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de Andrade RA, Pernambuco LDA, de Almeida ANS, Mulatinho MEDCP, Dos Santos ENF, da Silva HJ. Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review. Dysphagia 2024:10.1007/s00455-024-10714-1. [PMID: 38802587 DOI: 10.1007/s00455-024-10714-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024]
Abstract
This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.
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Affiliation(s)
- Rodrigo Alves de Andrade
- Department of Speech-Language-Hearing Sciences, Federal University of Pernambuco, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil.
| | - Leandro de Araújo Pernambuco
- Federal University of Pernambuco, UFPE, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil
| | | | | | | | - Hilton Justino da Silva
- Federal University of Pernambuco, UFPE, Av. Prof. Artur de Sá, S/N - Cidade Universitária, Recife, PE, CEP 50674-420, Brazil
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Tomsen N, Bolívar-Prados M, Ortega O, Clavé P. Therapeutic Effect on Swallowing Function and on Hydration Status of a New Liquid Gum-Based Thickener in Independently-Living Older Patients with Oropharyngeal Dysphagia. Nutrients 2023; 15:4621. [PMID: 37960274 PMCID: PMC10647578 DOI: 10.3390/nu15214621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
ThickenUp® Gel Express (TUGE) is a new, xanthan- and acacia-gum-based, liquid, thickening product. In independently living older adults with oropharyngeal dysphagia (OD), we assessed: (1) the rheological properties of TUGE; (2) its therapeutic effect at four viscosity levels (achieved by 5 g, 10 g, 20 g and 30 g of TUGE in water + Omnipaque X-ray contrast) versus thin liquid; and (3) the effect on hydration status and gastrointestinal tolerance after fourteen days. Shear viscosity of TUGE was measured in SI units (mPa·s at 50 s-1). The Penetration Aspiration Scale (PAS) score and the swallow response at each viscosity level was assessed with videofluoroscopy (VFS), and in the 14-day study we assessed fluid intake, hydration, and tolerance. Thickened fluids with TUGE were unaffected (-0.3%) by α-salivary amylase (α-SA). The shear viscosity values with VFS were 49.41 ± 2.38, 154.83 ± 10.22, 439.33 ± 11.72 and 672.5 ± 35.62 mPa·s. We studied 60 independently living adults (70 ± 11.4 years) with mild OD (PAS 4.1 ± 2.2, 25% aspirations). TUGE caused a shear-viscosity-dependent improvement in PAS at 150-670 mPa·s and in safety of swallow, slightly increased oral residue, did not affect pharyngeal residue and reduced time to laryngeal vestibule closure (-27%) at 670 mPa·s. Fluid intake with TUGE (1488 mL/day) was well tolerated, and hydration status improved. In conclusion, TUGE was unaffected by α-SA and strongly improved safety of swallow in a viscosity-dependent manner without affecting pharyngeal residue. Fourteen-day treatment of thickened fluids with TUGE is safe and well tolerated and improves hydration status in older adults with dysphagia.
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Affiliation(s)
- Noemí Tomsen
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Mireia Bolívar-Prados
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Omar Ortega
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Pere Clavé
- Gastrointestinal Physiology Lab, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Brito-de la Fuente E, Muñiz-Becerá S, Ascanio G. Lipid emulsions in clinical nutrition: Enteral and parenteral nutrition. ADVANCES IN FOOD AND NUTRITION RESEARCH 2023; 105:301-342. [PMID: 37516466 DOI: 10.1016/bs.afnr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
Clinical nutrition emulsions are important products that can be life-saving for many patients suffering from gastrointestinal tract disorders, swallowing impairment, cancer, liver diseases, and many other clinical conditions. The transfer of lipids to the human body can be either intravenously (Parenteral Nutrition, PN) or through the gastrointestinal tract (Enteral Nutrition, EN). PN emulsions are considered pharmaceuticals and thus regulated accordingly. On the other hand, EN emulsions are classified as Food for Specific Medical Purposes (FSMP) and do not follow pharmaceutical regulations. Regarding product design, PN emulsions must follow theoretical emulsion formulation and production aspects, but special requirements regarding droplet size distribution must be followed to comply with national pharmacopeia monographs. Furthermore, a full clinical program on clinical evidence to prove safety and efficacy must be provided for marketing approval. On the contrary, EN emulsions require limited clinical evidence to substantiate health or clinical benefits. A short introduction to clinical nutrition with a focus on lipid emulsions is presented in this chapter. Furthermore, a general overview of the composition and main ingredients of clinical nutrition lipid emulsions is reviewed. Main clinical aspects are also mentioned here, highlighting the difficulties of clinically proving the efficacy of these products. The manufacturing and control of clinical nutrition emulsions are also reviewed, focusing on PN products and the main regulatory requirements related to the safety of these intravenous emulsions. Finally, stability and physicochemical properties are reviewed, and examples of commercially available products are used to illustrate these properties linked to the stability of these products. Lipids in clinical nutrition is a moving field and we do hope this chapter may remain a valuable source to understand newly emerging research on this topic.
