The efficacy of sclerotherapy as the initial treatment in patients with bleeding from Dieulafoy's lesion of the upper gastrointestinal tract.

BACKGROUND: Dieulafoy's lesion (DL) is a rare and important cause of acute nonvariceal upper gastrointestinal bleeding (ANVUGIB), however, there is a lack of clear guidelines focus on the endoscopic hemostasis treatment for DL. Sclerotherapy, as the ANVUGIB guideline recommended endoscopic hemostasis method, is widely used in clinical practice. The aim of this study is to investigate the efficacy of sclerotherapy as the initial treatment for Dieulafoy's lesion of the upper gastrointestinal tract (UDL). METHODS: Patients with UDL who underwent the ANVUGIB standard endoscopic hemostasis between April 2007 and January 2023 were enrolled. The endoscopic therapy method was left to the discretion of the endoscopist. RESULTS: In total, 219 patients were finally obtained, with 74 (33.8%) receiving sclerotherapy and 145 (66.2%) receiving other standard endoscopic therapy. The rebleeding within 30 days was significantly lower in the sclerotherapy group compared to the other standard group (5.8% vs. 16.8%, p = 0.047). There were no significant differences between the two groups in terms of successful hemostasis rate (93.2% vs. 94.5%, p = 0.713), median number of red blood cell transfusions (3.5 vs. 4.0 units, p = 0.257), median hospital stay (8.0 vs. 8.0 days, p = 0.103), transferred to ICU rate (8.1% vs. 6.2%, p = 0.598), the need for embolization or surgery rate (12.2% vs. 9.7%, p = 0.567) and 30-day mortality (0 vs. 2.1%, p = 0.553). In addition, we found no difference in efficacy between sclerotherapy alone and combination (3.1% vs. 8.1%, p = 0.714). Further analysis revealed that thermocoagulation for hemostasis was associated with a higher rate of rebleeding (28.6% vs. 3.1%, p = 0.042) and longer hospital stay (11.5 vs. 7.5 days, p = 0.005) compared to sclerotherapy alone. CONCLUSION: Sclerotherapy represents an effective endoscopic therapy for both alone and combined use in patients with upper gastrointestinal Dieulafoy's lesion. Therefore, sclerotherapy could be considered as initial treatment in patients with bleeding of UDL.

Brain Activation Site of Laryngeal Elevation During Swallowing: An fMRI Study.

The object of this study is to investigate dysphagia caused by reduced laryngeal elevation in patients poststroke. The central mechanism of laryngeal elevation during swallowing was explored by comparing the brain activation area before and after treatment with that of healthy subjects. The treatment group included patients diagnosed with dysphagia poststroke that showed reduced laryngeal elevation. They were treated with electrical stimulation at the motor points of the muscles related to laryngeal elevation. Functional magnetic resonance imaging (fMRI) using the blood oxygenation level-dependent (BOLD) was used to observe brain activation of the normal healthy control group and treatment group during voluntary swallowing. Independent sample t test and paired sample t test were used to analyze the differences in brain activation between and within the groups. Compared with the control group, no activation was observed in the brainstem and putamen regions of the experimental group before treatment. Statistics showed that the experimental group had a wider range of brain activation than the control group pretreatment, including the left supplementary motor area, the cingulate gyrus, the inferior frontal gyrus, the right thalamus, and the right putamen. After the electrical stimulation, the brain stem subregion, the left cerebellar lobule IV and V, and parts of the cerebral cortex were more active, while the left supplementary motor area, paracentral lobule, and occipital lobule were less active post-treatment. (1) The brainstem and putamen are the specific brain regions that control laryngeal movement. (2) The enhanced activation of the cortical-basal ganglia-thalamic circuit after stroke is a compensatory mechanism. (3) The improvement of hyoid bone elevation was related to the enhanced activation of the IV and V lobes of the cerebellar hemisphere. The over-activation of the supplementary motor area poststroke would subside once the motor function improved.

Relationship between laryngopharyngeal reflux disease and gastroesophageal reflux disease based on synchronous esophageal and oropharyngeal Dx-pH monitoring.

