Risk of dysphagia in a population of infants born preterm: characteristic risk factors in a tertiary NICU

Abstract Objective: To examine the prevalence and characteristics of dysphagia and suck-swallow-breath incoordination as phenotypes of oral feeding difficulties. Method: A cross-sectional study with secondary data collected consecutively over 2 years from October 2020 to October 2022 to measure the prevalence of swallowing and oral feeding difficulty in preterm infants using Flexible endoscopic evaluation of swallowing examination at the tertiary Integrated Dysphagia Clinic. Results: The prevalence of swallowing disorders was 25 % and the prevalence of suck-swallow-breath incoordination was 62.5 %. The significant risk factor that may show a possible correlation with oral feeding difficulty was mature post-menstrual age (p = 0.006) and longer length of stay (p = 0.004). The dominant percentage of upper airway abnormality and disorder were retropalatal collapse (40 %), laryngomalacia (42.5 %), paradoxical vocal cord movement (12.5 %), and gastroesophageal reflux disease (60 %). The dominant characteristic of oral motor examination and flexible endoscopic evaluation of swallowing examination was inadequate non-nutritive sucking (45 %), inadequate postural tone (35 %), and inadequate nutritive sucking (65 %). Conclusion: Dysphagia in preterm infants is mostly observed in those with mature post-menstrual age, longer length of stay, and the presence of gastroesophageal reflux disease with inadequate non-nutritive sucking and nutritive sucking abilities. Suck-swallow-breath incoordination is primarily observed in those with immature post-menstrual age, a higher prevalence of cardiopulmonary comorbidity, and a higher prevalence of upper airway pathologies (laryngomalacia, paradoxical vocal cord movement) with inadequate nutritive sucking ability.

Clinical study on acupuncture treatment of Tiaoshen theory for the patients with functional dyspepsia with depression and liver-stomach disharmony / 国际中医中药杂志

Objective:To observe the clinical effect of acupuncture treatment based on Tiaoshen theory for the patients with functional dyspepsia (FD) and depression with liver-stomach disharmony syndrome. Methods:A total of 76 FD patients from May 2018 to August 2019 were randomly divided into 2 groups with 38 patients in each group. In the routine group, acupoints were selected routinely, and in Tiaoshen group, acupoints were selected by Tiaoshen theory. Both groups were treated for 28 days. The results were evaluated by Nepean Dyspepsia Index (NDI), TCM Syndrome Score and Hamilton Depression Scale-24 (HAMD-24). Results:The total effective rate of both groups was 94.6% (35/37) in Tiaoshen group and 75.0% (27/36) in routine group. There was significant difference between the two groups ( χ2=6.125, P=0.011). The NDI in Tiaoshen group was significantly lower than that of routine group ( t=3.038, P=0.003). The scores of interference domain, control domain, food and beverage domain and sleep disturbance domain in Tiaoshen group were significantly higher than those in routine group ( t=3.096, 2.460, 2.225, 2.732, P<0.05); the TCM Syndrome Score in Tiaoshen group was significantly lower than that of routine group ( t=3.241, P=0.002), and that of HAMD-24 was significantly lower than that of routine group ( t=2.767, P=0.007). Conclusion:Treatment based on Tiaoshen theory can improve the quality of life of FD patients in the fields of interference, control, food and beverage and sleep disturbance, and reduce the patients’depression.

Analysis on FANG Ding-ya's Clinical Experience in Applying Sini Powder / 中国中医药信息杂志

Sini Powder was used to treat the symptoms of cold limbs caused by yang-qi depression. Nowadays it is used to sooth the liver and relieve depression as well as regulate the function of liver and spleen. On the basis of syndrome differentiation of TCM combined with modern pharmacological research, Professor FANG Ding-ya uses Sini Powder in a variety of diseases, such as mental disease, lower abdomen disease, and digestive system diseases, and modifies according to different clinical symptoms, with good efficacy.

Efficacy on catgut embedding therapy combined with traditional Chinese medicine on the patients with insomnia and TCM pattern of no connection of heart and kidney / 国际中医中药杂志

Objective To investigate the effects on catgut embedding therapy combined with traditional Chinese medicine on the patients with insomnia and TCM pattern of no connection of heart and kidney.Methods One hundred and ten patients with insomnia and TCM pattern of no connection of heart and kidney were were divided into the catgut embedding therapy group and traditional Chinese medicine group (n=55, repectively). Traditional Chinese medicine group was treated by theLiuwei-Dihuang pills andJiaotaipills, while the catgut embedding therapy group was treated with catgut embedding therapy based on the treatement of TCM groups. Pittsburgh Sleep Index (PSQI) was the outcome for analysis.Results The total effect rate (89.09%vs. 67.27%,χ2=7.674,P<0.01) in catgut embedding therapy group was significantly higher than that in traditional Chinese medicine group. The catgut embedding therapy group were significantly better than the traditional Chinese medicine group in the total score of PSQI (6.71 ± 3.55vs.8.32 ± 2.48,t=2.757,P<0.05), sleep time (0.86 ± 1.11vs. 1.29 ± 0.88,t=2.251,P<0.05), sleep efficiency (0.13 ± 0.7vs. 0.43 ± 0.55,t=2.477,P<0.05), hypnotic drugs (0.93 ± 0.77vs. 1.41 ± 0.81,t=3.185,P<0.05) and daytime dysfunction(1.14 ± 0.61vs. 1.59 ± 0.60,t=3.900,P<0.05). Conclusion Catgut embedding combining traditional Chinese medicine showed better effect than the TCM alone on the patients with insomnia and TCM pattern of no connection of heart and kidney.

