Quantitative non-nutritive sucking measurement as a predictor of oral feeding readiness in newborns.

Background and purpose: The purpose of this study is to examine the relationship between the parameters of a silver nanowire-based flexible pressure sensor developed to measure the non-nutritive sucking (NNS) performance and predict the nutritive sucking status in preterm infants. Methods: Preterm infants who were referred for feeding difficulty during the transition period from tubal feeding to oral feeding were enrolled in our study. A flexible pressure sensor was used to measure the non-nutritive sucking parameters of neonates. The evaluator stimulated the infants' lips and tongue with a pacifier integrated with a sucking pressure sensor, to check whether non-nutritive sucking had occurred. When the sucking reflex was induced, it was measured. The infants' sucking characteristics were subdivided into classifications according to the NOMAS criteria and full oral feeding (FOF) status. Quantitative NNS measurement according to the feeding state was compared between groups. Results: When comparing the quantitative NNS measurement by feeding characteristics, the average sucking pressure was significantly higher in infants in the FOF capable group than those in the incomplete FOF group. In addition, the maximum and average sucking pressure was significantly higher in infants with a normal sucking pattern compared to those with a disorganized sucking pattern. The average NNS pressure was divided over the range of 0-3 kPa and the same weight was assigned to each item. When the optimal cut-off value for the sensitivity and specificity of the average NNS pressure to estimate the FOF was set, a pressure of 1.5 kPa yielded the highest sensitivity (84.62%) and specificity (67.65%) on the receiver operating characteristic (ROC) curve. The area under the curve (AUC) was 0.786, and this result was statistically significant. Conclusions: This study presents a quantitative parameter for non-nutritive sucking in preterm infants with the use of a flexible pressure sensor. Results show possible quantitative indicators that can aid in predicting when preterm infants can transition to oral feeding and their prognosis. This will serve as a basis for future research on determining the feeding transition period of newborns with health conditions that affect oral feeding.

The Potential of Fluralaner as a Bait Toxicant to Control Pest Yellowjackets in California.

The western yellowjacket, Vespula pensylvanica (Saussure), is an important seasonal pest of recreational and outdoor venues in the western United States. Its propensity to scavenge food increases the likelihood of stinging incidences. Control measures are limited to intensive trapping and treating subterranean nests. The only toxicant registered for baiting in the US is esfenvalerate, which is ineffective. The objective of this study was to determine the potential of the isoxazoline fluralaner as a bait toxicant. With microsatellite genotyping, a minimum of 27 different colonies were shown to forage at a single monitoring site. Some colonies disappeared after baiting, and new colonies were detected. The implications for baiting and monitoring are discussed. Minced chicken and hydrogel baits containing 0.022% and 0.045% fluralaner significantly reduced foraging yellowjackets. Several bait applications covering large areas will be necessary to provide long-term control.

Cardiac and Pulmonary Management Status of Duchenne Muscular Dystrophy in South Korea Based on Data From the National Health Insurance Database.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the cardiac and pulmonary management status of patients with Duchenne muscular dystrophy (DMD) in South Korea based on the Korean National Health Insurance database. METHODS: This study used data of patients with code G71.0 in the National Health Information database, and also those with the special case of code V012. Cardiac function was assessed based on whether echocardiography and 24-h electrocardiography were performed, as well as the frequency of these investigations. Furthermore, information on the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB), and beta blockers (BB) in the drug benefit list was checked. Medical charge records were also checked regarding the prescription of respiratory functional assessments and treatments. RESULTS: The diagnostic criteria were met by 479 patients, with 41% of these patients receiving a cardiac evaluation, 29.8% being prescribed ACEi at 14.4±3.7 years of age, 59.5% undergoing pulmonary function tests, and 42.1% received pulmonary rehabilitation. The age at receiving ventilator support was 19.4±2.7 years. The frequency of cardiac and respiratory function tests increased with age, but the interval between tests was longer than the recent DMD care recommendations. The trend of taking ACEi, ARB, and BB for cardiac management in South Korea did not change during the study analysis period. CONCLUSIONS: The findings of this study will contribute to recognizing the current status and the importance of applying an anticipatory approach to cardiopulmonary function in DMD patients.

Corticosteroid use and bone health management for Duchenne muscular dystrophy in South Korea.

