Oropharyngeal Dysphagia in children: mechanism, source, and management.

Oropharyngeal dysphagia (OPD) is a challenging and relatively common condition in children. Both developmentally normal and delayed children may be affected. The etiology of OPD is frequently multifactorial with neurologic, inflammatory, and anatomic conditions contributing to discoordination of the pharyngeal phase of swallowing. Depending on the severity and source, OPD may persist for several years with significant burden to a patient's health and family. This article details current understanding of the mechanism and potential sources of OPD in children while providing an algorithm for managing it in the acute and chronic setting.

Pharyngeal dysphagia in children with Down syndrome.

OBJECTIVE: Pharyngeal dysphagia (PD) in children with Down syndrome (DS) has not been examined. This study aims to describe the incidence, duration, and precipitating factors of PD in a large cohort of children with DS. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care children's hospital. METHODS: The International Classification of Diseases, Ninth Revision (ICD-9) code for DS was used to identify all children treated at a single institution from 1992 to 2012. Patient charts were reviewed for signs, symptoms, and documentation of PD. Videofluoroscopic swallow studies (VFSS) established the final diagnosis of PD in affected patients. Otolaryngologic interventions and their impact on PD were also explored. RESULTS: A total of 228 patients with the ICD-9 code for DS were found. Twenty-seven patients (11.8%) were excluded due to record deficiencies. Thus, of the 201 children with DS who were available for complete review, 116 (57.7%) had and established diagnosis of PD by VFSS. The mean age at first diagnosis of PD was 1.69 years. At the time of the study, the cohort mean age was 7.45 years, with only 20 patients demonstrating resolution of PD. Patients with a tracheotomy or significant neurologic delays were more likely to have worsening or prolonged PD. Laryngeal clefts were identified in 3 patients, whereas 78 (67%) underwent surgery for upper airway obstruction that did not consistently improve PD. CONCLUSION: This study suggests that PD is common, persistent, and should be routinely explored in children with DS. Intervention for upper airway obstruction had a limited role for PD in this study cohort.

Quantification of cardiolipin molecular species in Escherichia coli lipid extracts using liquid chromatography/electrospray ionization mass spectrometry.

RATIONALE: Cardiolipin (CL), a glycerophospholipid containing four acyl chains, is found in most organisms including Gram-negative bacteria such as Escherichia coli. While CL composes only a fraction of the total glycerophospholipids, the four acyl chains lead to a large number of possible molecular species as defined by the total number of carbons and unsaturations in the acyl chains. Understanding the molecular composition of CL, and how it changes under different growth conditions, will aid in understanding the complex role of CL in E. coli. METHODS: Normal-phase liquid chromatography/electrospray ionization mass spectrometry was used to quantify the CL molecular species (as defined by the total number of carbons:unsaturations in the acyl chains) in lipid extracts prepared from E. coli grown at 15 °C, 30 °C, 37 °C and 42 °C. RESULTS: Fifty-six different CL species were identified as [M-2H](2-) ions in E. coli lipid extracts ranging from 60:0 to 72:4. CL species with an increased total number of unsaturations were more abundant in lipid extracts prepared from cells grown at 15 °C as compared to higher temperatures. CONCLUSIONS: This work characterizes the CL composition of E. coli cells grown at various temperatures. By quantifying CL species at a molecular level we have illuminated the molecular complexity of the CL in this relatively simple model organism. This data will be useful for understanding CL function in E. coli and other organisms.