Head and neck diseases and disorders causing oropharyngeal dysphagia

The swallowing mechanism requires the coordinated movements of several structures of the head and neck region; it is therefore not surprising that diseases of the mouth, pharynx, larynx and cervical spine can lead to dysphagia. Although each disorder per se is relatively rare, the combination of all clinical situation represents an important group of clinical conditions that can not be overlooked. Self-perception of dysphagia is usually high as the impairment often involves the oral phase or is due to pain or obstruction. This review focus on the most common and important clinical conditions of the head and neck districts associated with dysphagia: head and neck cancer and impairments associated with its treatment, Zenker\u2019s diverticulum, head and neck infections, cervical spine disorders and cranial nerves deficits. Head and Neck disorders may impair swallowing through different mechanisms; symptoms, dysphagia severity, treatment options and prognosis for this variety of clinical situations vary enormously. Clinicians involved in the management of oro-pharyngeal dysphagia should be aware of the different diseases of this area and build teams or connections with different medical specialists in order to guarantee the best treatment option for each patient

Measurement of the antiproton–nucleus annihilation cross section at 5.3 MeV

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Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Women's Hospital (I-RBWH) dysphagia screening tool = Screening della disfagia nelle unità di cure sub-acute utilizzando la versione italiana del Royal Brisbane and Women’s Hospital (I-RBWH) dysphagia screening tool

La maggior parte dei test di screening per la disfagia \ue8 stato sviluppato per essere utilizzato in pazienti con stroke. Solo pochi strumenti risultano applicabili a popolazioni pi\uf9 eterogenee di pazienti, come quelli ricoverati nelle unit\ue0 di cure per Sub-acuti. Tra questi, il Royal Brisbane and Women\u2019s Hospital (RBWH) dysphagia screening tool \ue8 stato concepito per essere utilizzato da personale infermieristico e possiede un\u2019eccellente sensibilit\ue0 e specificit\ue0. Al momento non \ue8 disponibile una versione italiana di questo strumento. Scopo del lavoro \ue8 di analizzare l\u2019affidabilit\ue0 e l\u2019accuratezza nello screening della versione italiana del RBWH (I-RBWH) dysphagia screening tool. A tal fine sono stati arruolati 105 pazienti, tutti ricoverati presso l\u2019unit\ue0 di cure Sub-acute. Ogni paziente \ue8 stato valutato con il I-RBWH dysphagia screening tool da personale infermieristico (per due volte) e da una logopedista. Quest\u2019ultima, non solo era all\u2019oscuro dei risultati ottenuti durante la valutazione infermieristica, ma ha anche eseguito una valutazione standardizzata delle abilit\ue0 deglutitorie utilizzando il Mann Assessment of Swallowing ability (MASA). L\u2019affidabilit\ue0 intra- e inter-rater si sono rilevate soddisfacenti. Il confronto tra i risultati ottenuti dal personale infermieristico durante la somministrazione del I-RBWH e i punteggi del MASA hanno dimostrato un\u2019eccellente sensibilit\ue0 (93%), specificit\ue0 (96%), valore predittivo positivo (90%) e valore predittivo negativo (97%). Questi dati supportano l\u2019affidabilit\ue0 e l\u2019accuratezza del I-RBWH dysphagia screening tool nello screening della disfagia nei pazienti ricoverati nelle unit\ue0 di cure per Sub-acuti. Il suo utilizzo in clinica \ue8 pertanto raccomandabile.The large majority of the available dysphagia screening tools has been developed for the stroke population. Only few screening tools are suitable for heterogeneous groups of patients admitted to a subacute care unit. The Royal Brisbane and Women's Hospital (RBWH) dysphagia screening tool is a nurse-administered, evidence-based swallow screening tool for generic acute hospital use that demonstrates excellent sensitivity and specificity. No Italian version of this tool is available to date. The aim of this study was to determine the reliability and screening accuracy of the Italian version of the RBWH (I-RBWH) dysphagia screening tool. A total of 105 patients consecutively admitted to a subacute care unit were enrolled. Using the I-RBWH tool, each patient was evaluated twice by trained nurses and once by a speech and language pathologist (SLP) blind to nurses' scores. The SLP also performed standardised clinical assessment of swallowing using the Mann assessment of swallowing ability (MASA). During the first and the second administration of the I-RBWH by nurses, 28 and 27 patients, respectively, were considered at risk of dysphagia, and 27 were considered at risk after SLP assessment. Intra- and inter-rater reliability was satisfactory. Comparison between nurse I-RBWH scores and MASA examination demonstrated a sensitivity and specificity of the I-RBWH dysphagia screening tool up to 93% and 96%, respectively; the positive and negative predictive values were 90% and 97%, respectively. Thus, the current findings support the reliability and accuracy of the I-RBWH tool for dysphagia screening of patients in subacute settings. Its application in clinical practice is recommended