This study aimed to determine the current corticosteroid use and bone health management status of patients with Duchenne muscular dystrophy (DMD) in South Korea. This is a national population-based study utilized information from the databased of Korean National Health Insurance Database. Database regarding bone status, spine radiography findings, bone mineral density, and laboratory test results were obtained, as well as the proportion of patients with spine and lower limb prostheses, occurrence of scoliosis, and age at scoliosis surgery. Deflazacort dose in the ambulant group (aged < 15 years) increased by age and year. The maintenance dose of prednisolone and deflazacort for the 15-19 years group decreased by year. Among the patients, 12.47% underwent spine radiography, 23.11% underwent dual-energy X-ray absorptiometry, and 22.7% underwent vitamin D tests. Moreover, 40.9% of the patients were prescribed vitamin D at a mean age of 14.6 ± 6.1 years, while 10.22% were prescribed bisphosphonate at 17.92 ± 3.4 years. Further, 16.1% of the patients underwent posterior spinal instrumentation and fusion at 14.4 ± 2.3 years and 5.3% underwent anterior spinal instrumentation and fusion at 14.4 ± 2.3 years. Ankle-foot orthosis and spine orthosis prescriptions were noted in 4.91% and 1.84% of patients, respectively. In this our study, the current corticosteroid use and bone health management status of DMD in South Korea has been presented. The dose prescription for corticosteroid and bone health monitoring did not reach to current recommendation.

Is Age-Predicted Maximal Heart Rate Applicable in Patients With Heart or Lung Disease?

OBJECTIVE: To compare the predicted and actual maximal heart rate (HRmax) values in the cardiopulmonary exercise test (CPET). METHODS: We retrospectively investigated 1,060 patients who underwent a CPET between January 2016 and April 2020 at our institution's cardiopulmonary rehabilitation center. The following patients were included: those aged >20 years, those tested with a treadmill, and those who underwent symptom-limited maximum exercise testing- reaching ≥85% of the predicted HRmax (62% if taking beta-blockers) and highest respiratory exchange ratio ≥1.1. Ultimately, 827 patients were included in this study. Data on diagnosis, history of taking beta-blockers, age, body mass index (BMI), and CPET parameters were collected. Subgroup analysis was performed according to age, betablockers, BMI (low <18.5 kg/m2, normal, and high ≥25 kg/m2), and risk classification. RESULTS: There was a significant difference between the actual HRmax and the predicted value (p<0.001). Betablocker administration resulted in a significant difference in the actual HRmax (p<0.001). There were significant differences in the moderate-to-high-risk and low-risk groups and the normal BMI and high BMI groups (p<0.001). There was no significant difference between the elderly and younger groups. We suggest new formulae for HRmax of cardiopulmonary patients: estimated HRmax=183-0.76×age (the beta-blocker group) and etimated HRmax=210-0.91×age (the non-beta-blocker group). CONCLUSION: Age-predicted HRmax was significantly different from the actual HRmax of patients with cardiopulmonary disease, especially in the beta-blocker group. For participants with high BMI and moderate-tosevere risk, the actual HRmax was significantly lower than the predicted HRmax.

The Korean-Lung Information Needs Questionnaire: Translation, validation and clinical implications in comprehensive pulmonary rehabilitation.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and persistent respiratory symptoms. Several symptom-related questionnaires have been validated to improve understanding for patient with COPD. We aimed to systematically translate the English version of the Lung Information Needs Questionnaire (LINQ) into Korean and to verify the reliability, validity and clinical implications in comprehensive pulmonary rehabilitation (PR). METHODS: The original version of LINQ was translated into Korean by two translators and reviewed by the translation committee. It was then reverse translated back into English. The committee compared the reconciled version in Korean and the original version in English. A cognitive debriefing was performed on the pre-final version, and a final version, K-LINQ, was obtained. A test-retest method for the analysis of reliability was performed within 2 weeks. Concurrent validity analysis was performed using Pearson correlation test of the K-LINQ and other evaluation tools. RESULTS: A total of 110 patients were enrolled. The length, readability, understanding and suitability of the questionnaire rated well in scores for face validity of 52 Korean patients with COPD. No significant correlation was derived from the total K-LINQ and each domain with other scales such as mMRC, K-CAT and K-LCADL. The intra-class correlation coefficient of total score K-LINQ showed high reliability. Patients who attended PR showed significantly poor pulmonary function or more severe symptoms. In addition, a significantly lower score in total score and exercise domain of K-LINQ were confirmed in the group of PR attendees. CONCLUSIONS: We translated the LINQ into Korean, implemented cross-cultural adaptation and verified its validity and reliability. K-LINQ can now be useful in various clinical and research fields in the Republic of Korea and could serve a complementary role and become an axis of successful treatment strategies, including a comprehensive PR programme.

