ABSTRACT
Objective:To investigate the effect of a Passy-Muir speaking valve (PMV) on the biomechanics of swallowing and on aspiration among persons tracheotomized after brain damage.Methods:Twenty tracheotomized patients with aspiration after brain injury were selected and randomly divided into a non-PMV intervention group and a PMV intervention group, each of 10. Both groups were given routine swallowing training, while the PMV intervention group was additionally provided with a PMV and trained to use it. The treatment ended when the tracheal tube was removed or after 2 weeks. High-resolution manometry and videofluoroscopy were used to evaluate the maximum pressure in the velopharynx (VP-Max), the maximum post-deglutitive upper esophageal sphincter (UES) pressure (UES-Max) and Rosenbek penetration aspiration (PAS) scores for both groups before and after the treatment.Results:Before the treatment there was no significant difference between the two groups in terms of average VP-Max, UES-Max or PAS score. After the treatment, the average VP-Max and UES-Max had increased significantly in both groups, and the average PAS score of the PMV intervention group had decreased significantly. There was a significant positive correlation between the increases in VP-Max and the decrease in PAS scores.Conclusion:Inserting a PMV can improve velopharynx contraction and post-deglutitive UES among persons tracheotomized after a brain injury. The increase in maximum velopharynx pressure is positively correlated with decreases in aspiration.
ABSTRACT
Objective@#To investigate the effect of a Passy-Muir speaking valve (PMV) on the biomechanics of swallowing and on aspiration among persons tracheotomized after brain damage.@*Methods@#Twenty tracheotomized patients with aspiration after brain injury were selected and randomly divided into a non-PMV intervention group and a PMV intervention group, each of 10. Both groups were given routine swallowing training, while the PMV intervention group was additionally provided with a PMV and trained to use it. The treatment ended when the tracheal tube was removed or after 2 weeks. High-resolution manometry and videofluoroscopy were used to evaluate the maximum pressure in the velopharynx (VP-Max), the maximum post-deglutitive upper esophageal sphincter (UES) pressure (UES-Max) and Rosenbek penetration aspiration (PAS) scores for both groups before and after the treatment.@*Results@#Before the treatment there was no significant difference between the two groups in terms of average VP-Max, UES-Max or PAS score. After the treatment, the average VP-Max and UES-Max had increased significantly in both groups, and the average PAS score of the PMV intervention group had decreased significantly. There was a significant positive correlation between the increases in VP-Max and the decrease in PAS scores.@*Conclusion@#Inserting a PMV can improve velopharynx contraction and post-deglutitive UES among persons tracheotomized after a brain injury. The increase in maximum velopharynx pressure is positively correlated with decreases in aspiration.
ABSTRACT
Objective To compare the diagnostic value of MRE and DWI in staging hepatic fibrosis in pa-tients with CHB. Methods In this retrospective analysis ,we investigated 93 patients with CBH and live fibrosis. Ninety-three patients were grouped according to their pathological grading of fibrosis ,from S0 to S4. Sixteen healthy patients were enrolled as the control group. Spearman correlation analysis was used to analyze the correla-tion between the stiffness and ADC value and their staging fibrosis. ROC analysis was conducted to compare the per-formance of the stiffness and ADC value in staging hepatic fibrosis. Results Both liver stiffness value(r=0.962, P<0.01)and ADC value(r=-0.823,P<0.01)were highly correlated with the stage of liver fibrosis. The area un-der ROC(AUC)for the detection of≥S1≥S2/≥S3/S4 stage fibrosis with the stiffness and ADC value were 0.963/0.868、0.995/0.947、0.998/0.948、0.996/0.889 respectively ,with statistically significant differences (P < 0.05 , resectively). Conclusions MRE and DWI have higher value ,and MRE is more accurate than DWI for staging hepatic fibrosis in patients with CHB.
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Objective To compare the diagnostic value of MRE and DWI in staging hepatic fibrosis in pa-tients with CHB. Methods In this retrospective analysis ,we investigated 93 patients with CBH and live fibrosis. Ninety-three patients were grouped according to their pathological grading of fibrosis ,from S0 to S4. Sixteen healthy patients were enrolled as the control group. Spearman correlation analysis was used to analyze the correla-tion between the stiffness and ADC value and their staging fibrosis. ROC analysis was conducted to compare the per-formance of the stiffness and ADC value in staging hepatic fibrosis. Results Both liver stiffness value(r=0.962, P<0.01)and ADC value(r=-0.823,P<0.01)were highly correlated with the stage of liver fibrosis. The area un-der ROC(AUC)for the detection of≥S1≥S2/≥S3/S4 stage fibrosis with the stiffness and ADC value were 0.963/0.868、0.995/0.947、0.998/0.948、0.996/0.889 respectively ,with statistically significant differences (P < 0.05 , resectively). Conclusions MRE and DWI have higher value ,and MRE is more accurate than DWI for staging hepatic fibrosis in patients with CHB.
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Objective To investigate the safety and feasibility of early removal of chest tubes after video-assisted thoracoscopic (VAST) lobectomy for lung cancer. Methods A retrospective study was performed based on the clinical data of sixty consecutive patients who underwent VATS lobectomy plus mediastinal lymph nodes dissection for lung cancer from October 2013 to September 2014 in a single center. Thirty patients were enrolled into the early removal management group (chest tubes removal when the drainage volume is less than 300 mL/d), while the other thirty patients were enrolled into the traditional management group (chest tubes removal at the drainage volume less than 100 mL/d ). Results Patients who underwent early removal management had a shorter time of chest tubes removal and postoperative hospital stay compared to the patients in the traditional management group [(2.10 ± 0.99) d vs. (3.83 ± 1.41) d, t = 5.485, P = 0.000; (7.97 ± 1.54) d vs. (9.20 ± 2.01)d, t = 2.669, P = 0.010)]. No statistically significant differences were observed among the drainage volume, postoperative complications and symptoms on fifteen days post-operation. No complication occurred on thirty days post-operation. Conclusions Early removal of the chest tubes after VATS lobectomy ,when the drainage volume is less than 300 mL/d,is safe and feasible. This leads to a shorter length of hospital stay without addtional risk of early postoperative complications.