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Development of a System to Monitor Laryngeal Movement during Swallowing Using a Bend Sensor  [PDF]
Qiang Li, Kazuhiro Hori, Yoshitomo Minagi, Takahiro Ono, Yong-jin Chen, Jyugo Kondo, Shigehiro Fujiwara, Kenichi Tamine, Hirokazu Hayashi, Makoto Inoue, Yoshinobu Maeda
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0070850
Abstract: Background Swallowing dysfunction (also known as dysphagia), which results in a deterioration of nutritional intake, slows rehabilitation and causes aspiration pneumonia, is very common following neurological impairments. Although videofluorographic (VF) examination is widely used for detecting aspiration, an objective and non-invasive method for assessing swallowing function has yet to be established because of a lack of adequate devices and protocols. In this paper, a bend sensor whose resistance is altered by bending was introduced to monitor swallowing-related laryngeal movement. Methods Six healthy male volunteers were recruited in the present study. Specific time points on the signal waveform produced by the bend sensor were defined to describe laryngeal movement by differential analysis. Additionally, the physiological significance of the obtained waveform was confirmed by analyzing the sequential correlations between the signal waveform from the bend sensor and hyoid bone kinetics simultaneously recorded by VF. Results Seven time points were successfully defined on the signal waveform to reference laryngeal movement. Each time point was well correlated with certain VF events, with evidence of no significant time lags, and there were positive correlations between waveform time points and matched VF events. Furthermore, obvious similarities were noticed between the duration of each phase on the signal waveform and the duration of the matched hyoid bone activity. Conclusions The present monitoring system using a bend sensor might be useful for observing the temporal aspects of laryngeal movement during swallowing, and it was well coordinated with hyoid bone movement.
Physiological Changes In Oropharyngeal Swallowing With Age:An Electrophysiological Study  [PDF]
Journal of Neurological Sciences , 2007,
Abstract: It is important to distinguish the effects of normal aging on oropharyngeal swallowing from many disorders which may lead to dysphagia. The purpose of this study was to determine the neurophysiological alterations of normal aging on the oropharyngeal swallowing in normal subjects with different age groups.We studied three different age groups, a total of 110 healthy volunteers with an age range between 17 and 81 years by using electrophysiological methods. The EMG activity of submental / suprahyoid muscles (SM-EMG) and mechanical upward and downward laryngeal movements were recorded during dry and wet (3 ml water) swallowing. By this method, the total duration and the amplitude of SM-EMG, the time of upward displacement of the larynx, swallowing variability (jitter) and A-0 interval (an interval related to triggering of the swallowing reflex) were measured from subjects of the three different age groups.All parameters were influenced by advanced age. Several parameters, including total duration of SM-EMG, time necessary for triggering of the swallowing reflex and swallowing variability were significantly increased in the oldest age group compared with those in the younger age groups. It was also found that the delay in triggering the pharyngeal stage of swallowing is one of the important parameters that altered in the elderly.In this study, it has been demonstrated that some physiological changes occur in oropharyngeal swallowing with increasing age without any alteration in the basic pattern of deglutition.
