-G 14-bp insertion/deletion polymorphism is associated with susceptibility to AR in the Asian population.

Association between phonation and the vowel quadrilateral in patients with stroke: A retrospective observational study.

Articulation disorder is associated with impaired control of respiration and speech organ movement. There are many cases of dysarthria and dysphonia in stroke patients. Dysphonia adversely affects communication and social activities, and it can interfere with everyday life. The purpose of this study is to assess the association between phonation abilities and the vowel quadrilateral in stroke patients.The subjects were stroke patients with pronunciation and phonation disorders. The resonance frequency was measured for the 4 corner vowels to measure the vowel space area (VSA) and formant centralization ratio (FCR). Phonation ability was evaluated by the Dysphonia Severity Index (DSI) and maximal phonation time (MPT) through acoustic evaluation for each vowel. Pearsons correlation analysis was performed to confirm the association, and multiple linear regression analysis was performed between variables.The correlation coefficients of VSA and MPT/u/ were 0.420, VSA and MPT/i/ were 0.536, VSA and DSI/u/ were 0.392, VSA and DSI /i/ were 0.364, and FCR and DSI /i/ were -0.448. Multiple linear regression analysis showed that VSA was a factor significantly influencing MPT/u/ (ß = 0.420, P = .021, R = 0.147), MPT/i/ (ß = 0.536, P = .002, R = 0.262), DSI/u/ (ß = 0.564, P = .045, R = 0.256), and DSI/i/ (ß = 0.600, P = .03, R = 0.302).The vowel quadrilateral can be a useful tool for evaluating the phonation function of stroke patients.

Association between vitamin D deficiency and cognitive function in the elderly Korean population: A Korean frailty and aging cohort study.

It is well known that vitamin D (VitD) plays an important role in bone and calcium metabolism in the human body. VitD has additional roles in the body including modulation of cell growth, neurogenesis, neuroprotection, detoxification, immune function, and reduction of inflammation. Recent studies reveal insufficiency of VitD as a risk factor for cognitive decline or dementia. VitD has a role in normal brain function; insufficiency of VitD may lead to decreased memory and cognitive function.Using 2 years of baseline data from Korean frailty and aging cohort study, 2990 subjects (1415 men and 1575 women) were recruited. A short form of Korean version of the consortium to establish a registry for Alzheimer disease (CERAD-K), an assessment of cognitive status in patients with dementia was used. Among CERAD-K tests, we included word list memory/recall/recognition, digit span (forward, backward), trail making test (TMT) A, and mini-mental state examination in the Korean version of the CERAD assessment packet (MMSE-KC). Serum samples were collected and 25-hydroxyvitamin D (25(OH)D) was measured. Serum 25(OH)D concentrations were classified into clinically relevant categories as: deficient (<10 nmol/L), insufficient (10-30 nmol/L), and sufficient (≥30 nmol/L).The mean age of participants was 76.5 ±â€Š3.9 years, and 52.7% were women. Among 2990 participants, 119 (4.0%) were classified as 25(OH)D deficient and 2253 (75.3%) as insufficient. Only 618 (20.7%) participants were sufficient for 25(OH)D. Among them performance in MMSE-KC, TMT A, and digit span tests was better in sufficient, insufficient, and deficient groups, which was statistically significant (P < .05). However, in multivariable regression analysis after adjusting for age, sex, body mass index, education, center, seasonality, physical activity, and alcohol use, association between 25(OH)D and cognitive function was not statistically significant.Although, when comparing VitD levels, there were differences in cognitive tests among the groups, fully adjusted analysis did not show any association. This result suggests that cognition was not affected by VitD levels alone but also population and sociological variables. In a fully adjusted model, there was no statistically significant association between VitD and cognitive function in the elderly Koreans in logistic regression analysis.

Correlations between swallowing function and acoustic vowel space in stroke patients with dysarthria.

BACKGROUND: Dysphagia and dysarthria tend to coexist in stroke patients. Dysphagia can reduce patients' quality of life, cause aspiration pneumonia and increased mortality. OBJECTIVE: To evaluate correlations among swallowing function parameters and acoustic vowel space values in patients with stroke. METHODS: Data from stroke patients with dysarthria and dysphagia were collected. The formant parameter representing the resonance frequency of the vocal tract as a two-dimensional coordinate point was measured for the /a/, /ae/, /i/, and /u/vowels, and the quadrilateral vowel space area (VSA) and formant centralization ratio (FCR) were measured. Swallowing function was evaluated by a videofluoroscopic swallowing study (VFSS) using the videofluoroscopic dysphagia scale (VDS) and penetration aspiration scale (PAS). Pearson's correlation and linear regression analyses were used to assess the correlation of VSA and FCR to VDS and PAS scores. RESULTS: Thirty-one stroke patients with dysphagia and dysarthria were analyzed. VSA showed a negative correlation to VDS and PAS scores, while FCR showed a positive correlation to VDS score, but not to PAS score. VSA and FCR were significant factors for assessing dysphagia severity. CONCLUSIONS: VSA and FCR values were correlated with swallowing function and may be helpful in predicting dysphagia severity associated with stroke.