Kyoung Hyo Choi

The effect of electrical stimulation therapy on dysphagia following treatment for head and neck cancer

The purpose of this study was to evaluate the effect of neuromuscular electrical stimulation (NMES) in patients suffering from dysphagia following treatment for head and neck cancer. In a prospective, double blinded, randomized case control study between January 2006 and December 2007, 14 patients were randomized to 30min of NMES and 30min of traditional swallowing training for 5 days per week for 2 weeks (experimental group), and 12 patients were randomized to sham stimulation plus traditional swallowing training (control group). Effects were assessed using the clinical dysphagia scale (CDS), the functional dysphagia scale (FDS), the American speech-language-hearing association national outcome measurement system (ASHA NOMS) and the M.D. Anderson dysphagia inventory (MADI). Pretreatment evaluation showed no significant differences between the two groups for all parameters. Average changes of FDS score were 11.4+/-8.1 for the experimental group and 3.3+/-14.0 for the control group (P=0.039). CDS, ASHA NOMS and MADI showed some difference with treatment, but the changes were not significant (P>0.05). NMES combined with traditional swallowing training is superior to traditional swallowing training alone in patients suffering from dysphagia following treatment for head and neck cancer.

Effect of Lumbar Stabilization and Dynamic Lumbar Strengthening Exercises in Patients With Chronic Low Back Pain

Objective To compare the effects of lumbar stabilization exercises and lumbar dynamic strengthening exercises on the maximal isometric strength of the lumbar extensors, pain severity and functional disability in patients with chronic low back pain (LBP). Methods Patients suffering nonspecific LBP for more than 3 months were included prospectively and randomized into lumbar stabilization exercise group (n=11) or lumbar dynamic strengthening exercise group (n=10). Exercises were performed for 1 hour, twice weekly, for 8 weeks. The strength of the lumbar extensors was measured at various angles ranging from 0° to 72° at intervals of 12°, using a MedX. The visual analog scale (VAS) and the Oswestry Low Back Pain Disability Questionnaire (ODQ) were used to measure the severity of LBP and functional disability before and after the exercise. Results Compared with the baseline, lumbar extension strength at all angles improved significantly in both groups after 8 weeks. The improvements were significantly greater in the lumbar stabilization exercise group at 0° and 12° of lumbar flexion. VAS decreased significantly after treatment; however, the changes were not significantly different between the groups. ODQ scores improved significantly in the stabilization exercise group only. Conclusion Both lumbar stabilization and dynamic strengthening exercise strengthened the lumbar extensors and reduced LBP. However, the lumbar stabilization exercise was more effective in lumbar extensor strengthening and functional improvement in patients with nonspecific chronic LBP.

Kinematic analysis of dysphagia: significant parameters of aspiration related to bolus viscosity.

The purpose of this study was to investigate the mechanisms of aspiration with respect to the viscosity of ingested material in patients with dysphagia. Seventy patients with dysphagia underwent videofluoroscopic swallow studies (VFSS) between May 1, 2009 and September 30, 2009. Based on the findings of the VFSS, patients were divided into three groups: a thick-fluid aspiration group, a thin-fluid aspiration group, and a no-aspiration group. Kinematic analyses were performed during thick-fluid swallowing. Among our 70 patients, 23 had thick-fluid aspiration, 20 had thin-fluid aspiration, and 27 had no aspiration. A shortened duration of upper esophageal sphincter (UES) opening, a shorter interval between UES opening and peak pharyngeal constriction, and a diminished extent of laryngeal elevation were all significant risk factors for thick-fluid aspiration. A prolonged latency of the swallowing reflex, pharyngeal transit time, and the interval between bolus arrival at the vallecula and laryngeal elevation were all significant risk factors for thin-fluid aspiration. Our kinematic analysis of dysphagia employing the VFSS indicated that the mechanisms relevant to aspiration differed with respect to food viscosity.

