Clinical effectiveness of the sequential 4-channel NMES compared with that of the conventional 2-channel NMES for the treatment of dysphagia in a prospective double-blind randomized controlled study

Background To date, conventional swallowing therapies and 2-channel neuromuscular electrical stimulation (NMES) are standard treatments for dysphagia. The precise mechanism of 2-channel NMES treatment has not been determined, and there are controversies regarding the efficacy of this therapy. The sequential 4-channel NMES was recently developed and its action is based on the normal contractile sequence of swallowing-related muscles. Objective To evaluate and compare the rehabilitative effectiveness of the sequential 4-channel NMES with that of conventional 2-channel NMES. Methods In this prospective randomized case–control study, 26 subjects with dysphagia were enrolled. All participants received 2- or 4-channel NMES for 2–3weeks (minimal session: 7 times, treatment duration: 300–800min). Twelve subjects in the 4-channel NMES group and eleven subjects in the 2-channel NMES group completed the intervention. Initial and follow-up evaluations were performed using the videofluoroscopic dysphagia scale (VDS), the penetration-aspiration scale (PAS), the MD Anderson dysphagia inventory (MDADI), the functional oral intake scale (FOIS), and the Likert scale. Results The sequential 4-channel NMES group experienced significant improvement in their VDS (oral, pharyngeal, and total), PAS, FOIS, and MDADI (emotional, functional, and physical subsets) scores, based on their pretreatment data. VDS (oral, pharyngeal, and total) and MDADI (emotional and physical subsets) scores, but not PAS and FOIS scores, significantly improved in the 2-channel NMES group posttreatment. When the two groups were directly compared, the 4-channel NMES group showed significant improvement in oral and total VDS scores. Conclusions The sequential 4-channel NMES, through its activation of the suprahyoid and thyrohyoid muscles, and other infrahyoid muscles mimicking physiological activation, may be a new effective treatment for dysphagia. Trial registration: clinicaltrial.gov, registration number: NCT03670498, registered 13 September 2018, https://clinicaltrials.gov/ct2/show/NCT03670498?term=NCT03670498&draw=2&rank=1 .This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (Grant Number: HI18C1169). This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Min‑ istry of Science, ICT and Future Planning (NRF- NRF-2016R1D1A1B03935130)

Study on Associating Emotions in Verbal Reactions to Facial Expressions in Dementia

The purpose of this study was to provide basic data on cognitive therapy and to improve social support programs for the elderly with dementia by identifying the difficulties they experienced in emotional communication by identifying how they recognized emotions in verbal reactions to facial expressions using Ekman’s photographs of facial expressions and comparing their responses with the general elderly population. There were 141 participants in this study. Data collection was conducted from 3 April 2019 to 30 June 2019 in Seoul, in the Gyeonggi-do and Gangwon-do provinces of South Korea. This study performed descriptive research in which subjects made participative decisions with their guardian through recruitment. The tools used in this study included a general characteristic questionnaire and the Ekman 6 facial expressions photographs tool, which underwent intensive validity studies. The collected data were analyzed using the R version 3.5.1 statistic computing platform. The ability of the elderly with dementia to associate verbal expressions with facial expressions differed from that of the general elderly population. The rates of correct associations of verbal expressions to facial expressions were similar across dementia grades. There was a significant difference in the proportion of correct associations between positive and negative emotions in the elderly with dementia compared to the general elderly population. In the elderly with dementia, pictures showing fear, anger, and disgust had higher wrong rates of incorrect answers than correct answers. The average score of elderly with dementia in associating verbal expressions with six facial expressions was 2.69, which was even lower when they were asked to associate verbal expressions with pictures showing facial expressions of anger or disgust. This study shows that elderly persons with dementia have difficulties identifying two negative emotions (anger, disgust) and find it much easier to identify a positive emotion of happiness represented by a smiling face. Since the ability of the elderly with dementia to interpret verbal expressions to facial expressions was different from that of the general elderly population, careful attention and consideration are needed to support and communicate emotions to the elderly with dementia

