Κυριακή 5 Νοεμβρίου 2017

An Aerodigestive Approach to Laryngeal Clefts and Dysphagia Using Injection Laryngoplasty in Young Children

Abstract

Purpose of Review

Our objective is to summarize the presentation, diagnosis, and management of mild laryngeal clefts in children. We focus on deep interarytenoid notches (DIN), a subclassification of type 1 laryngeal clefts (LC1), and review the literature and our multidisciplinary experience utilizing injection laryngoplasty (IL).

Recent Findings

DIN is a mild form of LC1 and is considered a normal anatomical variant. Recent cohort studies demonstrate IL to be a safe, low-risk, and efficacious treatment of LC1, but few studies focus on DIN. We present results from two aerodigestive clinic (ADC) pilot studies at our institution, in patients 1–3 years old, with DIN-related dysphagia and aspiration (DA). Feeding, respiratory-related symptom scores, and aspiration/penetration assessed on modified barium swallow (MBS) significantly improved following combined IL and feeding therapy using a thickener weaning protocol (TWP). Subgroup analysis reveals combined IL and TWP to be particularly effective in patients with severe baseline DA.

Summary

Multidisciplinary aerodigestive evaluation and management with IL and feeding therapy focused on weaning levels of thickener is emerging as a novel and effective approach for treatment of DIN-related DA in young children. Further comparative, prospective trials investigating effects of IL and feeding therapy are required to validate results.



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Vertical distributions and source identification of the radionuclides 239Pu and 240Pu in the sediments of the Liao River estuary, China

Publication date: January 2018
Source:Journal of Environmental Radioactivity, Volume 181
Author(s): Kexin Zhang, Shaoming Pan, Zhiyong Liu, Guosheng Li, Yihong Xu, Yongpei Hao
Activity concentration of plutonium (Pu) and its isotopic compositions are extensively used for measuring transport processes of Pu and identifying its source. We investigated the spatial distribution characteristics of 239+240Pu activity concentrations and 240Pu/239Pu atom ratio in several sediment cores collected from the Liao River coastal zone. Additionally, we calculated the 239+240Pu inventories and based on the 240Pu/239Pu atom ratio to trace Pu source. The activity concentrations of 239+240Pu in surface sediments of the Liao River estuary ranged between 0.103 ± 0.008 and 0.978 ± 0.035 mBq/g, with an average of 0.294 ± 0.024 mBq/g. The 240Pu/239Pu atom ratios, ranging from 0.173 ± 0.047 to 0.215 ± 0.061 (mean: 0.188 ± 0.049 (1σ)), were consistent with global fallout value, which indicates the global atmospheric fallout is the main source of Pu in sediment cores from the both sides of Liao River estuary. As for the tidal flat core LT-2, the mean 240Pu/239Pu atom ratio, slightly higher than that of the global fallout value, was 0.217 ± 0.050. Such pattern of Pu isotopic compositions indicated that Pu on the tidal flat in the Liao River estuary is sourced from a combination of global fallout and close-in fallout from the PPG by ocean currents transporting. And by using a two end-member mixing model, the results indicate the relative contribution of the PPG close-in fallout to core LT-2 is round 27% and 73% can be attributed to global fallout and river input. Therefore, these results clearly indicate that the direct global fallout is the main source of Pu in the Liao River estuary.

Graphical abstract

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Sources of inflow and nature of redistribution of 90Sr in the salt lakes of the Crimea

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Publication date: Available online 5 November 2017
Source:Journal of Environmental Radioactivity
Author(s): N.Yu. Mirzoyeva, S.I. Arkhipova, N.V. Kravchenko
At the first time for the period after the Chernobyl NPP accident the nature of the redistribution of the 90Sr concentrations in components of the ecosystems of the salt lakes of the Crimea were identified and described. Concentration of 90Sr in water of the salt lakes depends on the sources of the inflow this radionuclide into aquatic ecosystems and salinity level of lakes water. Until April 2014 the flow of the Dnieper river water through the Northern-Crimean canal was more important factor of contamination of salt lakes of the Crimea by 90Sr, than atmospheric fallout of this radionuclide after the Chernobyl NPP accident. Concentrations of 90Sr in water of the salt lakes of the Crimea exceeded 2.4–156.5 times its concentrations in their bottom sediments. The 90Sr dose commitments to hydrophytes, which were sampled from the salt lakes of the Crimea have not reached values which could impact them during entire the after-accident period.



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On Denny-Brown’s ‘spastic dystonia’ - what is it and what causes it?