Effect of stroke location on the laryngeal cough reflex and pneumonia risk
W Robert Addington, Robert E Stephens, John G Widdicombe, Kamel Rekab
Cough , 2005, DOI: 10.1186/1745-9974-1-4
Abstract: A prospective study of 818 consecutive acute stroke patients utilizing a reflex cough test (RCT), which assesses the neurological status of the LCR compared to magnetic resonance imaging or computerized tomography for stroke location and subsequent pneumonia outcome. Stroke diagnosis and stroke location were made by a neurologist and clinical radiologist, respectively; both were blinded to the RCT results.Brainstem (p-value < .007) and cerebral strokes (p-value < .005) correlated with the RCT results and pneumonia outcome. Of the 818 patients, 35 (4.3%) developed pneumonia. Of the 736 (90%) patients who had a normal RCT, 26 (3.5%) developed pneumonia, and of the 82 (10%) patients with an abnormal RCT, 9 (11%) developed pneumonia despite preventive interventions (p-value < .005). The RCT had no serious adverse events.The RCT acted as a reflex hammer or percussor of the LCR and neurological airway protection and indicated pneumonia risk. Despite stroke location, patients may exhibit "brainstem shock," a global neurological condition involving a transient or permanent impairment of respiratory drive, reticular activating system or LCR. Recovery of these functions may indicate emergence from brainstem shock, and help predict morbidity and mortality outcome.The laryngeal cough reflex (LCR) protects the supraglottic larynx from significant aspiration of food or fluids during inspiration or pharyngeal spillage during swallowing [1]. The reflex cough test (RCT), using nebulized tartaric acid solution, provides an effective stimulus to the receptors in the supraglottic mucosa, and, like a reflex hammer or percussor, triggers a cascade of neurological activity in both craniospinal nerves and the central nervous system. The vagus nerve mediates the afferent component of the LCR. Tartaric acid-induced cough stimulates rapid adapting receptors (RARs) in the supraglottic region of the larynx and sensory impulses are conveyed to the medulla via the middle ramus of the internal bra
Cannabinoids and Viral Infections  [PDF]
Carol Shoshkes Reiss
Pharmaceuticals , 2010, DOI: 10.3390/ph3061873
Abstract: Exogenous cannabinoids or receptor antagonists may influence many cellular and systemic host responses. The anti-inflammatory activity of cannabinoids may compromise host inflammatory responses to acute viral infections, but may be beneficial in persistent infections. In neurons, where innate antiviral/pro-resolution responses include the activation of NOS-1, inhibition of Ca 2+ activity by cannabinoids, increased viral replication and disease. This review examines the effect(s) of cannabinoids and their antagonists in viral infections.
Investigating the complexity of respiratory patterns during the laryngeal chemoreflex
Andrei Dragomir, Yasemin Akay, Aidan K Curran, Metin Akay
Journal of NeuroEngineering and Rehabilitation , 2008, DOI: 10.1186/1743-0003-5-17
Abstract: In this study we quantified the output of the respiratory neural network, the diaphragm EMG signal, during the laryngeal chemoreflex and eupnea in early postnatal (3–10 days) piglets. We tested the hypothesis that diaphragm EMG activity corresponding to reflex-related events involved in clearance (restorative) mechanisms such as cough and swallow exhibit lower complexity, suggesting that a synchronized homogeneous group of neurons in the central respiratory network are active during these events. Nonlinear dynamic analysis was performed using the approximate entropy to asses the complexity of respiratory patterns.Diaphragm EMG, genioglossal activity EMG, as well as other physiological signals (tracheal pressure, blood pressure and respiratory volume) were recorded from 5 unanesthetized chronically instrumented intact piglets. Approximate entropy values of the EMG during cough and swallow were found significantly (p < 0.05 and p < 0.01 respectively) lower than those of eupneic EMG.Reduced complexity values of the respiratory neural network output corresponding to coughs and swallows suggest synchronous neural activity of a homogeneous group of neurons. The higher complexity values exhibited by eupneic respiratory activity are the result of a more random behaviour, which is the outcome of the integrated action of several groups of neurons involved in the respiratory neural network.The laryngeal chemoreflex (LCR) has been investigated in many epidemiological and physiological studies as a putative exogenous stressor that may contribute to the pathogenesis of sudden infant death syndrome (SIDS) [1-3]. The triple-risk model proposed for SIDS states that death occurs at the confluence of three factors – a inherently vulnerable infant, exposed to an exogenous stressor during a critical period of postnatal development [4]. The LCR is elicited when liquid reaches the laryngeal mucosal receptors. Commonly, the LCR response consists of a series of events that may be categorize
