Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis.

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

Effect of barium sulfate contrast medium on rheology and sensory texture attributes in a model food.

BACKGROUND: The swallowing process can be visualized using videoradiography, by mixing food with contrast medium, e.g., barium sulfate (BaSO(4)), making it radiopaque. The sensory properties of foods may be affected by adding this medium. PURPOSE: To evaluate if and to what extent sensory and rheological characteristics of mango purée were altered by adding barium sulfate to the food. MATERIAL AND METHODS: This study evaluated four food samples based on mango purée, with no or added barium sulfate contrast medium (0%, 12.5%, 25.0%, and 37.5%), by a radiographic method, and measured sensory texture properties and rheological characteristics. The sensory evaluation was performed by an external trained panel using quantitative descriptive analysis. The ease of swallowing the foods was also evaluated. RESULTS: The sensory texture properties of mango purée were significantly affected by the added barium in all evaluated attributes, as was the perception of particles. Moreover, ease of swallowing was significantly higher in the sample without added contrast medium. All samples decreased in extensional viscosity with increasing extension rate, i.e., all samples were tension thinning. Shear viscosity was not as dependent on the concentration of BaSO(4) as extensional viscosity. CONCLUSION: Addition of barium sulfate to a model food of mango purée has a major impact on perceived sensory texture attributes as well as on rheological parameters.

Do dysphagic patients with an absent pharyngeal swallow have a shorter survival than dysphagic patients with pharyngeal swallow? Prognostic importance of a therapeutic videoradiographic swallowing study (TVSS).

PURPOSE: To study survival in two groups of dysphagic patients--one group unable to elicit the pharyngeal stage of swallow (APS) and another group with pharyngeal swallow (WPS)--and to compare recommendations regarding nutrition and therapeutic strategies based on the therapeutic swallowing study. MATERIAL AND METHODS: In this retrospective study, the records of dysphagic patients who have undergone a therapeutic videoradiographic swallowing study (TVSS) were reviewed. Forty patients without pharyngeal swallow were matched for age and gender with 40 patients with pharyngeal swallow; altogether 80 patients were included in the study. Survival was registered at 3, 12, and 72 months after the TVSS. RESULTS: In this study, the APS group had a significantly shorter survival time (P=0.0030) compared to the WPS group when followed-up at 12 months. In the APS group, most patients (37.5% (15/40)) died within the 3 months after TVSS. At 72 months, 62.5% (25/ 40) of the patients in the APS group had died. In the WPS group, 5% (2/40) had died within 3 months and 47.4% (19/40) after 12 months. At 72 months, 52.5% (21/40) of the patients in the WPS group had died. Regarding nutritional and therapeutic recommendations based on TVSS, 34/40 in the APS group were recommended no oral intake. Eighteen naso-gastric tubes were placed directly after TVSS. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, and tongue exercises (in 8 patients). In the WPS group, all patients were recommended oral intake. Diet modification was recommended in 29 patients. The therapeutic strategies recommended were head-positioning, thermal tactile stimulation, tongue exercises, supraglottic swallow, and effortful swallow (in 24 patients). CONCLUSION: Patients unable to elicit the pharyngeal stage of swallow had a shorter survival time than patients with pharyngeal swallow, probably due to a more severe underlying disease. Tube feeding was more frequent in the APS group. Fewer therapeutic strategies were recommended compared to the WPS group. In the WPS group, diet modification was frequent. Several patients had different therapeutic strategies. At the end of the study, 8/40 patients (20%) in the APS group had recovered and regained the ability to elicit the pharyngeal stage of swallow. All eight had achieved active swallowing rehabilitation.

Videoradiographic analysis of how carbonated thin liquids and thickened liquids affect the physiology of swallowing in subjects with aspiration on thin liquids.