SUBVOLCANIC ZONED GRANITIC PLUTON IN THE BARTON AND WEAVER PENINSULAS, KING GEORGE ISLAND, ANTARCTICA

The subvolcanic granitic pluton in the Barton and Weaver Peninsulas, King George Island, is mainly composed of granodiorite with small volumes of gabbro, diorite and aplitic dikes. The pluton shows a vertically compositional zonation; the lower part consists of gabbro and diorite, whereas the upper part is mainly granodiorite. Various geochemical signatures of the pluton confirm that all subunits of the pluton were formed by accumulation and fractionation in a calc-alkaline magma at a shallow level of the crust. The positive Sr and Eu anomalies as well as textural features of gabbro strongly support that gabbro was the cumulate derived from accumulation of calcic plagioclase and in situ crystallization of ferromagnesian minerals. Taking into account the geochemical features of gabbro as a cumulate, the primary magma of the pluton is considered to have been intermediate (dioritic or quartz dioritic) in composition

Improving Lipid Production of Yarrowia lipolytica by the Aldehyde Dehydrogenase-Mediated Furfural Detoxification

Yarrowia lipolytica, the non-conventional yeast capable of high lipogenesis, is a microbial chassis for producing lipid-based biofuels and chemicals from renewable resources such as lignocellulosic biomass. However, the low tolerance of Y. lipolytica against furfural, a major inhibitory furan aldehyde derived from the pretreatment processes of lignocellulosic biomass, has restricted the efficient conversion of lignocellulosic hydrolysates. In this study, the furfural tolerance of Y. lipolytica has been improved by supporting its endogenous detoxification mechanism. Specifically, the endogenous genes encoding the aldehyde dehydrogenase family proteins were overexpressed in Y. lipolytica to support the conversion of furfural to furoic acid. Among them, YALI0E15400p (FALDH2) has shown the highest conversion rate of furfural to furoic acid and resulted in two-fold increased cell growth and lipid production in the presence of 0.4 g/L of furfural. To our knowledge, this is the first report to identify the native furfural detoxification mechanism and increase furfural resistance through rational engineering in Y. lipolytica. Overall, these results will improve the potential of Y. lipolytica to produce lipids and other value-added chemicals from a carbon-neutral feedstock of lignocellulosic biomass

Intraoperative neurophysiology in tethered cord surgery:Techniques and results

©AANS, 2017. OBJECTIVE The aim of this study was to establish optimal electric stimulation parameters for intraoperatively monitoring the bulbocavernosus reflexes (BCRs) in infants. METHODS The authors retrospectively reviewed the medical records of all infants (age < 24 months) who had undergone an untethering operation for tethered cord syndrome between May 2013 and February 2014 at a single institution and whose baseline BCR had been elicited during surgery. Using different combinati ons of stimulation parameters-number of stimulation pulses: 4 or 8 pulses, interpulse interval: 1, 2, or 5 msec, and polarity of stimulation: biphasic or monophasic-the authors compared the relative mean amplitude of 10 BCR responses (rmaBCRs) to each combination of parameters. RESULTS The rmaBCRs were larger with the 8-pulse stimulations than with the 4-pulse stimulations (p < 0.0001). There was a tendency, though not statistically significant, for larger rmaBCRs to be obtained with the longer interpulse interval in the 8-pulse stimulation (p = 0.1289). The biphasic stimulation produced larger rmaBCRs than the monophasic stimulation (p = 0.0005). CONCLUSIONS Biphasic 8-pulse stimulations with 5-msec or 2-msec intervals yield the largest BCR responses. Considering that an 8-pulse stimulation with 5-msec intervals may overlap the onset of the BCR, a biphasic 8-pulse stimulation with 2-msec intervals is recommended as the optimal stimulation paradigm to monitor intraoperative BCRs in infants