PURPOSE: To use the synchronous esophageal and oropharyngeal Dx-pH monitoring analysis to investigate the relationship between LPRD and GERD. MATERIALS AND METHODS: Synchronous esophageal and oropharyngeal Dx-pH monitoring, electronic gastroscopy, reflux symptom index (RSI) and gastroesophageal reflux questionnaire (Gerd-Q) were collected from 514 consecutive patients and comparative analysis was done. RESULTS: A total of 85 patients had positive Ryan score and 251 cases had positive DeMeester or acid exposure time percent (AET) ≥4.2%. Moreover, 61.2% (52/85) of all LPRD cases were pure LPRD without GERD. There was no statistical difference in the acid exposure to oropharynx between pure LPRD group and LPRD+GERD group (U test, P > 0.05). Furthermore, there were no statistical differences in the other esophageal reflux data between pure GERD without LPRD group and LPRD+GERD group (U test, P > 0.05) apart from the number of episodes, which was higher in the pure GERD group than in LPRD+GERD group (U test, P = 0.027). Additionally, 149 patients were diagnosed with reflux esophagitis by electronic gastroscopy. No significant difference in the acid exposure to oropharynx was seen between different grades of reflux esophagitis (U test, P > 0.05). Among the LPRD patients, 32 cases (37.6%) were negative for Gerd-Q, Dx-pH esophageal probe and gastroscopy. CONCLUSION: The results of synchronous esophageal and oropharyngeal Dx-pH monitoring demonstrated that LPRD and GERD could co-exist as separate medical conditions. Our data suggest that some LPRD are not accompanied by GERD, and that LPRD is not secondary to severe GERD.

Dysphagia Post Subcortical and Supratentorial Stroke.

BACKGROUND: Studies have recognized that the damage in the subcortical and supratentorial regions may affect voluntary and involuntary aspects of the swallowing function. The current study attempted to explore the dysphagia characteristics in patients with subcortical and supratentorial stroke. METHODS: Twelve post first or second subcortical and supratentorial stroke patients were included in the study. The location of the stroke was ascertained by computed tomography and magnetic resonance imaging. The characteristics of swallowing disorder were assessed by video fluoroscopic swallowing assessment/fiberoptic endoscopic evaluation of swallowing. The following main parameters were analyzed: oral transit time, pharyngeal delay time, presence of cricopharyngeal muscle achalasia (CMA), distance of laryngeal elevation, the amounts of vallecular residue and pyriform sinus residue (PSR), and the extent of pharyngeal contraction. RESULTS: Eighty-three percent of the 12 patients were found suffering from pharyngeal dysphagia, with 50% having 50%-100% PSRs, 50% having pharyngeal delay, and 41.6% cases demonstrating CMA. Simple regression analysis showed PSRs were most strongly associated with CMA. Pharyngeal delay in the study can be caused by infarcts of basal ganglia/thalamus, infarcts of sensory tract, infarcts of swallowing motor pathways in the centrum semiovale, or a combination of the three. CONCLUSION: Subcortical and supratentorial stroke may result in pharyngeal dysphagia such as PSR and pharyngeal delay. PSR was mainly caused by CMA.

Patient self-perceptions of swallowing difficulties as compared to expert ratings of videofluorographic studies.

BACKGROUND/AIMS: Research investigating the relationship between subjective and objective assessment of dysphagia in patients with various diagnoses has yielded conflicting results. The goal of this study is to investigate the reliability of patient self-perceptions of swallowing difficulties compared to expert ratings of videofluorographic studies considering three medical diagnostic categories: neurological disorders, structural deficits and general medical diagnoses. METHODS: One hundred and three patients who were referred for videofluorographic swallow evaluation were included in the study. Face-to-face interviews with patients were conducted before their videofluorographic studies. The correlation between patient self-perceptions and expert ratings of the videofluorographic studies was established by comparing the results of patients' self-reports with the results of the videofluorographic studies. RESULTS: The correlation between patient self-perceptions of swallowing difficulties and expert ratings of the videofluorographic studies varied greatly depending on the patients' medical diagnoses. The correlation was mild in patients with neurological disorders, moderate in patients with structural deficits and high in patients with general medical diagnoses. CONCLUSION: The results of this study demonstrated that patient self-perceptions of swallowing difficulties should be used as one of the criteria, but not the only one, in making referrals for further swallowing evaluation, especially in patients with neurological disorders.

Cartilage engineering using chondrocyte cell sheets and its application in reconstruction of microtia.

The imperfections of scaffold materials have hindered the clinical application of cartilage tissue engineering. The recently developed cell-sheet technique is adopted to engineer tissues without scaffold materials, thus is considered being potentially able to overcome the problems concerning the scaffold imperfections. This study constructed monolayer and bilayer chondrocyte cell sheets and harvested the sheets with cell scraper instead of temperature-responsive culture dishes. The properties of the cultured chondrocyte cell sheets and the feasibility of cartilage engineering using the chondrocyte cell sheets was further investigated via in vitro and in vivo study. Primary extracellular matrix (ECM) formation and type II collagen expression was detected in the cell sheets during in vitro culture. After implanted into nude mice for 8 weeks, mature cartilage discs were harvested. The morphology of newly formed cartilage was similar in the constructs originated from monolayer and bilayer chondrocyte cell sheet. The chondrocytes were located within evenly distributed ovoid lacunae. Robust ECM formation and intense expression of type II collagen was observed surrounding the evenly distributed chondrocytes in the neocartilages. Biochemical analysis showed that the DNA contents of the neocartilages were higher than native human costal cartilage; while the contents of the main component of ECM, glycosaminoglycan and hydroxyproline, were similar to native human costal cartilage. In conclusion, the chondrocyte cell sheet constructed using the simple and low-cost technique is basically the same with the cell sheet cultured and harvested in temperature-responsive culture dishes, and can be used for cartilage tissue engineering.