PURPOSE: To analyze how carbonated thin liquids affected the physiology of swallowing in dysphagic patients. MATERIAL AND METHODS: 40 patients were analyzed; 36 were neurologically impaired. During a therapeutic videoradiographic swallowing examination the patients had to swallow liquids with the following consistencies three times: thin, thickened and carbonated. The liquids were given in doses of 3 x 5 ml. The swallows were analyzed regarding penetration/aspiration, pharyngeal transit time and pharyngeal retention. RESULTS: Significant difference was found regarding penetration/aspiration when comparisons were made between thin liquid and carbonated thin liquid (p<0.0001). Carbonated liquid reduced the penetration to the airways. The comparison between thin liquid and thickened liquid (p<0.0001) showed significant less penetration with thickened liquids. Pharyngeal transit time was reduced both when comparing thin liquid with thin carbonated liquid (p<0.0001) and thickened liquid (p<0.0001). Pharyngeal retention was significantly reduced (p<0.0001) with carbonated thin liquid compared to thickened liquid. The comparison of thin liquids and carbonated thin liquids showed p=0.0013, thin and thickened liquids p=0.0097. CONCLUSIONS: Carbonated liquids reduced penetration/aspiration into the airways, reduced pharyngeal retention and pharyngeal transit time became shorter. Therefore, carbonated liquids are a valuable treatment option for patients with penetration/aspiration. Thickened liquids may still be an option for patients who cannot tolerate carbonated liquids and liquids with this consistency are safer than thin liquids.

Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in patients with pharyngeal dysfunction.

Simultaneous videoradiography and solid-state manometry (videomanometry) was performed in 8 patients (4 women, 4 men; age range = 46-81 years, mean age = 70 years) with pharyngeal dysfunction. Five patients had severe pharyngeal dysfunction with frequent misdirected swallows. Three patients had moderate pharyngeal dysfunction with delayed initiation of pharyngeal swallow. Three different swallowing techniques were used: supraglottic swallow, effortful swallow, and chin tuck. Ten video radiographic variables and six manometric variables were analyzed. Contrast media penetration to the airways was analyzed regarding number of events and level of penetration. Supraglottic swallow, effortful swallow, and chin tuck did not reduce the number of misdirected swallows, but effortful swallow and chin tuck significantly (p = 0.008) reduced the depth of contrast penetration into the larynx and trachea. There was no significant improvement of pharyngeal retention. Chin tuck reduced the distance between the thyroid and the hyoid and the distance between the mandible and the hyoid. No other measured variable was significantly altered. This study shows that none of the different swallowing techniques reduced the number of misdirected swallows. However, there was a significantly reduced depth of the misdirected swallows. The swallowing techniques did not seem to prevent the occurrence of retention or improve weak pharyngeal constrictor muscles in this group of patients with severe to moderate dysfunction.

Treatment of dysphagia improves nutritional conditions in stroke patients.

Dysphagia is a common symptom in stroke patients, and malnutrition is prevalent among these patients. Thus far, nutritional effects of dysphagic treatment have not been evaluated. The aim of the present report was to study the effects of swallowing techniques on nutritional and anthropometric variables. A survey with follow-up was performed at the Departments of Geriatric Medicine and Neurology, Malmö University Hospital, Sweden. Thirty-eight stroke patients, 53-89 years of age, with subjective complaints of dysphagia and oral/pharyngeal dysfunction according to videofluoroscopic barium swallowing examination (VSBE), were given swallowing treatment. The treatment included oral motor exercise, different swallowing techniques, positioning, and diet modification. Plasma protein levels, body composition, VSBE, and a viso-analogical scale for subjective complaints were repeated before and after treatment. At baseline, 94% of cases had signs of penetration and 50-72% had plasma protein levels below recommended levels. Treatment reduced the degree of oral dysfunction, (dissociation) and pharyngeal dysfunction (penetration and constrictor paresis). Sixty percent of cases showed an improved overall VSBE score, and improved levels of albumin and total iron-binding capacity were restricted to this group. In cases with unchanged or decreased VSBE score, body weight was reduced and a negative correlation to total iron-binding capacity was noted (r = -0.60, p < 0.05). Changes of subjective complaints did not correlate with swallowing function or nutritional improvements. Swallowing treatment improves swallowing function, and improved swallowing function is associated with improvements in nutritional parameters. Subjective complaints is not sufficient to evaluate the clinical course, and nutritional parameters should be monitored in patients with oral or pharyngeal dysfunction.

