Effect of anterior cervical osteophyte in poststroke dysphagia: a case-control study

[Ventral cervical spondylophytes as differential diagnosis of neurogenic dysphagia]

BACKGROUND

Ventral cervical spondylophytes can lead to severe dysphagia if they are of sufficient extent and height localization and represent an important differential diagnosis of neurogenic dysphagia, especially in older patients.

OBJECTIVE

Presentation of various etiologies of ventral cervical spondylophytes, specific symptoms and abnormalities of the swallowing function caused by spondylophytes, their manifestation in the instrumental swallowing diagnostics and an outlook on treatment options.

MATERIAL AND METHODS

Summary of the current literature on spondylophyte-related dysphagia and an overview of research results regarding differential diagnostic aspects of neurogenic dysphagia.

RESULTS

The manifestation forms of ventral cervical spondylophytes can be very diverse. With respect to dysphagia, disorders of pharyngeal bolus transfer and an increased tendency to aspiration have been observed. The occurrence and severity of the symptoms depend primarily on the extent of the bony attachments and their height localization.

CONCLUSION

In some cases, symptomatic ventral cervical spondylophytes can be a relevant differential diagnosis of neurogenic dysphagia. For a more precise evaluation of the dysphagic symptoms and their association with the spondylophytic outgrowths, a video fluoroscopy of swallowing (VFS) should be added to the fiber endoscopic evaluation (FEES). In most cases, a resection of the bone spurs leads to a significant improvement or even to a complete restitution of the swallowing disorders.

Neuroprotective Effect of Daidzein Extracted From Pueraria lobate Radix in a Stroke Model Via the Akt/mTOR/BDNF Channel

Daidzein is a plant isoflavonoid primarily isolated from Pueraria lobate Radix as the dry root of P. lobata (Wild.) Ohwi, have long been used as nutraceutical and medicinal herb in China. Despite the report that daidzein can prevent neuronal damage and improve outcome in experimental stroke, the mechanisms of this neuroprotective action have been not fully elucidated. The aim of this study was to determine whether the daidzein elicits beneficial actions in a stroke model, namely, cerebral ischemia/reperfusion (I/R) injury, and to reveal the underlying neuroprotective mechanisms associated with the regulation of Akt/mTOR/BDNF signal pathway. The results showed that I/R, daidzein treatment significantly improved neurological deficits, infarct volume, and brain edema at 20 and 30 mg/kg, respectively. Meanwhile, it was found out that the pretreatment with daidzein at 20 and 30 mg/kg evidently improved striatal dopamine and its metabolite levels. In addition, daidzein treatment reduced the cleaved Caspase-3 level but enhanced the phosphorylation of Akt, BAD and mTOR. Moreover, daidzein at 30 mg/kg treatment enhanced the expression of BDNF and CREB significantly. This protective effect of daidzein was ameliorated by inhibiting the PI3K/Akt/mTOR signaling pathway using LY294002. To sum up, our results demonstrated that daidzein could protect animals against ischemic damage through the regulation of the Akt/mTOR/BDNF channel, and the present study may facilitate the therapeutic research of stroke.

Role of bilateral corticobulbar tracts in dysphagia after middle cerebral artery stroke

BACKGROUND AND PURPOSE

The corticobulbar tract is a potential neural pathway involved in swallowing. The frontal operculum, insular cortex, corona radiata and internal capsule, which are frequently involved in middle cerebral artery (MCA) strokes, are locations in which lesions cause dysphagia. However, it is unclear whether the locations are linked to the corticobulbar tract or whether corticobulbar tract integrity is associated with dysphagia severity. This study aimed to assess the association between corticobulbar tract integrity and dysphagia severity after MCA stroke.

METHODS

Thirty dysphagic patients after MCA stroke and 27 healthy controls were examined. Diffusion tensor imaging (DTI)-derived parameters of the corticobulbar tract were compared between patient and control groups. Next, patients were divided into mild and moderate-to-severe dysphagia groups, and DTI-derived parameters of the corticobulbar tract were compared between the subgroups. Logistic regression analysis was used to determine the association between corticobulbar tract integrity and dysphagia severity.

RESULTS

The tract volume (TV) of the affected corticobulbar tract was lower in dysphagic patients than in healthy controls (P < 0.001). According to dysphagia severity, TV of the unaffected corticobulbar tract was higher in the mild dysphagia group than in the moderate-to-severe dysphagia group (P = 0.012). TV of the unaffected corticobulbar tract was independently associated with dysphagia severity according to the logistic regression model (adjusted odds ratio 0.817, 95% confidence interval 0.683-0.976).

CONCLUSIONS

The corticobulbar tract was affected after MCA stroke and may be associated with dysphagia. A higher corticobulbar TV in the unaffected hemisphere was indicative of better swallowing function in dysphagic patients after MCA stroke.

Segmentation of cervical intervertebral disks in videofluorography by CNN, multi-channelization and feature selection

PURPOSE

Dysphagia has a large impact on the society because it is a risk factor of malnutrition and aspiration pneumonia, and therefore, it is necessary to elucidate the entire mechanism of dysphagia. In this study, we propose a segmentation method of cervical intervertebral disks (CIDs) in videofluorography (VF) by use of patch-based convolutional neural network (CNN), our multi-channelization (MC) method and image feature selection.

METHODS

Twenty image filters are individually applied to a VF frame image to generate feature images. One color image, called a multi-channelized image, is generated by setting three selected feature images to its red, green and blue channels. Patch-based CNN is applied to the MC image, and the segmentation accuracy of CIDs is evaluated by the pixel-based F-measure. The combination of the three feature images is optimized by the simulated annealing method.

RESULTS

The proposed method was applied to actual VF dataset consisting of 19 patients and 39 healthy participants. The segmentation accuracy was 59.3% in the F-measure when Sobel and morphological top-hat filters were selected in MC, whereas it was 56.2% when original frame images were used.

CONCLUSION

The experimental results demonstrated that the proposed method was able to segment CIDs from actual VF and also that the MC method was able to increase the segmentation accuracy by approximately 3%. In this study, LeNet was used as CNN. One of our future tasks is to use other CNNs.

Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure

Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.