Successfully Managed Respiratory Insufficiency in a Patient with a Novel Pathogenic Variant of the BMPER Gene: A Case Report.

Bone morphogenetic protein-binding endothelial cell precursor-derived regulator (BMPER) gene mutation presents a disease spectrum ranging from a mild type of ischiospinal dysostosis (ISD) to a more severe type of diaphanospondylodysostosis (DSD). It is known that BMPER gene mutations are very rare, and their resulting clinical manifestations, including musculoskeletal modifications, appear in a spectrum of various types and severity levels. With the development of genetic diagnosis, case reports of patients with specific mutations in the BMPER gene have been published. The most commonly known clinical features are kidney structural problems, including neuroblastoma and renal cysts. Meanwhile, respiratory failure is a common and fatal symptom for patients with BMPER gene mutation, but it does not appear to have been well evaluated or managed so far. We report a case of a confirmed novel mutation of c.1750delT (p.Cys584fs) in the BMPER gene in a female adolescent patient and highlight the importance of the regular assessment of respiratory failure for successful management of this condition.

Gold Standard? Method of Citric Acid Solution Swallowing Test as a Screening Test for Patients with Tracheostomy.

This study aimed to apply various ranges of citric acid levels in the mouth and T-cannula to compare the validity with instrumental aspiration measures in patients with tracheostomy. Sixty-one patients underwent the citric acid cough reflex test (CRT) and videofluoroscopic swallowing study (VFSS). Citric acid was delivered via facemask and T-cannula at concentrations of 0.4 mol/L, 0.6 mol/L, and 0.8 mol/L. Further, we recorded the coughing count and presence of ≥ 2 (C2) and ≥ 5 (C5) coughs. CRT via facemask at 0.4 mol/L C2, 0.6 mol/L C5, and 0.8 mol/L C2 and C5 were significantly associated with the presence of tracheal aspiration during VFSS. The sensitivity and specificity were optimized at 0.8 mol/L C2 for mouth inhalation and at 0.8 mol/L C5 for T-cannula inhalation. There was a significant difference in the coughing count during CRT at 0.4 mol/L and 0.8 mol/L via mouth inhalation between patients with or without tracheal aspiration, but not via T-cannula. The AUC for 0.8 mol/L facemask inhalation was 0.701. The optimal cut-off value of coughing count was thrice with 84.62% sensitivity and 50.00% specificity on the ROC curve. Afferent sensory nerve desensitization around and below the tracheostomy site could affect coughing reflex initiation and decrease the sensitivity of detecting aspiration in tracheotomized patients. The citric acid CRT via facemask can reliably detect tracheal aspiration and presence of coughing reflex compared to that via T-cannula in patients with tracheostomy.

What is the Adequate Cuff Volume for Tracheostomy Tube? A Pilot Cadaver Study.

OBJECTIVE: To determine the patterns of tracheostomy cuff pressure changes with various air inflation amounts in different types of tracheostomy tubes to obtain basic data for appropriately managing long-term tracheostomy. METHODS: We performed tracheostomy on a 46-year-old male cadaver. Three types of tracheostomy tubes (single-cuffed, double-cuffed, and adjustable flange), divided into 8 different subtypes based on internal tube diameters and cuff diameters, were inserted into the cadaver. Air was inflated into the cuff, and starting with 1 mL air, the cuff pressure was subsequently measured using a manometer. RESULTS: For the 7.5 mm/14 mm tracheostomy tube, cuff inflation with 3 mL of air yielded a cuff pressure within the recommended range of 20-30 cmH2O. The 7.5 mm/24 mm tracheostomy tube showed adequate cuff pressure at 5 mL of air inflation. Similar values were observed for the 8.0 mm/16 mm and 8.0 mm/27 mm tubes. Double-cuffed tracheostomy cuff pressures (7.5 mm/20 mm and 8.0 mm/20 mm tubes) at 3 mL air inflation had cuff pressures of 18-20 cmH2O at both the proximal and distal sites. For the adjustable flange tracheostomy tube, cuff pressure at 6 mL of cuff air inflation was within the recommended range. Maximal cuff pressure was achieved at inflation with almost 14 mL of air, unlike other tube types. CONCLUSION: Various types of tracheostomy tubes showed different cuff pressures after inflation. These values might aid in developing guidelines For patients who undergo tracheostomy and are discharged home without cuff pressure manometers, this standard might be helpful to develop guidelines.

