Temporal Analysis of Factors Associated with EAT-10 in Outpatients with Oropharyngeal Dysphagia from a Tertiary Care Clinic.

Self-perception of disease is increasingly recognized as a determinant of health. The Eating Assessment Tool-10 (EAT-10) is a functional health status questionnaire that measures the symptomatic severity of dysphagia from the patient's perspective. The objective of this work was to identify factors (demographics, clinical variables, swallowing physiology, health-related quality of life) associated with longitudinal change in EAT-10 scores in outpatients with oropharyngeal dysphagia at a multi-disciplinary, tertiary care clinic. All patients with swallowing concerns that were included in the UW Madison Voice and Swallowing Outcomes database from 12/2012 to 04/2015 were invited to complete EAT-10 and a general health-related quality of life survey (SF-12v2) at their initial evaluation and six months later. Forty-two patients were included in analysis (n = 42). Weaning from a gastrostomy tube was significantly associated with EAT-10 improvement. Approximately 70% of the sample had mild dysphagia, and floor effects were observed for all EAT-10 items in this sample subset. Mean SF-12v2 Physical Component Summary score was substantially lower than that of the general population. Significant, weak-moderate correlations were found between EAT-10 and SF-12v2 scores for all comparisons except for Physical Health Composite at six months (rs = = 0.24 to - 0.43). Weaning from a feeding tube appears to meaningfully improve self-perceived symptoms of dysphagia. Given the floor effects observed, validity of EAT-10 for patients with mild dysphagia should be examined. Future research should address contributors to self-perceived symptom change across the range of dysphagia severity.

Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment.

BACKGROUND: Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison. METHODS: Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (RT-PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist. RESULTS AND DISCUSSION: Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]ß1, alpha smooth muscle actin, interleukin-1ß, interleukin-17ß and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC-treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair.

Dietary protein level and skeletal development in the golden Syrian hamster.

The hamster was used as a model for investigating the effect of low, moderate, and high protein intake (12, 18, and 36% casein) on bone mineral content. Animals fed the low level of protein between 3 and 8 months of age had a reduction in the weight of all skeletal components measured, with the exception of the diaphyseal portion of the long bones. Diaphyseal weight and calcium remained significantly lower when expressed as a percentage of body weight. However, urinary calcium excretion was not lower than that of animals consuming an adequate protein intake. Ingesting a high protein diet resulted in a significant increase in urinary calcium excretion, and a reduced amount of both mineral and organic material in the diaphyses. We conclude that long-term consumption of a high protein ration led to the development of a mild osteoporotic condition in the hamster which was limited to the diaphyseal portions of the long bones.

Reduction of renal calcium reabsorption in man by consumption of dietary protein.

This experiment was designed to test whether protein consumption reduces the amount of filtered calcium reabsorbed by the kidney. Nine subjects were each fed meals containing 18 g protein and 54 g protein. The intake of energy, sodium, calcium, phosphorus, magnesium and zinc was similar in the two meals. For 4 hours after the meal, measurements were made of serum calcium (total and filterable), serum creatinine, and urinary calcium, creatinine, zinc and nitrogen. Calcium reabsorption was calculated in five clearance periods, as (filterable calcium X GFR) minus urinary calcium. Urinary calcium, zinc and nitrogen were significantly higher between 2 and 4 hours after consumption of the high protein meal. Protein level did not affect urine pH or volume, serum total or filterable calcium & or GFR. The percentage reabsorption of filtered calcium was significantly lower 0.5 hours after the high protein meal, so that at 2.5 hours, reabsorption was 98.0% compared to 98.7% after the lower protein meal. We conclude that protein consumption reduces the amount of calcium reabsorbed by the kidney.