Clinical Practice Guidelines for Oropharyngeal Dysphagia / 대한연하장애학회지

Objective@#Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. @*Methods@#Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. @*Results@#Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. @*Conclusion@#This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

Evaluation of Vocal Fold Paralysis through Videofluoroscopic Swallowing Study: Case Series Study / 대한연하장애학회지

These cases imply that the videofluoroscopic AP view helps the evaluation of the vocal fold movement in patients with vocal fold paralysis on laryngoscopy.

The Effects of Simultaneous Pulmonary Rehabilitation during Thoracic Radiotherapy in the Treatment of Malignant Diseases / 결핵및호흡기질환

Background@#Radiotherapy is a common treatment option for lung or esophageal cancer, particularly when surgery is not feasible for patients with poor lung function. However, radiotherapy can affect pulmonary function and thereby induce pneumonitis or pneumonia, which can be fatal in patients with respiratory impairment. The purpose of this study is to evaluate if reductions in pulmonary function after radiotherapy can be minimized through simultaneous pulmonary rehabilitation (PR). @*Methods@#In this matched case control study, we retrospectively analyzed patients who had undergone radiotherapy for thoracic malignant disease between January 2018 and June 2019. We analyzed results from pulmonary function tests and 6-minute walking tests (6MWT) conducted within the six months before and after radiotherapy treatment. @*Results@#In total, results from 144 patients were analyzed, with 11 of the patients receiving PR and radiotherapy simultaneously. Of the 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity were significantly different between the PR group and the matched control group (240 mL vs. –10 mL, p=0.017 and 5.5% vs. 1.0%, p=0.038, respectively). The median distance of 6MWT in the PR group also increased significantly, from 407.5 m to 493.0 m after radiotherapy (p=0.017). @*Conclusion@#Simultaneous PR improved pulmonary function, particularly in measures of FEV1, and exercise capacity for patients with lung or esophageal cancer even after radiotherapy treatment. These findings may provide an important base of knowledge for further large population studies with long-term follow-up analysis in the identification of the PR’s effects during thoracic radiotherapy.

Integrating Cardiac Rehabilitation with Neurorehabilitation in a Patient with Ischemic Stroke after Cardiac Surgery: a Case Report

Stroke and cardiac disorders are difficult to approach separately. Stroke survivors commonly have cardiovascular comorbidities and vice versa. These patients often need both neurorehabilitation and cardiac rehabilitation; therefore, this is an important issue in the rehabilitation process. However, no consensus has been reached on the integration of cardiac rehabilitation and neurorehabilitation. We report the case of a 52-year-old male patient who had ischemic stroke after mitral valvuloplasty. The patient underwent 3 weeks of inpatient neurorehabilitation, and then transited to 6 weeks of outpatient cardiac rehabilitation and occupational therapy. After 9 weeks of well-integrated rehabilitation, the patient experienced neurologic recovery and improvement in his cardiopulmonary fitness. Like this case, successful integrated rehabilitation will contribute to enhancing patients' functional recovery.

Neuroprotective Effect of Chronic Intracranial Toxoplasma gondii Infection in a Mouse Cerebral Ischemia Model

Toxoplasma gondii is an obligate intracellular protozoan parasite that can invade various organs in the host body, including the central nervous system. Chronic intracranial T. gondii is known to be associated with neuroprotection against neurodegenerative diseases through interaction with host brain cells in various ways. The present study investigated the neuroprotective effects of chronic T. gondii infection in mice with cerebral ischemia experimentally produced by middle cerebral artery occlusion (MCAO) surgery. The neurobehavioral effects of cerebral ischemia were assessed by measurement of Garcia score and Rotarod behavior tests. The volume of brain ischemia was measured by triphenyltetrazolium chloride staining. The expression levels of related genes and proteins were determined. After cerebral ischemia, corrected infarction volume was significantly reduced in T. gondii infected mice, and their neurobehavioral function was significantly better than that of the uninfection control group. Chronic T. gondii infection induced the expression of hypoxia-inducible factor 1-alpha (HIF-1α) in the brain before MCAO. T. gondii infection also increased the expression of vascular endothelial growth factor after the cerebral ischemia. It is suggested that chronic intracerebral infection of T. gondii may be a potential preconditioning strategy to reduce neural deficits associated with cerebral ischemia and induce brain ischemic tolerance through the regulation of HIF-1α expression.

Radiomics in Breast Imaging from Techniques to Clinical Applications: A Review

Recent advances in computer technology have generated a new area of research known as radiomics. Radiomics is defined as the high throughput extraction and analysis of quantitative features from imaging data. Radiomic features provide information on the gray-scale patterns, inter-pixel relationships, as well as shape and spectral properties of radiological images. Moreover, these features can be used to develop computational models that may serve as a tool for personalized diagnosis and treatment guidance. Although radiomics is becoming popular and widely used in oncology, many problems such as overfitting and reproducibility issues remain unresolved. In this review, we will outline the steps of radiomics used for oncology, specifically addressing applications for breast cancer patients and focusing on technical issues.