Serum Metabolic Profiling Reveals Potential Anti-Inflammatory Effects of the Intake of Black Ginseng Extracts in Beagle Dogs.

Black ginseng (BG) has better health benefits than white ginseng. The intake of BG changes the levels of metabolites, such as amino acids, fatty acids, and other metabolites. However, there is no research on the effect of BG extract intake on the metabolic profile of dog serum. In this study, serum metabolic profiling was conducted to investigate metabolic differences following the intake of BG extracts in beagle dogs. The beagle dogs were separated into three groups and fed either a regular diet (RD, control), RD with a medium concentration of BG extract (BG-M), or RD with a high concentration of BG extract (BG-H). Differences were observed among the three groups after the dogs ingested the experimental diet for eight weeks. The concentrations of alanine, leucine, isoleucine, and valine changed with the intake of BG extracts. Furthermore, levels of glycine and ß-alanine increased in the BG-H group compared to the control and BG-M groups, indicating that BG extracts are associated with anti-inflammatory processes. Our study is the first to demonstrate the potential anti-inflammatory effect of BG extract in beagle dogs. Glycine and ß-alanine are proposed as candidate serum biomarkers in dogs that can discriminate between the effects of ingesting BG-H.

Effects of Queso Blanco cheese containing Bifidobacterium longum KACC 91563 on fecal microbiota, metabolite and serum cytokine in healthy beagle dogs.

The study describes the effects of administration of Queso Blanco cheese containing Bifidobacterium longum on the fecal microbiota, metabolite and serum cytokine in healthy beagle dogs. Twelve healthy beagle dogs were randomly divided in three groups of four dogs each:a control group, not fed with any cheese, and groups fed with Queso Blanco cheese with B. longum KACC 91563 (QCB) or without B. longum (QC) for 8 weeks. Fecal microbiota was analyzed using a culture-based method and 16s rRNA gene sequencing. Serum cytokine levels, activation of natural killer cells, and proliferation of peripheral blood mononuclear cells were determined. SPME-GC-MS method was used to determine the concentrations of short chain fatty acids and indole in dog feces. Administration of QCB for 4 weeks significantly increased the Bifidobacterium. QCB supplementation for 8 weeks reduceds Enterobacteriaceae and Clostridium perfringens (p < 0.05). The abundance of Fusobacterium, Blautia and Collinesella in QCB group were reduced as compared with the control group. Serum TNF-α and IL-6 levels at 8 weeks significantly increased in QCB group as compared with QC group. There was no change in the concentrations of total short chain fatty acids by B. longum at 0 and 4 weeks. At week 8, the acetic acid, propionic acid and butyric acid of the QCB and QC groups were significantly decreased compared to the control group. In conclusion, our results demonstrate that administration of QCB had positive effects on fecal microbiota and immune response in beagle dogs. We suggest that Queso Blanco cheese containing B. longum KACC 91563 could be used as a functional food for companion animals.

Investigations on Metabolic Changes in Beagle Dogs Fed Probiotic Queso Blanco Cheese and Identification of Candidate Probiotic Fecal Biomarkers Using Metabolomics Approaches.

Intake of probiotic cheese improves the intestinal health of humans and animals. However, metabolic changes in the intestines of dogs in response to the ingestion of probiotic cheese have not been evaluated. Thus, we aimed to determine the metabolic changes in healthy beagle dogs fed queso blanco cheese with added Lactobacillus reuteri KACC 92293 and Bifidobacterium longum KACC 91563 (QCLB) and to identify potential fecal biomarkers to distinguish the metabolic changes based on intake of probiotic cheese through metabolomics approaches. The dogs were randomly divided into three groups and fed a regular diet without any cheese (control), a diet with queso blanco cheese (QC), or one with QCLB for eight weeks. The concentrations of acetic, propionic, and 4-aminobutyric acids were increased in the QCLB group compared to those in the control group. Additionally, higher levels of propionic acid and lower levels of xylose were found in the QCLB group compared to those in the QC group. This is the first report on the identification of metabolic changes in beagle dogs fed queso blanco cheese with added L. reuteri KACC 92293 and B. longum KACC 91563. We also found that metabolomics approaches can be useful for identifying potential fecal markers in dogs fed probiotic cheese.