Evaluación de la deglución en pacientes con cáncer precoz de laringe tratados con cirugía o radioterapia Swallowing assessment in early laryngeal cancer patients treated either with surgery or radiotherapy  [cached]
Carlos Celedón L,Galo Gambi A,Michel Royer F,Patricia Esquivel C
Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello , 2008,
Abstract: Introducción: La deglución es un proceso neuromuscular complejo, que requiere de indemnidad anatómica y de una adecuada coordinación de varios órganos. El tratamiento del cáncer laríngeo puede ocasionar trastornos de la deglución. Tradicionalmente se ha reportado una mayor frecuencia de esta alteración con los tratamientos quirúrgicos, sin embargo no existe información adecuada sobre su incidencia en pacientes sometidos a radioterapia por cáncer laríngeo precoz. Objetivo: Comparar la frecuencia de alteraciones de deglución postratamiento en cáncer laríngeo precoz Material y método: El presente es un estudio transversal de dos grupos de pacientes con cáncer laríngeo precoz, unos tratados con cirugía parcial vertical (CP) y otros con radioterapia exclusiva (RT). A cada paciente se le realizó una evaluación otorrinolaringológica, nasofibroscópica y videofluoroscópica postratamiento. Las diferencias entre los grupos se compararon utilizando el test Xi cuadrado. Resultados: Ingresaron veinte pacientes por grupo, la mayoría de género masculino y de edades similares. Ambos grupos presentan una alta incidencia de síntomas aspirativos (55% en RTy35% en CP) y alteraciones en nasofibroscopía y videofluoroscopía (35% en RTy 30% en CP). No hubo diferencias significativas entre ambos grupos. Discusión y conclusiones: Se demuestra una elevada incidencia de trastorno de la deglución en pacientes tratados por cáncer precoz de laringe, debiendo considerarse como una alteración frecuente en este grupo de pacientes, ya hayan sido tratados con RT o CP. Introduction. Swallowing is a complex neuromuscular process that requires anatomical indemnity andan adequate coordination ofseveral organs. Laryngeal cáncer treatment may cause swallowing disorders. Tradltionally, a hlgh frequency ofthis type of disorder after surgery has been reponed, but no actual data concerning its incidence in patients undergoing radiotherapy for early laryngeal cáncer has been published. Aim. To compare swallowing disorders frequency posterior to treatment in early laryngeal cáncer patients. Material and Method. Two groups of early laryngeal cáncer patients were transversallystudied, one treatedwith verticalpartialsurgery(CP), andtheothertreated exclusively with radiotherapy. Each patient had otorhinolaryngological, nasofibroscopic and videofluoroscopic evaluations after treatment. Differences between groups were compared using the _-square test. Results. Twenty patients pergroup were entered in this study predominantly males of similar age. Both groups presented a high incidence ofaspiration symptoms
Laryngeal mask airway vs endotracheal tube to facilitate bedside percutaneous tracheostomy in critically ill patients: a prospective comparative study.  [cached]
Ambesh S,Sinha P,Tripathi M,Matreja P
Journal of Postgraduate Medicine , 2002,
Abstract: BACKGROUND: Inadvertent puncture of endotracheal tube (ETT) cuff and accidental tracheal extubation are the potential life threatening complications during percutaneous dilatational tracheostomy (PDT). As an alternative to ETT, the laryngeal mask airway (LMA) has been used sporadically but no large study is available on its use. AIMS: To study the use of LMA during PDT on controlled ventilation in critically sick patients and compare its advantages and disadvantages in relation to ETT. SETTINGS AND DESIGN: This prospective, randomised, comparative study was conducted in intensive care unit of a super-speciality, tertiary care hospital. METHODS AND MATERIAL: The bedside PDT was performed in 60 critically ill patients using Ciaglia′s kit. The patients received controlled ventilation of lungs either through ETT or LMA. The feasibility of the procedure and complications were compared in two groups. RESULTS: In LMA group, 33% of patients suffered with potentially catastrophic complications, e.g., loss of airway, inadequate ventilation of lungs leading to significant hypoxia, gastric distension and regurgitation. In ETT group there were 6.6% incidence of ETT impalement, 6.6% cuff puncture and 3.3% accidental tracheal extubation. Despite the technical difficulties (cuff puncture, etc.) the ETT technique was basically safe, whereas despite of the theoretical advantages the LMA technique rendered some patients at considerable risks of hypoxia and gastric regurgitation-aspiration. CONCLUSION: The LMA does not provide safe patent airway to facilitate bedside PDT in critically sick population on controlled ventilation. The ETT is safer for controlled ventilation and should be continued to secure the airway for this purpose until a better alternative is available.