Inter-rater Reliability of Videofluoroscopic Dysphagia Scale

Objective To investigate the inter-rater agreement using the Videofluoroscopic Dysphagia Scale (VDS). Method The present study was designed as a multicenter, single-blind trial. A Videofluoroscopic Swallowing Study (VFSS) was performed using the protocol described by J.A Logemann. Thick-fluid, pureed food, mechanically altered food, regularly textured food, and thin-fluid boluses were sequentially swallowed. Each participant received a 3 ml bolus followed by a 5 ml bolus of each food material, in the order mentioned above. All study procedures were video recorded. Discs containing these video recordings in random order were distributed to interpreters who were blinded to the participant information. The video recordings were evaluated using a standardized VDS sheet and the inter-rater reliability was calculated. Results In total, 100 patients participated in this study and 10 interpreters analyzed the findings. Inter-rater reliability was fair in terms of lip closure (κ: 0.325), oral transit time (0.253), delayed triggering of pharyngeal swallowing (0.300), vallecular residue (0.275), laryngeal elevation (0.345), pyriform sinus residue (0.310), coating of the pharyngeal wall (0.310), and aspiration (0.393). However, other parameters of the oral phase were lower than those of the pharyngeal phase (0.06-0.153). Moreover, the summation of VDS reliability (intraclass correlation coefficient: 0.556) showed moderate agreement. Conclusion VDS shows a moderate rate of agreement for evaluating the swallowing function. However, many of the parameters demonstrated a lower rate of agreement, particularly the oral phase parameters.

Causative factors affecting peripheral neuropathy in burn patients

Peripheral neuropathy in burn patients may be frequently missed in clinical settings. Although its incidence has been reported, little is known regarding the factors that cause burn-related peripheral neuropathy. A retrospective chart review of the demographic and clinical characteristics of patients admitted to a university hospital based burn center was conducted to explore the characteristics of burn-related neuropathy and factors affecting its types or extent. The variables collected were gender, age, length of hospital stay, site and surface area of burn, type of burn, and electrodiagnostic findings. We found that flame injuries, and third degree injuries were the most common in patients with peripheral neuropathy. Axonotmesis was more common than demyelinating injury and polyneuropathy was more common than mononeuropathy. Higher degree and larger area burns were more frequently associated with axonotmesis than with demyelination. Length of hospital stay was significantly longer in patients with axonotmesis. Overall, more severe burns showed a significant association with axonotmesis and a tendency to be related to polyneuropathy.

A Phase III Clinical Trial Showing Limited Efficacy of Autologous Mesenchymal Stem Cell Therapy for Spinal Cord Injury.

BACKGROUND In our previous report, 3 of 10 patients with spinal cord injury who were injected with autologous mesenchymal stem cells (MSCs) showed motor improvement in the upper extremities and in activities of daily living. OBJECTIVE To report on the results of a phase III clinical trial of autologous MSCs therapy. METHODS Patients were selected based on the following criteria: chronic American Spinal Injury Association B status patients who had more than 12 months of cervical injury, and no neurological changes during the recent 3 months of vigorous rehabilitation. We injected 1.6 × 10 autologous MSCs into the intramedullary area at the injured level and 3.2 × 10 autologous MSCs into the subdural space. Outcome data were collected over 6 months regarding neurological examination, magnetic resonance imaging with diffusion tensor imaging, and electrophysiological analyses. RESULTS Among the 16 patients, only 2 showed improvement in neurological status (unilateral right C8 segment from grade 1 to grade 3 in 1 patient and bilateral C6 from grade 3 to grade 4 and unilateral right C8 from grade 0 to grade 1 in 1 patient). Both patients with neurological improvement showed the appearance of continuity in the spinal cord tract by diffusion tensor imaging. There were no adverse effects associated with MSCs injection. CONCLUSION Single MSCs application to intramedullary and intradural space is safe, but has a very weak therapeutic effect compared with multiple MSCs injection. Further clinical trials to enhance the effect of MSCs injection are necessary.

Changes in blood glucose and cortisol levels after epidural or shoulder intra-articular glucocorticoid injections in diabetic or nondiabetic patients.

