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Role of injection laryngoplasty in preventing post-stroke aspiration pneumonia, case series report.


  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000019220
  • 作者列表:"Han YJ","Jang YJ","Park GY","Joo YH","Im S
  • 发表时间:2020-02-01

INTRODUCTION:Injection laryngoplasty is a common procedure for patients with vocal fold dysfunction, but the literature on its benefits has been mainly focused on those related to structural lesions or laryngeal nerve involvement. Stroke patients may be at increased risk of aspiration due to insufficient vocal fold motion. However, how injection laryngoplasty can be of benefit in stroke patients has not been reported yet. PATIENT CONCERNS:Six chronic stroke patients with long-standing swallowing difficulties and who showed severe aspiration despite long-term swallowing rehabilitation. DIAGNOSIS:Laryngoscope evaluation revealed insufficient glottic closure as the cause of aspiration. INTERVENTIONS:Injection laryngoplasty was done per-orally under local anaesthesia with calcium hydroxylapatite (Radiesse Voice, 1-1.5 mL) in an office setting. Respiratory pressures and peak cough flows were assessed at baseline and at 2 weeks follow-up. OUTCOMES:At 2 weeks, the mean peak cough flow (Δ = +95.09 L/min) increased significantly after the procedure. The maximal expiratory (Δ = +18.40 cm H2O) and inspiratory (Δ = +20.20 cm H2O) pressures also improved, indicating that injection laryngoplasty was effective in augmenting respiratory and cough parameters. All cases showed improvement in the Functional Oral Intake Scale (Δ = +4). Feeding tubes were successfully removed. CONCLUSION:Injection laryngoplasty proved to be both successful and safe in improving glottic closure with immediate results in those who had failed to show a positive response after long-term swallowing rehabilitation. The positive and dramatic clinical outcomes were observed through changes in the coughing force. Our case series support the use of injection larygnoplasty as a powerful adjunctive treatment method to prevent aspiration pneumonia in post-stroke patients with vocal fold insufficiency. Pre- and post-injection peak cough flow changes may reflect improvement in glottic closure and indicate the safety of swallowing with reduced risk of aspiration.


导读: 注射喉成形术是声带功能障碍患者的常用术式,但有关其获益的文献主要集中在与结构性病变或喉神经受累有关的方面。由于声带运动不足,中风患者的误吸风险可能增加。然而,注射喉成形术如何在中风患者中获益尚未见报道。 患者关注的问题: 6 名长期吞咽困难的慢性脑卒中患者,尽管长期吞咽康复,但仍表现出严重的误吸。 诊断: 喉镜评估显示声门闭合不足是误吸的原因。 干预措施: 在办公室环境下,在局部麻醉下口服羟基磷灰石钙 (Radiesse Voice,1-1.5  mL) 进行喉成形术注射。在基线和 2 周随访时评估呼吸压力和咳嗽峰值流量。 结果: 在 2 周时,术后平均峰值咳嗽流量 (Δ   = + 95.09 l l/min) 显著增加。最大呼气 (Δ  =   + 18.40  cm  H2O) 和吸气 (Δ  =   + 20.20  cm  H2O) 压力也有所改善,表明注射laryngoplasty可有效增强呼吸和咳嗽.所有病例均显示功能性口服摄入量表改善 (Δ   =   + 4)。成功取出饲管。 结论: 注射喉成形术在改善声门闭合方面是成功的和安全的,对于那些在长期吞咽康复后没有显示出积极反应的人,可以立即得到结果。通过咳嗽力的变化观察到积极和显著的临床结果。我们的病例系列支持使用注射式声带成形术作为一种强有力的辅助治疗方法,以预防卒中后声带关闭不全患者的吸入肺炎。注射前和注射后咳嗽峰流量的变化可能反映了声门闭合的改善,并表明吞咽的安全性和误吸风险的降低。



来源期刊:Nature immunology
作者列表:["Adrover JM","Aroca-Crevillén A","Crainiciuc G","Ostos F","Rojas-Vega Y","Rubio-Ponce A","Cilloniz C","Bonzón-Kulichenko E","Calvo E","Rico D","Moro MA","Weber C","Lizasoaín I","Torres A","Ruiz-Cabello J","Vázquez J","Hidalgo A"]

METHODS::The antimicrobial functions of neutrophils are facilitated by a defensive armamentarium of proteins stored in granules, and by the formation of neutrophil extracellular traps (NETs). However, the toxic nature of these structures poses a threat to highly vascularized tissues, such as the lungs. Here, we identified a cell-intrinsic program that modified the neutrophil proteome in the circulation and caused the progressive loss of granule content and reduction of the NET-forming capacity. This program was driven by the receptor CXCR2 and by regulators of circadian cycles. As a consequence, lungs were protected from inflammatory injury at times of day or in mouse mutants in which granule content was low. Changes in the proteome, granule content and NET formation also occurred in human neutrophils, and correlated with the incidence and severity of respiratory distress in pneumonia patients. Our findings unveil a 'disarming' strategy of neutrophils that depletes protein stores to reduce the magnitude of inflammation.

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翻译标题与摘要 下载文献
作者列表:["Yang LC","Suen YJ","Wang YH","Lin TC","Yu HC","Chang YC"]

METHODS::Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan-Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.

翻译标题与摘要 下载文献
作者列表:["Ngocho JS","Horumpende PG","de Jonge MI","Mmbaga BT"]

METHODS:OBJECTIVE:To describe the treatment of community-acquired pneumonia (CAP) in children under five years in Tanzania. METHODS:Between January and December 2017, children aged 2-59 months with chest radiography-confirmed CAP were enrolled. The parents were interviewed to collect information on the patients and home-based medication. Clinical information was derived from the patient files. Nasopharyngeal swab and blood samples were collected for isolation of the causative pathogens. Swab samples were analysed by quantitative PCR whereas blood samples were tested using BacT/Alert 3D. RESULTS:Overall, 109 children with CAP were included in this analysis. Provision of care to most children was delayed (median = 4.6 days). A quarter (26.6%) were given unprescribed/leftover antibiotics at home. Only one child had positive bacterial culture. Referrals were associated with nasopharyngeal carriage of Streptococcus pneumoniae (p = 0.003) and Haemophilus influenzae (p = 0.004). Of all admitted children, more than a quarter (n = 29) did not need to be hospitalised and inappropriately received injectable instead of oral antibiotics. CONCLUSION:We found high rates of home treatment, particularly with antibiotics. Appropriate health care was delayed for most children because of home treatment. Efforts are needed at the community level to improve awareness of antimicrobial resistance.

翻译标题与摘要 下载文献