Temporal Analysis of Factors Associated with EAT-10 in Outpatients with Oropharyngeal Dysphagia from a Tertiary Care Clinic.

Self-perception of disease is increasingly recognized as a determinant of health. The Eating Assessment Tool-10 (EAT-10) is a functional health status questionnaire that measures the symptomatic severity of dysphagia from the patient's perspective. The objective of this work was to identify factors (demographics, clinical variables, swallowing physiology, health-related quality of life) associated with longitudinal change in EAT-10 scores in outpatients with oropharyngeal dysphagia at a multi-disciplinary, tertiary care clinic. All patients with swallowing concerns that were included in the UW Madison Voice and Swallowing Outcomes database from 12/2012 to 04/2015 were invited to complete EAT-10 and a general health-related quality of life survey (SF-12v2) at their initial evaluation and six months later. Forty-two patients were included in analysis (n = 42). Weaning from a gastrostomy tube was significantly associated with EAT-10 improvement. Approximately 70% of the sample had mild dysphagia, and floor effects were observed for all EAT-10 items in this sample subset. Mean SF-12v2 Physical Component Summary score was substantially lower than that of the general population. Significant, weak-moderate correlations were found between EAT-10 and SF-12v2 scores for all comparisons except for Physical Health Composite at six months (rs = = 0.24 to - 0.43). Weaning from a feeding tube appears to meaningfully improve self-perceived symptoms of dysphagia. Given the floor effects observed, validity of EAT-10 for patients with mild dysphagia should be examined. Future research should address contributors to self-perceived symptom change across the range of dysphagia severity.

Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment.

BACKGROUND: Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison. METHODS: Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (RT-PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist. RESULTS AND DISCUSSION: Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]ß1, alpha smooth muscle actin, interleukin-1ß, interleukin-17ß and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC-treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair.

At the crossroads: mucosal immunology of the larynx.

The larynx sits at the crossroads between gastrointestinal and respiratory tracts. Besides its intrinsic importance in breathing, swallowing and voice production, the larynx is also exposed to unique immunological challenges. Given the propensity of chronic inflammatory conditions such as chronic laryngitis, which affects up to 20% of Western populations, it is surprising that our understanding of the immunology of this organ remains relatively limited. Recent work on the immunological architecture of the laryngeal mucosa, and its changes that result from external challenges and inflammatory conditions, provided valuable insight into the fascinating immunology of this organ. The lessons learnt from these investigations may go beyond devising improved therapy for chronic laryngeal inflammation. Establishing whether and how the laryngeal mucosa may be involved in the modulation of wider mucosal responses may provide novel routes to the treatment of inflammatory diseases of the respiratory and alimentary tracts such as asthma and inflammatory bowel disease.

Fine needle aspiration: a novel application in laryngology.

Fine needle aspiration (FNA) has had an early start in medicine and has been heavily used in the United States since the 1980s. It is regarded as a highly effective means to sample mass lesions, serving as the first diagnostic procedure in many instances. FNA is safe, less invasive than biopsy, and reduces the risk of scar formation. Its main limitations can be overcome through effective training and practiced technique. In laryngology, the development of new and diversified therapeutic and diagnostic strategies depends on the development of equally appropriate diagnostic tools. FNA has the potential to be a relatively easy procedure that can be performed under local anesthesia, increasing the otolaryngologist's armamentarium. Combining the FNA procedure with technology now available, secondary to advances in genomic science, rather than cytology and H&E stains, provides the means of obtaining clinically useful information about benign and malignant disease for clinicians and researchers. This paper provides a review of the traditional FNA procedure. It offers an introduction to the future applicability of FNA to office-based laryngology. Lastly, this paper familiarizes the reader with the genomic principles being used for this procedure.

Microvascular radial forearm fasciocutaneous free flap in hard palate reconstruction.