ObjectiveThe aim of this study was to investigate the changes in blood glucose and cortisol levels after glucocorticoid injections into the epidural space or the glenohumeral joint in patients with or without diabetes. DesignTwenty-nine patients with sciatic or shoulder pain were included. Fasting plasma glucose and cortisol levels were measured at baseline. After glucocorticoid injection, the levels were measured again after 1, 7, and 21 days. The patients were divided into four subgroups according to the presence of diabetes and site of injection. ResultsIn all subgroups, fasting plasma glucose levels were significantly higher 1 day after injection but returned to baseline 7 days after the injection. Compared with baseline, cortisol levels were markedly reduced 1 and 7 days after the injection. For both the diabetic and nondiabetic subjects, this drop was significantly larger in the epidural injection than the glenohumeral joint injection. At 21 days after injection, cortisol levels returned to baseline in all subgroups except in the diabetic patients treated with epidural injections. ConclusionsThese findings indicate a need for caution when using local glucocorticoid injection therapy in diabetic patients, most notably when an epidural injection is given. It is also recommended that diabetic patients take more time off before receiving a succeeding epidural glucocorticoid injection.

Pretreatment Dysphagia Inventory and videofluorographic swallowing study as prognostic indicators of early survival outcomes in head and neck cancer.

The prognostic role of swallowing‐related, pretreatment subjective and objective findings has not been investigated in detail. The authors evaluated the association between pretreatment MD Anderson Dysphagia Inventory (MDADI) or videofluorographic swallowing study (VFSS) results and standard outcomes, including early recurrence and survival, in patients with treatment‐naïve head and neck squamous cell carcinoma (HNSCC).

Analysis of Molecular Expression in Adipose Tissue- Derived Mesenchymal Stem Cells : Prospects for Use in the Treatment of Intervertebral Disc Degeneration

Objective Recent studies have shown encouraging progress toward the use of autogenic and allogenic mesenchymal stem cells (MSCs) to arrest, or even lead to partial regeneration in, intervertebral disc (IVD) degeneration. However, this technology is still in its infancy, and further development is required. The aim of this study was to analyze whether rat adipose-derived mesenchymal stem cells (ADMSC) can differentiate towards IVD-like cells after treatment with transforming growth factor β3 (TGF-β3) in vitro. We also performed quantitative analysis of gene expression for ADMSC only, ADMSCs treated with TGF-β3, and co-cultured ADMSCs treated with TGF-β3. Methods ADMSCs were sub-cultured to homogeneity and used in fluorocytometry assays for CD11, CD45, and CD90/Thy1. ADMSCs were differentiated in spheroid culture towards the chondrogenic lineage by the presence of TGF-β3, dexamethasone, and ascorbate. We also co-cultured pure ADMSCs and nucleus pulposus cells in 24-well plates, and performed immunohistochemical staining, western blotting, and RT-PCR for quantitativeanalysis of gene expression. Results Results of fluorocytometry were positive for CD90/Thy1 and negative for CD11 and CD45. TGF-β3-mediated induction of ADMSCs led to the expression of the differentiation markers of intervertebral disc-like cells, such as aggrecan, collagen II, and sox-9. Co-cultured ADMSCs treated with TGF-β3 showed higher expression of differentiation markers and greater extracellular matrix production compared with ADMSCs treated with TGF-β3 alone. Conclusion ADMSC treated with TGF-β3 may be an attractive source for regeneration therapy in degenerative IVD. These findings may also help elucidate the pathologic mechanism of MSC therapy in the degeneration of IVD in vivo.

Pre-emptive swallowing stimulation in long-term intubated patients

Objective: To evaluate the effect of pre-emptive swallowing stimulation on the recovery of swallowing function in long-term intubated patients. Design and subjects: Patients in the intensive care unit intubated for at least 48 hours due to respiratory distress from March to August 2004 were randomly divided into two groups. Fifteen patients of mean age 55.39±17.9 years were stimulated (experimental group) and 18 patients of mean age 61.39±13.5 years were not stimulated (control group). The duration of intubation was 15.59±6.7 days in the experimental group and 15.79±6.5 days in the control group. Duration of stimulation in the experimental group was 7.39±3.6 days. After extubation, we compared the severity of dysphagia via video-fluoroscopic swallow study. Results: There were no statistically significant differences in the percentage of aspiration and the swallowed volume between the two groups. However, oral transit time in the experimental group (0.379±0.07 seconds) was significantly shorter than that of the control group (0.839±0.10 seconds), and the oropharyngeal swallowing efficiency of the experimental group (73.39±17.4%/s) was significantly higher than that of the control group (50.19±13.0%/s). Conclusion: Pre-emptive swallowing stimulation during intubation assists in the recovery of swallowing function in long-term intubated patients.