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Publication date: Available online 4 November 2017
Source:Clinical Neurophysiology
Author(s): Jakob Lorentzen, Maud Pradines, Jean-Michel Gracies, Jens Bo Nielsen
In this review, we will work around two simple definitions of two different entities, which most often co-exist in patients with lesions to central motor pathways: Spasticity is "Enhanced excitability of velocity-dependent responses to phasic stretch at rest",(Gracies, 2005) which will not be the subject of this review. Spastic dystonia is tonic, chronic, involuntary muscle contraction in the absence of any stretch or any voluntary command. Spastic dystonia is a much less well understood entity that will be the subject this review.Denny-Brown (1966) observed involuntary sustained muscle activity in monkeys with lesions restricted to the motor cortices . He further observed that such involuntary muscle activity persisted following abolition of sensory input to the spinal cord and concluded that a central mechanism rather than exaggerated stretch reflex activity had to be involved. He coined the term spastic dystonia to describe this involuntary tonic activity in the context of otherwise exaggerated stretch reflexes. Sustained involuntary muscle activity in the absence of any stretch or any voluntary command contributes to burdensome and disabling body deformities in patients with spastic paresis. Yet, little has been done since Denny-Brown's studies to determine the pathophysiology of this non- stretch or effort related sustained involuntary muscle activity following motor lesions and there is a clear need for research studies in order to improve current therapy.The purpose of the present review is to discuss some of the possible mechanisms that may be involved in the hope that this may guide future research. We discuss the existence of persistent inward currents in spinal motoneurones and present the evidence that the channels involved may be upregulated following central motor lesions. We also discuss a possible contribution from alterations in synaptic inputs from surviving or abnormally branched sensory and descending fibres leading to over-activity and lack of motor coordination. We finally discuss evidence of alterations in motor cortical representational maps and basal ganglia lesions.



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A longitudinal examination of event-related potentials sensitive to monetary reward and loss feedback from late childhood to middle adolescence

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Publication date: Available online 4 November 2017
Source:International Journal of Psychophysiology
Author(s): Autumn Kujawa, Ashley Carroll, Emma Mumper, Dahlia Mukherjee, Ellen Kessel, Thomas Olino, Greg Hajcak, Daniel N. Klein
Brain regions involved in reward processing undergo developmental changes from childhood to adolescence, and alterations in reward-related brain function are thought to contribute to the development of psychopathology. Event-related potentials (ERPs), such as the reward positivity (RewP) component, are valid measures of reward responsiveness that are easily assessed across development and provide insight into temporal dynamics of reward processing. Little work has systematically examined developmental changes in ERPs sensitive to reward. In this longitudinal study of 75 youth assessed 3 times across 6years, we used principal components analyses (PCA) to differentiate ERPs sensitive to monetary reward and loss feedback in late childhood, early adolescence, and middle adolescence. We then tested reliability of, and developmental changes in, ERPs. A greater number of ERP components differentiated reward and loss feedback in late childhood compared to adolescence, but components in childhood accounted for only a small proportion of variance. A component consistent with RewP was the only one to consistently emerge at each of the 3 assessments. RewP demonstrated acceptable reliability, particularly from early to middle adolescence, though reliability estimates varied depending on scoring approaches and developmental periods. The magnitude of the RewP component did not significantly change across time. Results provide insight into developmental changes in the structure of ERPs sensitive to reward, and support RewP as a consistently observed and relatively stable measure of reward responsiveness, particularly across adolescence.



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Heart rate variability mediates the link between rumination and depressive symptoms: A longitudinal study

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Publication date: Available online 5 November 2017
Source:International Journal of Psychophysiology
Author(s): Luca Carnevali, Julian F. Thayer, Jos F. Brosschot, Cristina Ottaviani
Ruminative thinking about negative feelings has been prospectively associated with increases in depressive symptoms and heightened risk for new onsets of major depression. One putative pathophysiological mechanism underlying this link might be represented by autonomic nervous system dysfunction. The objective of this longitudinal study was to evaluate the interplay between rumination, autonomic function (as revealed by heart rate variability (HRV) analysis), and depressive symptoms in healthy young subjects, over a three-year period. Rumination and depressive symptoms were evaluated in twenty-two women and twenty men at three assessment points (Time 0, 1 and 2) by the score on the Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale, respectively. Vagally-mediated HRV was assessed in a laboratory session (Time 0) and in two ambulatory sessions at Time 1 and Time 2 (~13 and 34months after Time 0, respectively). Ruminative thinking was found to be (i) a stable trait characteristic, (ii) more prevalent in women than men, and (iii) positively correlated with depressive symptoms. Moreover, resting HRV was negatively correlated with both rumination and depressive symptoms. Finally, HRV at Time 1 mediated the relationship between rumination at Time 0 and depressive symptoms at Time 2. We conclude that autonomic dysfunction, specifically low vagal tone, may be prospectively implicated in the generation of depressive symptoms in a non-clinical setting.



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Fla. county residents can text 9-1-1 now

The feature came just before Senator Bill Nelson introduced legislation that calls for the expansion of federal grants to assist with next-generation 911 systems

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