Cannabinoids, anxiety, and the periaqueductal gray
Saito, Viviane M;Moreira, Fabrício A;
Psychology & Neuroscience , 2010, DOI: 10.3922/j.psns.2010.1.004
Abstract: the use of cannabis sativa by humans dates back several thousand years, for both its psychotomimetic and potential medicinal properties. as scientific research methods developed, the cannabinoids present in this herb were characterized, as well as their complex interface with the human central nervous system, provided by the activation of specific receptors. the subsequent description of an endogenous cannabinoid system in the mammalian brain shifted the notion of cannabis as a recreational drug to a therapeutic alternative for psychiatric disorders. however, the neuroanatomical sites mediating its effects have remained uncertain. in the present paper, we review recent data suggesting that the midbrain periaqueductal gray may be a structure involved in the anxiolytic-like effects of cannabinoids.
Cannabinoids, anxiety, and the periaqueductal gray
Viviane M. Saito,Fabrício A. Moreira
Psychology & Neuroscience , 2010,
Abstract: he use of Cannabis sativa by humans dates back several thousand years, for both its psychotomimetic and potential medicinal properties. As scientific research methods developed, the cannabinoids present in this herb were characterized, as well as their complex interface with the human central nervous system, provided by the activation of specific receptors. The subsequent description of an endogenous cannabinoid system in the mammalian brain shifted the notion of cannabis as a recreational drug to a therapeutic alternative for psychiatric disorders. However, the neuroanatomical sites mediating its effects have remained uncertain. In the present paper, we review recent data suggesting that the midbrain periaqueductal gray may be a structure involved in the anxiolytic-like effects of cannabinoids.
Cannabinoids and their medicinal potential  [cached]
Deepika Tikoo,Geeta Sharma,Meenakshi Gupta
International Journal of Basic & Clinical Pharmacology , 2012, DOI: 10.5455/2319-2003.ijbcp001512
Abstract: Cannabis sativa L preparations have been used therapeutically since many years. Inspite of their medicinal value, the danger of its abusive potential led to the ban on its use in clinical practice in many countries. The recent research and in depth knowledge about the cannabinoid system which throw a light on their disease management potential has paved way for the cannabinoids to become a new therapeutic focus of attention. Cannabinoids are a group of compounds that mediate their effects through cannabinoid receptors which include CB1, predominantly expressed in the brain and CB2 which is primarily found in the cells of the immune system. Despite the addictive properties of cannabis, the therapeutic value of cannabinoids is too high to be put aside. Numerous diseases such as anorexia, pain, inflammation, obesity, cardiovascular disorders, neurodegenerative diseases, cancer, gastrointestinal diseases, hepatic disorders, skin related diseases, respiratory disorders like asthma and eye diseases like glaucoma have suggested cannabinoid agonists/ antagonists/ cannabinoids related compounds as potential treatment options. Developments of new specific ligands for the cannabinoid receptors are now underway and it needs to be seen, if in future, they can prove to be a boon for the medical world. The paper reviews the current understanding of the cannabinoid receptors, their ligands and their possible role in various diseases supported by preclinical and clinical studies. [Int J Basic Clin Pharmacol 2012; 1(2.000): 48-59]
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