THE AIM OF THIS STUDY: To report the reconstruction of palatal defects by microvascular radial forearm fasciocutaneous free flap (RFFF) and to report patient's quality of life outcomes after this procedure. MATERIAL AND METHODS: During the period 1990-2002, 30 cases of palatal defects were reconstructed using RFFF in our institution. RFFF allowed restoration of a vestibular sulcus to maintain dental prostheses. Outcome measurements included post-operative assessment of speech, swallowing and diet evaluation 6 months, 1 year and 2 years after reconstruction. Quality of life outcomes were measured 1 and 2 years post-reconstruction. RESULTS: RFFF surgery was successful in 28 cases. Six months after resection 28 patients reported satisfactory speech and swallowing. Two years after surgery, 92% (n=26) of patients resumed a normal diet. All patients underwent dental evaluation and 68% (n=19) of patients required dental rehabilitation over a post-operative period of 3-18 months. Patients self assessed their quality of life on a scale of 0-2. First year post-operatively, 21 patients reported a good quality of life (score=2). After the second year, 26 patients reported a good quality of life and the remaining two patients reported an intermediate quality of life (score=1) because they did not resume a normal diet. CONCLUSION: RFFF for palatal reconstruction is a reliable technique and provides a definitive separation between oral and sinusonasal cavities. Furthermore, it improves quality of life by improving speech, swallowing and chewing. It should be considered an integral component of head and neck cancer therapy and rehabilitation.

Issues in deep space radiation protection.

The exposures in deep space are largely from the Galactic Cosmic Rays (GCR) for which there is as yet little biological experience. Mounting evidence indicates that conventional linear energy transfer (LET) defined protection quantities (quality factors) may not be appropriate for GCR ions. The available biological data indicates that aluminum alloy structures may generate inherently unhealthy internal spacecraft environments in the thickness range for space applications. Methods for optimization of spacecraft shielding and the associated role of materials selection are discussed. One material which may prove to be an important radiation protection material is hydrogenated carbon nanofibers.

Radiation protection using Martian surface materials in human exploration of Mars.

To develop materials for shielding astronauts from the hazards of GCR, natural Martian surface materials are considered for their potential as radiation shielding for manned Mars missions. The modified radiation fluences behind various kinds of Martian rocks and regolith are determined by solving the Boltzmann equation using NASA Langley's HZETRN code along with the 1977 Solar Minimum galactic cosmic ray environmental model. To develop structural shielding composite materials for Martian surface habitats, theoretical predictions of the shielding properties of Martian regolith/polyimide composites has been computed to assess their shielding effectiveness. Adding high-performance polymer binders to Martian regolith to enhance structural properties also enhances the shielding properties of these composites because of the added hydrogenous constituents. Heavy ion beam testing of regolith simulant/polyimide composites is planned to validate this prediction. Characterization and proton beam tests are performed to measure structural properties and to compare the shielding effects on microelectronic devices, respectively.

Creation and utilization of a World Wide Web based space radiation effects code: SIREST.

In order for humans and electronics to fully and safely operate in the space environment, codes like HZETRN (High Charge and Energy Transport) must be included in any designer's toolbox for design evaluation with respect to radiation damage. Currently, spacecraft designers do not have easy access to accurate radiation codes like HZETRN to evaluate their design for radiation effects on humans and electronics. Today, the World Wide Web is sophisticated enough to support the entire HZETRN code and all of the associated pre and post processing tools. This package is called SIREST (Space Ionizing Radiation Effects and Shielding Tools). There are many advantages to SIREST. The most important advantage is the instant update capability of the web. Another major advantage is the modularity that the web imposes on the code. Right now, the major disadvantage of SIREST will be its modularity inside the designer's system. This mostly comes from the fact that a consistent interface between the designer and the computer system to evaluate the design is incomplete. This, however, is to be solved in the Intelligent Synthesis Environment (ISE) program currently being funded by NASA.

Approach and issues relating to shield material design to protect astronauts from space radiation.