Videomanometric analysis of supraglottic swallow, effortful swallow, and chin tuck in healthy volunteers.

Simultaneous videoradiography and solid-state manometry (videomanometry) was applied in eight healthy volunteers (four women, four men; age range 25-64 years, mean age 41 years) without swallowing problems. Three different swallowing techniques were tested; supraglottic swallow, effortful swallow, and chin tuck. Seven videoradiographic variables and six manometric variables were analyzed. The supraglottic swallowing technique did not differ significantly from that of the control swallows. The effortful swallow had a significantly (p = 0.0001) reduced hyoid-mandibular distance preswallow due to an elevation of the hyoid and the larynx, which caused a significantly (p = 0.007) reduced maximal hyoid movement and a significantly (p = 0.009) reduced laryngeal elevation during swallow. The chin tuck swallow had a significantly (p = 0. 001) reduced laryngohyoid distance and also a significantly (p = 0. 004) reduced hyoid-mandibular distance. The chin tuck swallow also displayed significantly (p = 0.003) weaker pharyngeal contractions. Videomanometry allows for analysis of bolus transport, movement of anatomical structures, and measurement of intraluminal pressures. These variables are important when evaluating swallowing techniques. In the present study, we made a few observations that never have been reported before. When healthy volunteers performed supraglottic swallow, they performed the technique somewhat differently. Therefore, we assume dysphagic patients would need a substantial period of training to perform a technique efficiently. Chin tuck could impair protection of the airways in dysphagic patients with weak pharyngeal constrictor muscles.

Assessment of respiration during video fluoroscopy of dysphagic patients.

RATIONALE AND OBJECTIVES: The authors evaluated the coordination of swallowing and respiration in dysphagic patients. MATERIALS AND METHODS: Video fluoroscopy and respirometry were performed simultaneously during 98 swallows in 33 patients (18 women, 15 men) with a median age of 70 years (interquartile range, 52-78 years). Pharyngeal transit time, deglutition apnea, and the ratio between the two (swallowing safety index) were calculated. Presence of a misdirected swallow (aspiration or penetration) was indicated. RESULTS: Pharyngeal transit time was not associated with deglutition apnea. Misdirected swallow was associated with a slightly prolonged pharyngeal transit time, a slightly shorter deglutition apnea, and a significantly lower swallowing safety index (1.8 [1.0-4.2] vs 4.5 [2.4-6.7]; P < .001) compared with normally directed swallow. The association between misdirected swallow and lower swallowing safety index was independent of pharyngeal transit time. CONCLUSION: Assessment of respiration is important in the evaluation of dysphagia. Aspiration, especially in elderly dysphagic patients, may be a consequence of primarily disturbed respiration. A low swallowing safety index may indicate risk of misdirected swallow.

CP beta3, a novel isoform of an actin-binding protein, is a component of the cytoskeletal calyx of the mammalian sperm head.

In the mammalian sperm head, the nucleus is tightly associated with the calyx, a cell type-specific cytoskeletal structure. Previously, we have identified and characterized some basic proteins such as calicin and cylicins I and II as major calyx components of bovine and human spermatids and spermatozoa. Surprisingly we have now discovered another calyx constituent which by amino acid sequencing and cDNA cloning was recognized as a novel isoform of the widespread beta subunit of the heterodimeric actin-binding "capping protein" (CP). This polypeptide, CP beta3, of sperm calices, is identical with the beta2 subunit present in diverse somatic cell types, except that it shows an amino-terminal extension of 29 amino acids and its mRNA is detected only in testis and, albeit in trace amounts, brain. This CP beta3 mRNA contains the additional sequence, encoded by exon 1 of the gene, which is missing in beta2 mRNAs. Antibodies specific for the beta3 amino-terminal addition have been used to identify the protein by immunoblotting and to localize it to the calyx structure by immunofluorescence microscopy. We conclude that in spermiogenesis the transcription of the gene encoding the beta1, beta2, and beta3 CP subunits is regulated specifically to include exon 1 and to give rise to the testis isoform CP beta3, which is integrated into the calyx structure of the forming sperm head. This surprising finding of an actin-binding protein isoform in an insoluble cytoskeletal structure is discussed in relation to the demonstrated roles of actin and certain actin-binding proteins, such as Limulus alpha-scruin, in spermiogenesis and spermatozoa.