Two Pediatric Cases of Successful Management of Postictal Transient Urinary Retention.

We report two cases of postictal urinary retention in pediatric patients with cognitive impairment. Two girls with intellectual disabilities, concomitant cerebral palsy (case 1) and Rett syndrome (case 2), developed urinary retention following seizures. Their caregivers brought them to the hospital with complaints of abdominal distension. After excluding neurological progression, they were referred to the rehabilitation clinic for the evaluation and management of postictal urinary retention. We followed two different approaches in each case to restore normal urination. While serial manual cystometrograms were performed in case 1, clean intermittent catheterization with a voiding diary was performed in case 2 until restoration of normal urination. Based on these pediatric cases of successfully managed postictal urinary retention, we suggest that more attention may be needed for children with cognitive impairment to diagnose and manage postictal urinary retention.

Virulence and antimicrobial resistance profiles of Escherichia coli encoding mcr gene from diarrhoeic weaned piglets in Korea during 2007-2016.

OBJECTIVE: This study aimed to analyse the presence of mcr genes and virulence genes in Escherichia coli (E. coli) isolates from diarrhoeic piglets between 2007-2016 in Korea. METHODS: A total of 364 E. coli isolates were obtained from diarrhoeic weaned piglets between 2007-2016. Minimum inhibitory concentrationss were determined according to the Clinical and Laboratory Standards Institute (CLSI). DNA samples were tested for the presence of mcr-1, mcr-2 and mcr-3 genes. Furthermore, multiplex PCR was used to detect toxin, fimbrial and non-fimbrial adhesin genes. RESULTS: It was found that 2.5% (nine of 364) of the isolates carried the mcr genes. Four isolates carried the mcr-1 gene and eight isolates had the mcr-3 gene. Three isolates carried both mcr-1 and mcr-3 genes; the mcr-2 gene was not found. All isolates carrying mcr genes were multidrug-resistant. F18 (77.8%, seven of nine) and Stx2e (44.4%, four of nine) were frequently detected in E. coli carrying the mcr gene. CONCLUSIONS: In conclusion, it would appear that the most prevalent mcr gene of E. coli from diarrhoeic weaned piglets in Korea was mcr-3. It is believed that this is the first report of two plasmid-mediated colistin resistance genes - mcr-1 and mcr-3 - coexisting in the same isolates (0258, 0491, 0516) from piglets with diarrhoea in Korea. Those mcr-positive isolates showed multidrug resistance and the majority of those encoded Stx2e and F18. This indicates the risk of inefficient treatment for oedema disease in weaned piglets.

Effects of Weissella cibaria CMU on Halitosis and Calculus, Plaque, and Gingivitis Indices in Beagles.

Weissella (W.) cibaria strain Chonnam Medical University (CMU) has shown oral colonizing ability and inhibitory effects on the formation of volatile sulfur compounds (VSCs) in vitro studies. The present study was conducted to analyze the effects of the W. cibaria CMU on canine oral health. Halitosis, calculus, plaque, gingivitis, and intraoral microbiota were assessed in 3 groups: control (maltodextrin), W. cibaria CMU low concentration (CMU-L, 2 × 107 colony forming unit [CFU]), and high-concentration (CMU-H, 2 × 109 CFU). Halitosis was analyzed using both organoleptic evaluation and measurement of VSCs. Intraoral microbiota were analyzed by real-time polymerase chain reaction. From week 4, the total VSC level in the CMU-H group (4.0 ± 1.30 ng/10 mL) was significantly lower than in the control group (6.3 ± 2.28 ng/10 mL). Significant reduction in methyl mercaptan in the CMU-treated groups was also observed. In addition, the plaque index in the CMU-treated groups was significantly decreased. The CMU-treated groups showed significant decreases in Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia and demonstrated the colonizing ability of W. cibaria CMU in the oral cavity. We demonstrated that W. cibaria CMU suppresses halitosis, colonizes the oral cavity, and inhibits the proliferation of malodor-causing oral bacteria in beagles. According to these results, we expect that W. cibaria CMU could be a new oral hygiene solution by reducing VSC production and inhibiting the growth of oral harmful bacteria in companion animals.

Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients.

OBJECTIVE: To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement. METHODS: A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured. RESULTS: Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018). CONCLUSION: We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.

The immune-modulating effects of viable Weissella cibaria JW15 on RAW 264.7 macrophage cells.

The objective of this study is to investigate the immune-enhancing ability of viable and heat-killed Weissella cibaria JW15 (JW15) isolated from Kimchi in RAW 264.7 macrophages. The immune effects were evaluated by measuring the production of NO, cytokines, inflammatory enzyme, and activation of NF-κB. Viable JW15 executed higher activity on stimulating the release of TNF-α as well as activating NF-κB compared to that of heat-killed JW15. Additionally, viable and heat-killed JW15 significantly increased the production of NO, IL-6 and TNF-α more than that of Lactobacillus rhamnosus GG (LGG). Furthermore, viable JW15 induced higher production of iNOS compared with that of viable LGG. Collectively, our finding indicates that viable JW15 had similar, if not more, immune-enhancing activities as heat-killed JW15. In addition, viable JW15 had higher immune-enhancing activity than commercial strain LGG. Therefore, viable JW15 has the potential to be used as a functional food to improve the host immune response.

Pharyngeal Dystonia Misdiagnosed as Cricopharyngeal Dysphagia Successfully Treated by Pharmacotherapy.

A 43-year-old woman suffered from drooling and dysphagia after a stroke in the left posterior inferior cerebellar artery territory. Videofluoroscopic swallowing study showed compatible findings of cricopharyngeal dysphagia. Despite the injection of botulinum neurotoxin, no symptom improvement was achieved and pharyngeal dystonia was considered as the cause. Medications for dystonia dramatically helped with saliva control and resulted in a small improvement in the progression of food from the pharyngeal to esophageal phase. After adjusting the drug dose, the patient was able to perform social activities without drooling. Moreover, she could consume food orally; however, this was limited to small amounts of liquid, and the main method of nutrition support was via an orogastric tube. Therefore, we suggest that physicians should make a differential diagnosis of combined dystonia in patients complaining of dysphagia by esophageal manometry and electromyography.

Secondary Lymphedema After Intestinal Tuberculosis: A Case Report.

Lymphedema, a chronic disease that lowers patients' quality of life, is categorized as primary or secondary. Secondary lymphedema can be improved by treating the underlying cause. However, in many cases, efforts are not made to identify the primary cause of lymphedema and treatment is targeted at the edema itself, resulting in misdiagnosis. Here, we describe the case of a 61-year-old man with right leg edema of unknown cause that had persisted for 3 years. Intestinal tuberculosis was confirmed during a re-evaluation of the cause, and his symptoms improved after anti-tuberculous treatment. This improvement was assessed qualitatively by indocyanine green lymphography before and after treatment, as well as by observation of the clinical symptoms. Lower extremity lymphedema caused by intestinal tuberculosis is extremely rare, and this case reveals the importance of continuing to identify the causes of resistant pathologies.

Revisiting respiratory muscle strength and pulmonary function in spinal cord injury: The effect of body positions.

OBJECTIVES: In the subjects with high cervical spinal cord injury (SCI), The difference of respiratory muscle strength and pulmonary function according to supine and sitting position were investigated whether there are changes in the tendency. METHODS: Twenty-three subjects with high cervical SCI and 23 subjects with low cervical and thoracic SCI were evaluated. The reference neurological level of injury for dividing the groups was fifth cervical vertebrae (C5). SCI severity was classified as motor-complete SCI. The supine and sitting forced vital capacity (FVC), percent of the predicted FVC (FVC%), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP), MEP / MIP ratio, and peak cough flow (PCF) were compared. RESULTS: The significantly higher FVC, FVC% in the low cervical and thoracic SCI group was identified in the supine position than the sitting position. The same tendency was observed in the high cervical SCI group. In the comparison of respiratory muscle strength, higher values of supine MEP and MIP were found only in the high cervical SCI group. PCF is more positively correlated with MIP than with MEP in all groups. CONCLUSION: We found that the supine position is more advantageous for the strong breathing and larger lung capacity in patients with high cervical SCI. The positive correlation between PCF and MIP in the patients with high cervical SCI was also confirmed. These results may be used to establish a pulmonary rehabilitation strategy for patients with high cervical SCI.