Deficiência de cobre em suínos: caracterização clínico-patológica / Copper deficiency in swine: clinical-pathologic characterization

São relatados dois casos de deficiência de cobre em suínos (A e B), fêmeas, sem raça definida, de três meses de idade, provenientes de propriedade rural em Planaltina, GO. Os animais apresentavam incoordenação, paresia de membros pélvicos, com progressão para os membros torácicos e andar com flexão da articulação metacarpo-falangeana. Na propriedade de origem dos animais, outros dois suínos apresentavam atrofia da musculatura da coxa e posição sentada quando parados. O rebanho recebia dieta não-balanceada constituída por milho, soro de leite e sobras de lavoura. Na necropsia, não foram observadas alterações significativas, mas histologicamente havia vacuolização periaxonal multifocal no tronco encefálico e na medula espinhal, quantidade discreta de esferoides axonais e macrófagos no interior dos vacúolos. A coloração com azul rápido de luxol (ARL) para mielina demonstrou que as áreas de vacuolização caracterizavam focos de desmielinização. Amostras de fígado dos dois suínos apresentaram níveis de cobre muito abaixo do normal, de 13,1 partes por milhão (ppm) (suíno A) e 5,7ppm (suíno B). Este trabalho descreve dois casos de desmielinização medular e de tronco encefálico devido à deficiência de cobre em suínos jovens.

Two cases of copper deficiency are described in three-month-old female crossbred piglets from a swine herd in Planaltina, GO. The animals presented incoordination, hindlimbs paresis progressing to the forelimbs, and gait with flexion of the metacarpofalangeal articulation. On the farm of origin of the animals, other two piglets presented atrophy of thigh muscle and sitting position when in station. The herd was fed with unbalanced diet consisting of corn, whey and leftover crop. On necropsy no significant changes were observed, but histologically there was multifocal periaxonal vacuolization in the brainstem and in spinal cord, discrete amount of axonal spheroids and macrophages in the vacuoles. The luxol fast blue (LFB) stain for myelin showed that the vacuolated sites represent demyelinated areas. Liver sample of the two piglets had very low copper levels, 13.1 parts per million (ppm) in swine A and 5.7 (ppm) in swine B. This paper describes two cases of spinal cord and brainstem demyelination due to copper deficiency in piglets.

Clinical Features of Cricopharyngeal Incoordination in Newborns and Infants / 대한소아소화기영양학회지

PURPOSE: Cricopharyngeal incoordination is a rare cause of swallowing difficulties in newborns and infants; it is characterized by delayed pharyngeal contractions related to cricopharyngeal relaxation. Dysphagia and repeated aspiration are common findings despite normal sucking. We conducted this study to assess the clinical features of cricopharyngeal incoordination in newborns and infants. METHODS: An analysis of the clinical data from 17 patients with cricopharyngeal incoordination who were admitted to the Department of Pediatrics, Pusan National University Hospital, between 2000 and 2006 was conducted retrospectively. The diagnosis of cricopharyngeal incoordination was established by the clinical characteristics and the videofluoroscopic swallowing studies. RESULTS: The male to female ratio was 1:1.1 (males 8, females 9) the age range 1 to 60 days. The body weight of 11 patients (64.7%) was less than the 10th percentile at diagnosis. Six patients (35.3%) were born prematurely. The associated anomalies or diseases were chromosomal anomaly (2 cases), congenital heart disease (3 cases), and laryngomalacia, hypoxic brain damage or neonatal seizures (1 case each). The chief complaints of patients were recurrent aspiration pneumonia (10 cases), feeding difficulty (9 cases), dyspnea (4 cases), and chocking (4 cases). The severity of aspiration on the videoesophagogram or esophagogram was mild in 12 cases. The correlation between the severity of aspiration and the duration of tube feeding after the diagnosis was significant (p<0.05). CONCLUSION: Cricopharyngeal incoordination should be considered in the differential diagnosis of newborns and infants, without known risk factors associated with swallowing dysfunction, when they present with unexplained respiratory problems. Although the prognosis of cricopharyngeal incoordination is good, early diagnosis and tube feeding are recommended to prevent the complications associated with this disorder.

Clinical efficacy of Simo Tang on functional dyspepsia with syndrome of incoordination between the liver and spleen and its effect on motilin and substance P in plasma / 中华中医药杂志

0.05). However,Simo Decoction can ameliorate the symptoms,such as epigastric pain,early satiety,etc.,better than Domperidone tablets(P