Outcomes of Injection Laryngoplasty for Deep Interarytenoid Groove

Abstract Introduction Deep interarytenoid groove (DIG) may cause swallowing dysfunction in children; however, the management of DIG has not been established. Objective We evaluated the subjective and objective outcomes of interarytenoid augmentation with injection in children with DIG. Methods Consecutive children under 18 years of age who underwent injection laryngoplasty for DIG were reviewed. Data pertaining to demographics, past medical history, past surgical history, and results of pre and postoperative video fluoroscopic swallow study (VFSS) were obtained. The primary outcome measure was the presence of thin liquid aspiration or penetration on postoperative VFSS. The secondary outcome measure was caregiver-reported improvement of symptoms. Results Twenty-seven patients had VFSS before and after interarytenoid augmentation with injection (IA). Twenty (70%) had thin liquid penetration and 12 (44%) had thin liquid aspiration before the IA. Thin liquid aspiration resolved in 9 children (45%) and persisted in 11 (55%). Of the 12 children who had thin liquid aspiration prior to IA, 6 (50%) had resolution of thin liquid aspiration after IA. Conclusions Injection laryngoplasty is a safe tool to improve swallowing function in children with DIG. Further studies are needed to assess the long-term outcomes of IA and identify predictors of successful IA in children with DIG.

The Effects of Noni (Morinda citrifolia L.) Fruit Juice on Cholesterol Levels: A Mechanistic Investigation and an Open Label Pilot Study.

The traditional usage of noni fruit did not include any claims for lowering cholesterol levels in humans. However, recently a commercial noni fruit juice blend, Tahitian Noni Original® Bioactive (TNOB),was shown in a double blind, and placebo control clinical trial to significantly lower cholesterol levels in current smokers. But, its effect on cholesterol levels of nonsmokers with normal cholesterol levels, and its mechanisms of action, has not been fully elucidated. The current study evaluates the effects of various noni preparations (TNOB, NFJC (noni fruit juice concentrates), NFJME (noni fruit juice methanol extract)) on HMG-CoA Reductase and ACAThepatic/intestine enzymes in vitro. Further, TNOB was evaluated for its potential cholesterol-lowering effects in 10 non-smoking subjects with normal to mild cholesterol levels. TNOB and NFJC both inhibited HMG-CoA Reductase, and ACAT enzymes concentration-dependently in-vitro, and NFJC has a <1.0 mg/mL IC50 on HMG-CoA Reductase enzymes. NFJME, the active fraction from the noni fruit juice, in 100μg/mL, inhibited HMG-CoA reductase by 81%. TNOB showed a trend towards lowering total cholesterol and LDL levels while increasing HDL levels in nonsmokers. Noni fruit juice has the potential to lower cholesterol levels in nonsmokers perhaps via its inhibitory effects on HMGCoA reductase and ACAT enzymes as its possible mechanism of action. However, a larger clinical trial is warranted to assess its effects in non-smokers with higher cholesterol levels above 220 mg/dL to evaluate the nature of this cholesterol-lowering trend seen in this pilot study.