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Affiliation(s)
- Edmundo Brito-de la Fuente
- Instituto de Ciencias Aplicadas y Tecnología, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Mexico City, Mexico.
| | - Sahylin Muñiz-Becerá
- Instituto de Ciencias Aplicadas y Tecnología, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Mexico City, Mexico
| | - Gabriel Ascanio
- Instituto de Ciencias Aplicadas y Tecnología, Universidad Nacional Autónoma de México, Circuito Exterior S/N, Ciudad Universitaria, Mexico City, Mexico
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Gallegos C, Turcanu M, Assegehegn G, Brito-de la Fuente E. Rheological Issues on Oropharyngeal Dysphagia. Dysphagia 2023; 38:558-585. [PMID: 34216239 DOI: 10.1007/s00455-021-10337-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
There is an increasing proof of the relevance of rheology on the design of fluids for the diagnosis and management of dysphagia. In this sense, different authors have reported clinical evidence that support the conclusion that an increase in bolus viscosity reduces the risks of airway penetration during swallowing. However, this clinical evidence has not been associated yet to the definition of objective viscosity levels that may help to predict a safe swallowing process. In addition, more recent reports highlight the potential contribution of bolus extensional viscosity, as elongational flows also develops during the swallowing process. Based on this background, the aim of this review paper is to introduce the lecturer (experts in Dysphagia) into the relevance of Rheology for the diagnosis and management of oropharyngeal dysphagia (OD). In this sense, this paper starts with the definition of some basic concepts on Rheology, complemented by a more extended vision on the concepts of shear viscosity and elongational viscosity. This is followed by a short overview of shear and elongational rheometrical techniques relevant for the characterization of dysphagia-oriented fluids, and, finally, an in-depth analysis of the current knowledge concerning the role of shear and elongational viscosities in the diagnosis and management of OD (shear and elongational behaviors of different categories of dysphagia-oriented products and contrast fluids for dysphagia assessment, as well as the relevance of saliva influence on bolus rheological behavior during the swallowing process).
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Affiliation(s)
- Crispulo Gallegos
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany.
| | - Mihaela Turcanu
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Getachew Assegehegn
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
| | - Edmundo Brito-de la Fuente
- Product and Process Engineering Center, Fresenius Kabi Deutschland GmbH, Daimlerstrasse 22, 61352, Bad Homburg, Germany
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Sepehri S, Andersson J, Schaller V, Grüttner C, Stading M, Johansson C. Remote Sensing of the Nano-Rheological Properties of Soft Materials Using Magnetic Nanoparticles and Magnetic AC Susceptometry. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 13:67. [PMID: 36615976 PMCID: PMC9823654 DOI: 10.3390/nano13010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/02/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
We have developed a nano-rheological characterization tool to extract the frequency- and scale-dependent rheological properties of soft materials during oral processing. Taking advantage of AC susceptometry, the dynamic magnetization of magnetic nanoparticles blended in the matrix material is measured. The magnetic AC susceptibility spectra of the particles are affected by the viscosity and mechanical modulus of the matrix material and provide the rheological properties of the matrix. Commercially available iron-oxide magnetic nanoparticles with 80 and 100 nm particle sizes are used as tracers in the frequency range of 1 Hz-10 kHz. The AC susceptibility is measured using two differentially connected coils, and the effects of the sample temperature and distance with respect to the detection coils are investigated. The developed measurement setup shows the feasibility of remote nano-rheological measurements up to 2 cm from the coil system, which can be used to, e.g., monitor the texture of matrix materials during oral processing.