Air Evacuation of Passengers with Potential SARS-CoV-2Infection Under the Guidelines for Appropriate Infection Control and Prevention

This report describes the air evacuation of 80 Koreans from Iran to Korea on March 19 th , 2020, with a direct transfer of passengers between airplanes in Dubai. The passengers were potentially infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so, strict precautions were taken for the duration of the flight, and the passengers were screened before embarking from Dubai and disembarking at Incheon International Airport in Korea. Passengers with fever or symptoms of SARSCoV-2 were assessed by a quarantine doctor, and if they were suspected of being infected with SARSCoV-2, they were categorized as a “patient under investigation (PUI)”. There was 1 passenger designated as a PUI before the departure from Dubai and another designated as a PUI upon arrival into Korea. The first PUI tested negative, but the second PUI tested positive for SARS-CoV-2. All those aboard the flight (passengers, aircrew, and medical staff) were screened for SARS-CoV-2 upon arrival into Korea and completed a mandatory 14-day medical quarantine. There were no additional cases of infection.

Assessment of Dysarthria Using One-Word Speech Recognition with Hidden Markov Models

BACKGROUND: The gold standard in dysarthria assessment involves subjective analysis by a speech–language pathologist (SLP). We aimed to investigate the feasibility of dysarthria assessment using automatic speech recognition. METHODS: We developed an automatic speech recognition based software to assess dysarthria severity using hidden Markov models (HMMs). Word-specific HMMs were trained using the utterances from one hundred healthy individuals. Twenty-eight patients with dysarthria caused by neurological disorders, including stroke, traumatic brain injury, and Parkinson's disease were participated and their utterances were recorded. The utterances of 37 words from the Assessment of Phonology and Articulation for Children test were recorded in a quiet control booth in both groups. Patients were asked to repeat the recordings for evaluating the test–retest reliability. Patients' utterances were evaluated by two experienced SLPs, and the consonant production accuracy was calculated as a measure of dysarthria severity. The trained HMMs were also employed to evaluate the patients' utterances by calculating the averaged log likelihood (aLL) as the fitness of the spoken word to the word-specific HMM. RESULTS: The consonant production accuracy reported by the SLPs strongly correlated (r = 0.808) with the aLL, and the aLL showed excellent test–retest reliability (intraclass correlation coefficient, 0.964). CONCLUSION: This leads to the conclusion that dysarthria assessment using a one-word speech recognition system based on word-specific HMMs is feasible in neurological disorders.

Limitation of Intraoperative Transcranial Electrical Stimulation-Motor Evoked Potential Monitoring During Brain Tumor Resection Adjacent to the Primary Motor Cortex

Transcranial electrical stimulation-motor evoked potential (TES-MEP) is a valuable intraoperative monitoring technique during brain tumor surgery. However, TES can stimulate deep subcortical areas located far from the motor cortex. There is a concern about false-negative results from the use of TES-MEP during resection of those tumors adjacent to the primary motor cortex. Our study reports three cases of TES-MEP monitoring with false-negative results due to deep axonal stimulation during brain tumor resection. Although no significant change in TES-MEP was observed during surgery, study subjects experienced muscle weakness after surgery. Deep axonal stimulation of TES could give false-negative results. Therefore, a combined method of TES-MEP and direct cortical stimulation-motor evoked potential (DCS-MEP) or direct subcortical stimulation should be considered to overcome the limitation of TES-MEP.

The Accuracy of the Swallowing Kinematic Analysis at Various Movement Velocities of the Hyoid and Epiglottis

OBJECTIVE: To evaluate the accuracy of the swallowing kinematic analysis. METHODS: To evaluate the accuracy at various velocities of movement, we developed an instrumental model of linear and rotational movement, representing the physiologic movement of the hyoid and epiglottis, respectively. A still image of 8 objects was also used for measuring the length of the objects as a basic screening, and 18 movie files of the instrumental model, taken from videofluoroscopy with different velocities. The images and movie files were digitized and analyzed by an experienced examiner, who was blinded to the study. RESULTS: The Pearson correlation coefficients between the measured and instrumental reference values were over 0.99 (p<0.001) for all of the analyses. Bland-Altman plots showed narrow ranges of the 95% confidence interval of agreement between the measured and reference values as follows: 0.14 to 0.94 mm for distances in a still image, -0.14 to 1.09 mm/s for linear velocities, and -1.02 to 3.81 degree/s for angular velocities. CONCLUSION: Our findings demonstrate that the distance and velocity measurements obtained by swallowing kinematic analysis are highly valid in a wide range of movement velocity.

Expression of p53 and Epidermal Growth Factor Receptor in the Oral and Oropharyngeal Squamous Cell Carcinomas / 대한이비인후과학회지

The prognostic significance of the squamous cell carcinomas of the oral and oropharynx have been evaluated to identify those features associated with aggressive biologic behavior according to the immunologic and histologic characteristics. For determining prognostic indicators, the authors performed immunohistochemical staining of p53 and epidermal growth factor receptor(EGFR) in 29 cases of squamous cell carcinomas of the oral and oropharynx. The expression rate of p53 was 51.7%, that of EGFR was 96.6%, and overexpression rate of EGFR was 41.4%, however there were no statistical significance between the reactivity of EGFR, p53 and clinicopathological features such as primary stage, nodal stage, clinical stage, death and histologic grade.