One major obstacle to human space exploration is the possible limitations imposed by the adverse effects of long-term exposure to the space environment. Even before human spaceflight began, the potentially brief exposure of astronauts to the very intense random solar energetic particle (SEP) events was of great concern. A new challenge appears in deep space exploration from exposure to the low-intensity heavy-ion flux of the galactic cosmic rays (GCR) since the missions are of long duration and the accumulated exposures can be high. Since aluminum (traditionally used in spacecraft to avoid potential radiation risks) leads to prohibitively expensive mission launch costs, alternative materials need to be explored. An overview of the materials related issues and their impact on human space exploration will be given.

Shielding against galactic cosmic rays.

Ions of galactic origin are modified but not attenuated by the presence of shielding materials. Indeed, the number of particles and the absorbed energy behind most shield materials increases as a function of shield thickness. The modification of the galactic cosmic ray composition upon interaction with shielding is the only effective means of providing astronaut protection. This modification is intimately connected with the shield transport properties and is a strong function of shield composition. The systematic behavior of the shield properties in terms of microscopic energy absorption events will be discussed. The shield effectiveness is examined with respect to conventional protection practice and in terms of a biological endpoint: the efficiency for reduction of the probability of transformation of shielded C3H10T1/2 mouse cells. The relative advantage of developing new shielding technologies is discussed in terms of a shield performance as related to biological effect and the resulting uncertainty in estimating astronaut risk.

Issues in protection from galactic cosmic rays.

Radiation risks to astronauts depend on the microscopic fluctuations of energy absorption events in specific tissues. These fluctuations depend not only on the space environment but also on the modifications of that environment by the shielding provided by structures surrounding the astronauts and the attenuation characteristics of the astronaut's body. The effects of attenuation within the shield and body depends on the tissue biological response to these microscopic fluctuations. In the absence of an accepted method for estimating astronaut risk, we examined the attenuation characteristics using conventional linear energy transfer (LET)-dependent quality factors (as one means of representing relative biological effectiveness, RBE) and a track-structure repair model to fit cell transformation (and inactivation) data in the C3H10 T1/2 mouse cell system obtained for various ion beams. Although the usual aluminum spacecraft shield is effective in reducing dose equivalent with increasing shield thickness, cell transformation rates are increased for thin aluminum shields. Clearly, the exact nature of the biological response to LET and track width is critical to evaluation of biological protection factors provided by a shield design. A significant fraction of biological injury results from the LET region above 100 keV/mu m. Uncertainty in nuclear cross-sections results in a factor of 2-3 in the transmitted LET spectrum beyond depths of 15 g/cm2, but even greater uncertainty is due to the combined effects of uncertainty in biological response and nuclear parameters. Clearly, these uncertainties must be reduced before the shield design can be finalised.

Issues in space radiation protection: galactic cosmic rays.

When shielding from cosmic heavy ions, one is faced with limited knowledge about the physical properties and biological responses of these radiations. Herein, the current status of space shielding technology and its impact on radiation health is discussed in terms of conventional protection practice and a test biological response model. The impact of biological response on optimum materials selection for cosmic ray shielding is presented in terms of the transmission characteristics of the shield material. Although liquid hydrogen is an optimum shield material, evaluation of the effectiveness of polymeric structural materials must await improvement in our knowledge of both the biological response and the nuclear processes.

Formulating a restraint use policy.

When the federal government notified Canadian hospital administrators that several deaths had resulted from improper application of physical restraints, we decided to examine our nursing practice in relation to restraint use. The government communiqué indicated that at any one time, up to 10% of a hospital's patient population may be using some form of restraint. A hospital-wide survey indicated that 13.2% of our patients were managed with physical restraints and that insufficient documentation occurred. This was interpreted as a significant clinical-administrative problem and we recognized the need for a formal policy. Other adult care facilities can benefit from our experience in solving this dilemma.