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Affiliation(s)
- Sobhan Sepehri
- Digital Systems, RISE Research Institutes of Sweden, Arvid Hedvalls Backe 4, SE-41133 Gothenburg, Sweden
| | - Johanna Andersson
- Bioeconomy and Health, RISE Research Institutes of Sweden, Frans Perssons väg 6, SE-40229 Gothenburg, Sweden
| | - Vincent Schaller
- Digital Systems, RISE Research Institutes of Sweden, Arvid Hedvalls Backe 4, SE-41133 Gothenburg, Sweden
| | - Cordula Grüttner
- Micromod Partikeltechnologie GmbH, Friedrich-Barnewitz-Str. 4, D-18119 Rostock, Germany
| | - Mats Stading
- Bioeconomy and Health, RISE Research Institutes of Sweden, Frans Perssons väg 6, SE-40229 Gothenburg, Sweden
| | - Christer Johansson
- Digital Systems, RISE Research Institutes of Sweden, Arvid Hedvalls Backe 4, SE-41133 Gothenburg, Sweden
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Kongjaroen A, Methacanon P, Seetapan N, Fuongfuchat A, Gamonpilas C, Nishinari K. Effects of dispersing media on the shear and extensional rheology of xanthan gum and guar gum-based thickeners used for dysphagia management. Food Hydrocoll 2022. [DOI: 10.1016/j.foodhyd.2022.107857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ohie K, Chiba H, Kumagai S, Yoshida T, Tasaka Y. A method for evaluating time-resolved rheological functionalities of fluid foods. J Texture Stud 2022; 53:444-452. [PMID: 35338484 PMCID: PMC9544376 DOI: 10.1111/jtxs.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 11/27/2022]
Abstract
We have developed an effective method for evaluating time-resolved rheological functionalities of swallowed foods using ultrasonic spinning rheometry (USR). USR can obtain variations over time in the rheological properties of fluids despite the fluids being in heterogeneous and non-equilibrium conditions. In addition, USR can evaluate time variations of shear-thinning property changing in a few seconds. Demonstrations were conducted with typical thickener solutions: starch, guar gum, and xanthan gum-based solutions, with alpha-amylase as a digestive enzyme. The flow curve of the starch-based solutions lowered with time, and a few minutes after addition of the amylase, the viscosity dropped to one-hundredth of the original value. In contrast, the guar gum and xanthan gum-based solutions maintained the original viscosities as generally known. Applying the power law fitting to series of these flow curves, the time variation of the shear thinning property is quantitatively characterized by the plots on typical K-n space, where K and n are parameters in the model, consistency index and power law exponent. The qualitative characteristics of the thickeners are successfully quantified in the K-n space, and this will be a practical tool for evaluating the time-resolved rheological properties of swallowed foods.
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Affiliation(s)
- Kohei Ohie
- Laboratory for Flow Control, Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Haruko Chiba
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Kumagai
- Nutrition Management Center, Hokkaido University Hospital, Sapporo, Japan
| | - Taiki Yoshida
- National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, Tsukuba Central 3, 1-1-1, Umezono, Tsukuba, Japan
| | - Yuji Tasaka
- Laboratory for Flow Control, Faculty of Engineering, Hokkaido University, Sapporo, Japan
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Lavoisier A, Shreeram S, Jedwab M, Ramaioli M. Effect of the rheological properties of the liquid carrier on the in vitro swallowing of solid oral dosage forms. J Texture Stud 2021; 52:623-637. [PMID: 34118071 DOI: 10.1111/jtxs.12618] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
Solid oral dosage forms (SODF) are the most popular oral drug delivery forms, but they can be difficult to swallow, especially for patients suffering from swallowing disorders. This study investigated the dynamics of different combinations of liquid carriers and SODF during the oral phase of swallowing using an in vitro model. The rheological properties of the carriers were characterized using shear and extensional rheometry, and their effect on bolus velocity, bolus shape, post-swallow residues, and SODF position within the bolus was evaluated. The latter has been identified as a novel and promising variable to discriminate between alternative formulations. When swallowed with water, capsules and tablets did not impact significantly the velocity of the bolus, but they lagged behind the liquid bolus, suggesting that low viscosity Newtonian fluids are not efficient carriers for SODF. Increasing the viscosity of the carrier at high shear rates improved the ability of the liquid to transport the SODF but also increased the amount of post-swallow residues. At equivalent shear viscosity, elastic and extensional properties of carriers influenced positively the position of the SODF in the bolus. Capsules and tablets were transported toward the front of these boluses, during the oral phase of swallowing, which is considered beneficial to avoid SODF sticking to the mucosa in the following stages of swallowing. Thin elastic liquids appear as an interesting option to promote safe swallowing of capsules and tablets. Clinical studies are, however, necessary to confirm this positive effect in healthy and dysphagic patients.
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Affiliation(s)
- Anaïs Lavoisier
- Paris-Saclay Food and Bioproduct Engineering research unit, INRAE, AgroParisTech, Massy, France
| | | | | | - Marco Ramaioli
- Paris-Saclay Food and Bioproduct Engineering research unit, INRAE, AgroParisTech, Massy, France
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