[LILAs (lipid-like leukocyte activators) isolated from Saccharomyces cerevisiae induce calcium mobilization in human neutrophilic granulocytes[]. / Aus Saccharomyces cerevisiae isolierte LILAs (Lipid-like leukocyte activators) induzieren Kalziumeinstrom in humane neutrophile Granulozyten.

Recently, we isolated some new and functionally identical panchemotactic factors (Lipid-like leucocyte activators = LILAs) from Candida albicans, Saccharomyces cerevisiae and various dermatophytes, which are chemotactic for human neutrophilic and eosinophilic granulocytes as well as for monocytes. In order to answer the question, whether human neutrophilic granulocytes express a specific receptor for LILA, we now investigated the mobilisation of the intracellular second messenger calcium within human neutrophils which were stimulated with LILA. Furthermore, LILA-mediated activation of neutrophils was subjected to desensitisation experiments with the well known neutrophil activators 5-oxo-eicosatetraenoic acid, leukotriene B4, platelet activating factor, C5a, Interleukin-8, and N-for-myl-methionyl-leucyl-phenylalanin (FMLP). The intracellular calcium concentration was measured by use of the fluorescence indicator FURA-2/AM. As a result we were able to show a significant dose-dependent increase in the intracellular calcium concentration after stimulation of human neutrophils with LILA. The desensitisation experiments revealed no cross-desensitisation between LILA and the well known stimuli. Our results show that LILA induces an intracellular calcium signal in addition to its panchemotactic activities. Therefore, calcium may act as second messenger in LILA-stimulated activation of neutrophils. Since LILA-mediated activation was maintained in the desensitisation experiments, LILA-specific receptors may be present on human neutrophils.

Molecular nature of calicin, a major basic protein of the mammalian sperm head cytoskeleton.

In the mammalian sperm head the nucleus is tightly associated, in many species in its posterior part, with a large and dense nonfilamentous cytoskeletal structure, the calyx, whose major proteins are basic, representing a novel category of cytoskeletal element. Using specific antibodies, biochemical methods, and cDNA cloning we have characterized one of these calyx proteins, previously termed calicin, in bull and man. The polypeptide of 588 amino acids (Mr of 66,889; IEP 8.1) is very similar in the two species and is encoded by a approximately 2.2-kb mRNA that has been detected only in testis but not in any other tissue or cell culture examined. Sequence analysis has revealed that calicin is homologous to the kelch protein of the ring canal structure of Drosophila ovaries. In particular, it contains three consecutive repeating units of 48 amino acids each which are homologous to the so-called "beta-strand folds" occurring in proteins of the kelch family, including the actin cross-linking protein scruin of Limulus sperm and a series of other eukaryotic, bacterial, and viral proteins. Moreover, the amino terminal domain of calicin contains a region of about 100 amino acids homologous to an extended motif shared by the kelch protein as well as various zinc finger and poxvirus proteins. The possible role of calicin as a morphogenic cytoskeletal element in spermiogenic differentiation is discussed, also in relation to the demonstrated absence or altered arrangement of calicin in frequent forms of human teratozoospermia such as "round-headed" or other "postacrosomal sheath defect" sperm malformations.

[Steroid hormone receptor status of colorectal cancers]. / Zum Steroidhormonrezeptorenstatus kolorektaler Karzinome.

