The effectiveness of chin-down manoeuvre in patients with dysphagia: A systematic review and meta-analysis.

AIM: The chin-down posture is a widely used compensatory manoeuvre for patients with dysphagia. The aim of this study was designed to systematically measure the effectiveness of chin-down manoeuvre application. METHODOLOGY: We retrieved the PubMed, Web of Science, Embase, Cochrane Library, EBSCO, Medline, CNKI, WANFANG, VIP and SinoMed databases from inception to 30 August 2022. Raters independently screened literature according to inclusion and exclusion criteria. The quality of the included literature was evaluated, and data were extracted. The software Review Manager software 5.3 was used for statistical analysis. RESULTS: Fourteen studies with a total of 571 patients were included in this meta-analysis. The meta-analysis indicated that chin-down manoeuvre could significantly reduce the risk of aspiration (MD = -1.35, 95% CI [-2.25, -0.44], Z = 2.92, p < .01), decrease the chin angle (MD = -12.20, 95% CI [-14.61, -9.79], Z = 9.91, p < .001), shorten oral transit time (MD = -0.81, 95% CI [-1.20, -0.43], Z = 4.17, p < .001), reduce the maximum swallowing pressure at upper oesophageal sphincter (MD = -82.07, 95% CI [-112.77, -51.37], Z = 5.24, p < .001) and decrease pharyngeal residue. CONCLUSIONS: Existing evidence indicated that chin-down manoeuvre could reduce the risk of aspiration and pharyngeal residue, decrease the maximum swallowing pressure at UES. More large-sample, high-quality clinical trials are still needed in the future to further ascertain the results of this research.

The Therapeutic Effect of Swallow Training with a Xanthan Gum-Based Thickener in Addition to Classical Dysphagia Therapy in Chinese Patients with Post-Stroke Oropharyngeal Dysphagia: A Randomized Controlled Study.

Objective: In patients with post-stroke oropharyngeal dysphagia (PSOD), classical dysphagia therapy (CDT) continues to provide unsatisfactory outcomes and makes it challenging for them to remove the nasal feeding tube. Increasing bolus viscosity helps prevent aspiration in PSOD. However, conventional starch thickeners enhance post-digestion residue. This study aims to evaluate the efficacy of swallow training with xanthan gum-based thickener (XGT) (Softia G, NUTRI Co., Ltd., Yokkaichi, Japan) additional to CDT in Chinese PSOD patients with a nasogastric tube when compared to CDT alone. Methods: Patients with PSOD who had a nasogastric tube were randomly assigned to either the experimental group (E-group) or the control group (C-group) in this randomized controlled, single-blind, parallel-group study. Both groups received CDT for 4 weeks. The E-group cases received additional swallow training with a Softia G-prepared hydrogel training material. The Functional Oral Intake Scale (FOIS) and modified volume-viscosity swallow test (M-VVST) for swallowing safety and efficacy according to adjusted Chinese dietary habits were administered before and after treatment. Post-training, both groups' nasogastric tube removal rates were calculated. Results: One hundred sixty-seven participants (E-group: 82 and C-group: 85) completed the study. The E-group's median score of FOIS improved significantly than the C-group after training (median = 5 vs. 3, P < 0.001). The incidence of coughing, voice changes, oxygen desaturation of 3% or more, pharyngeal residue and piecemeal deglutition in the E-group was significantly lower than that in the C-group (P < 0.05). The E-group had 100% nasogastric tube removal, while the C-group had 28.24% (P < 0.001). Conclusion: Swallow training with XGT Softia G in addition to CDT can promote swallowing safety and efficacy in Chinese patients with PSOD more effectively than CDT alone.

Rapidly Containing the First Indigenous Outbreak of Chikungunya in Taiwan-Lessons Learned.

The first indigenous outbreak of chikungunya in Taiwan occurred in New Taipei City, northern Taiwan, from August to October 2019. This study identified important containment strategies for controlling the outbreak. The outbreak investigation and ovitrap data were collected from the Department of Health, New Taipei City Government. A geographic information system (GIS) was applied for spatial analysis, and descriptive statistics were used to compute the demographic features and medical visits of confirmed cases. There were 19 residents infected during the outbreak. The source of this outbreak was a mountain trail with abundant Aedes albopictus. The atypical symptoms and lack of a rapid test led to multiple clinical visits by the patients (mean: 2.79; standard deviation: 1.65). The clinical symptoms of chikungunya are very similar to those of dengue fever. We noted that only eight patients were polymerase chain reaction (PCR)-positive in their first blood collection, and an average of 3.13 days between illness onset and PCR-positive results. The improved laboratory panel test, targeted and rapid insecticide spraying at the households and their communities, strict closure of the mountain trail, and ovitrap surveillance for evaluating intervention were important approaches to rapidly contain the outbreak.

A quasi-2D flood modeling approach to simulate substance transport in polder systems for environment flood risk assessment.

In flood modeling, many one-dimensional (1D) hydrodynamic and water quality models are too restricted in capturing the spatial differentiation of processes within a polder or system of polders and two-dimensional (2D) models are too demanding in data requirements and computational resources, especially if Monte-Carlo techniques are to be used for model uncertainty analyses. The first goal of this paper is to show the successful development of a quasi-2D modeling approach which still calculates the dynamic wave in 1D but the discretisation of the computational units is in 2D, allowing a better spatial representation of the flow and substance transport processes in the polders without a large additional expenditure on data pre-processing and simulation processing. The models DYNHYD (1D hydrodynamics) and TOXI (sediment and micro-pollutant transport) were used as a basis for the hydrodynamic and water quality simulations. An extreme flood event on the Elbe River, Germany, with a proposed polder system variant was used as a test case. The results show a plausible differentiation of suspended sediment and zinc concentrations within the polders both spatially and temporally. This fulfills the second goal of this research. The third goal of this work is to provide an example methodology of carrying out an environmental risk assessment in inundated areas by flood waters, as required by the European Union floods directive. The deposition of zinc in polders was used for this example, due to its high contamination potential in the Elbe River. The extended quasi-2D modeling system incorporates a Monte-Carlo uncertainty analysis to assess the environmental impact of heavy metal deposition in the polders during extreme flooding. The environmental risk computed gives a 48% chance of exceeding the inspection value of 500 mg zinc/kg sediment for a flood such as the August 2002 event.

Projection Onto Convex Sets (POCS) method for photoacoustic tomography with a non negative constraint.

Photoacoustic imaging is a biomedical imaging modality capable of early cancer detection. In this paper, we proposed a novel iterative Projections Onto Convex Sets (POCS) method for improving photoacoustic reconstruction. This method aims to obtain a non negative pressure distribution satisfying the measured signals. This POCS method is performed in the Fourier Bessel space avoiding matrix inversions in the projections, speeding up projections and is capable of handling the large data sets present in photoacoustic imaging. The numerical experiments performed showed that improved reconstruction was obtained with a few iterations together with the recovery of some lost information.