The effects of taste and consistency on swallow physiology in younger and older healthy individuals: a surface electromyographic study.

Recent studies done on healthy older individuals have demonstrated elevated taste thresholds for sweet, sour, and salty taste. At suprathreshold levels, such individuals have also shown less ability to discriminate between different intensities of the same tastant. This study was designed to provide information on swallow timing and muscle contraction intensity variables in healthy older people during swallowing of liquid and cottage cheese consistencies in 3 taste conditions (sweet, salty, and sour). Taste and consistency were incorporated in the design of this study to determine not only the effect of taste and consistency independently, but also the effects of taste and consistency in combination. Surface electromyography (EMG) at 3 sites--the orbicularis oris inferior region, submental muscle region, and infrahyoid muscle region--were included in the study. Results revealed that the start of submental muscle activation was significantly later in older participants than in younger participants. The 3 taste conditions had higher EMG levels and shorter activation times than the no-taste condition, although different taste conditions and different muscle sites were affected differently. With thicker consistency, substantially increased EMG amplitude and duration were noted for all three sites. A more pronounced effect of taste was manifested as earlier submental or infrahyoid muscle activation when the three tastants were added to a thicker consistency. Interaction of taste, consistency, and age was also noted for onset time at the submental and infrahyoid sites.

One-stage reconstruction of two atypical small concha-type microtic ears.

This report presents 2 cases of atypical small concha-type microtia, which were reconstructed with full utilization of the remnant cartilage. To repair the deformity, we harvested the 8th and 9th costal cartilage to form the helix and anthelix structure. The remnant auricular cartilage mass was retained and utilized as the base block of the framework, onto which sculptured helical rim and anthelix were added. Thus an ear of symmetrical shape, projection and visible convolutions was reconstructed. We suggest making use of the remnant cartilage to minimize the donor site morbidity, especially for mild to moderate microtia reconstruction.

Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study.

BACKGROUND: Past research has suggested that medical diagnosis and trach cuff conditions may contribute to swallow physiology changes in patients with tracheostomy. This study attempts to investigate the differences in swallow physiology between patients with trach cuff-inflated and trach cuff-deflated conditions with respect to four medical diagnostic categories: neuromuscular disorder, head and neck cancer, respiratory diseases, and general medical diagnosis. METHODS: Retrospective database analysis of videofluoroscopic study results in 623 patients with tracheostomies with trach cuff-inflated or cuff-deflated conditions. Swallow disorders were examined for each patient. RESULTS: The frequencies of reduced laryngeal elevation and silent aspiration were found to be significantly higher in the cuff-inflated condition than the cuff-deflated condition. Significant swallow physiology changes were also found to be significantly different among various medical diagnostic categories. CONCLUSIONS: It is important to evaluate changes in swallow physiology under both the trach cuff-inflated and cuff-deflated conditions to fully assess swallow function.

Surface electromyographic and electroglottographic studies in normal subjects under two swallow conditions: normal and during the Mendelsohn manuever.

Surface electromyography (EMG) has been used successfully in teaching patients swallow maneuvers in clinical settings. The present study aims to determine if surface EMG can reliably demonstrate differences in muscle activity between the normal swallow and the Mendelsohn maneuver and whether there is a close temporal relationship between submental muscles and laryngeal elevation as demonstrated by electroglottography (EGG). Surface EMG was measured from five muscle groups (superior and inferior orbicularis oris, masseter, submental and infrahyoid) in 20 normal subjects under two swallowing conditions: normal and during performance of the Mendelsohn maneuver. A significant difference in EMG activity from the submental muscle group between the normal swallow and the Mendelsohn maneuver indicates that EMG at this location can be used reliably to differentiate between these two swallow conditions. The onset of submental activity and laryngeal elevation occurred within 10 ms of each other. The offset of submental activity and the return of the larynx to its resting position occurred within 24 ms of each other. Regarding the temporal relationship among the five muscle groups, the sequence of the most frequent muscle initiation was orbicularis oris inferior. orbicularis oris superior, masseter. submental muscle group, and infrahyoid muscle group. The sequence of the most frequent muscle termination was orbicularis oris superior, orbicularis oris inferior, masseter, submental muscle group, and infrahyoid muscle group in both normal swallow and the Mendelsohn maneuver.