Tumor samples of 26 consecutive colorectal carcinomas were studied for the presence of steroid hormone receptors for estrogen and progesterone. In all cases, the estradiol receptor binding capacity was below 2 fmol/mg cytosol protein. In 4 of 26 samples, progesterone receptor levels from 13 to 23 fmol/mg cytosol protein were observed. Because of the identification of steroid receptors in some cases and single reports in literature about tumor regression under hormone therapy of colorectal carcinoma, further investigations seem indicated to study the hormone sensitivity of colorectal carcinoma.

[Intraoperative measurement of radiation dosage following 123-iodine meta-iodobenzylguanidine scintigraphy in surgical therapy of metastatic pheochromocytoma]. / Intraoperative Strahlendosismessung nach 123-Jod-MIBG-Szintigraphie zur operativen Therapie des metastasierenden Phäochromozytoms.

We investigated whether preoperative injection of 123-Jod-MIBG might be useful for intraoperative staging of chromaffine tumor cells. This was performed in a 46 year old patient in whome the diagnosis of a malignant pheochromocytoma had been established by 123-Jod-MIBG image and in catacholamine secretion. The rational for intraoperative staging of this patient was a discrepancy between computer tomography (CT) and the radio nuclide imagine. Intraoperative the tumor mass was identified with an activity of 10 x 10(4) Imp/sec as compared to normal tissue (15 x 10(2). A lymph node metastasis was found to be identified only by prior MIBG imagine and not by CT scanning. We thus conclude that intraoperative employment of this single probe measurement method might help to identify chromaffine tumor cells that have not been located fully by CT.

[Stomach cancer in patients under 40]. / Das Magenkarzinom bei Patienten unter 40 Jahren.

Fifty-one patients below the age of forty were treated for stomach carcinoma at the Surgical Hospital of Mainz University, between 1970 and 1986. They accounted for 5.2 per cent of all patients with stomach carcinoma. Diagnosis had been delayed under the following characteristic circumstances: The interval between onset of symptoms and diagnosis had been more than a year in 34 per cent of all cases. Fifty per cent of the patients had been originally hospitalised, following false suspicious diagnosis. Primary examination for gastro-intestinal passage produced falsely negative results in 43 per cent. The same falsely negative outcome was recorded from 24 per cent, following gastroscopy, and from twelve per cent, following gastroscopy combined with tissue sampling. The percentage of early stomach carcinomas was twice as high as that recorded from patients over forty. Undifferentiated carcinomas, on the other hand, were predominant in patients below forty, whereas adenocarcinomas were primarily recorded from patients over forty. Curative resection was successful in 55 per cent of the over-forties and 44 per cent of the under-forties. No-recurrence intervals were longer among the over-forties. However, five-year survival rates in Stages I, II, and III were better among the under-forties. Hence, the conclusion has been drawn from these findings that stomach carcinoma prognosis of patients below forty is better than that in higher age groups. This, however, is contradictory to other investigations reported in the literature.

Intraoperative localization of malignant pheochromocytoma by 123-I-metaiodobenzylguanidine single probe measurement.

Metaiodobenzylguanidine (MIBG) imaging is a well-established method for locating intra- and extraadrenal pheochromocytomas. We investigated whether preoperative injection of 123-I-MIBG might be useful for intraoperative staging of chromaffine tumor cells. This was performed in a 46-year-old patient in whom the diagnosis of a malignant pheochromocytoma had been established by 123-I-MIBG imaging and enhanced catecholamine secretion. The rationale for intraoperative staging in this patient was a discrepancy between computed tomography (CI) of the abdomen and the radionuclide imaging, because scintigraphy revealed a mass with MIBG uptake in the right lower abdomen that could not be visualized by CT. We thus applied a preoperative dose of 4 mCi 123-I-MIBG and determined tissue activity by direct organ measurement. A right abdominal mass was thus identified with an activity of 10 x 10(4) impulses/s as compared to normal tissue (15 x 10(2)). The left-sided tumor was found to be identified correctly by prior CT and MIBG imaging. We thus conclude that intraoperative application of this single probe measurement might help to identify chromaffine tumor cells that have not been located fully by CT.