Dysphagia screening in subacute care settings using the Italian version of the Royal Brisbane and Womens Hospital (I-RBWH) dysphagia screening tool

La maggior parte dei test di screening per la disfagia è stato sviluppato per essere utilizzato in pazienti con stroke. Solo pochi strumenti risultano applicabili a popolazioni più eterogenee di pazienti, come quelli ricoverati nelle unità di cure per Sub-acuti. Tra questi, il Royal Brisbane and Womens Hospital (RBWH) dysphagia screening tool è stato concepito per essere utilizzato da personale infermieristico e possiede uneccellente sensibilità e specificità. Al momento non è disponibile una versione italiana di questo strumento. Scopo del lavoro è di analizzare laffidabilità e laccuratezza nello screening della versione italiana del RBWH (I-RBWH) dysphagia screening tool. A tal fine sono stati arruolati 105 pazienti, tutti ricoverati presso lunità di cure Sub-acute. Ogni paziente è stato valutato con il I-RBWH dysphagia screening tool da personale infermieristico (per due volte) e da una logopedista. Questultima, non solo era alloscuro dei risultati ottenuti durante la valutazione infermieristica, ma ha anche eseguito una valutazione standardizzata delle abilità deglutitorie utilizzando il Mann Assessment of Swallowing ability (MASA). Laffidabilità intra- e inter-rater si sono rilevate soddisfacenti. Il confronto tra i risultati ottenuti dal personale infermieristico durante la somministrazione del I-RBWH e i punteggi del MASA hanno dimostrato uneccellente sensibilità (93%), specificità (96%), valore predittivo positivo (90%) e valore predittivo negativo (97%). Questi dati supportano laffidabilità e laccuratezza del I-RBWH dysphagia screening tool nello screening della disfagia nei pazienti ricoverati nelle unità di cure per Sub-acuti. Il suo utilizzo in clinica è pertanto raccomandabile

A compact and cost-effective hard X-ray free-electron laser driven by a high-brightness and low-energy electron beam

We present the first lasing results of SwissFEL, a hard X-ray free-electron laser (FEL) that recently came into operation at the Paul Scherrer Institute in Switzerland. SwissFEL is a very stable, compact and cost-effective X-ray FEL facility driven by a low-energy and ultra-low-emittance electron beam travelling through short-period undulators. It delivers stable hard X-ray FEL radiation at 1-Å wavelength with pulse energies of more than 500 μJ, pulse durations of ~30 fs (root mean square) and spectral bandwidth below the per-mil level. Using special configurations, we have produced pulses shorter than 1 fs and, in a different set-up, broadband radiation with an unprecedented bandwidth of ~2%. The extremely small emittance demonstrated at SwissFEL paves the way for even more compact and affordable hard X-ray FELs, potentially boosting the number of facilities worldwide and thereby expanding the population of the scientific community that has access to X-ray FEL radiation

International Consensus Statement on Rhinology and Allergy: Rhinosinusitis

Background: The 5 years since the publication of the first International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR‐RS) has witnessed foundational progress in our understanding and treatment of rhinologic disease. These advances are reflected within the more than 40 new topics covered within the ICAR‐RS‐2021 as well as updates to the original 140 topics. This executive summary consolidates the evidence‐based findings of the document. Methods: ICAR‐RS presents over 180 topics in the forms of evidence‐based reviews with recommendations (EBRRs), evidence‐based reviews, and literature reviews. The highest grade structured recommendations of the EBRR sections are summarized in this executive summary. Results: ICAR‐RS‐2021 covers 22 topics regarding the medical management of RS, which are grade A/B and are presented in the executive summary. Additionally, 4 topics regarding the surgical management of RS are grade A/B and are presented in the executive summary. Finally, a comprehensive evidence‐based management algorithm is provided. Conclusion: This ICAR‐RS‐2021 executive summary provides a compilation of the evidence‐based recommendations for medical and surgical treatment of the most common forms of RS

Contact and photocontact allergy to ketoprofen: clinical and experimental study

In the last 3 years, we have studied 10 patients with allergic reactions to topical ketoprofen. We have investigated the sensitization and irritant potential of the drug and the possibility of cross-reactivity with other aryl-propionic non-steroidal anti-inflammatory drugs (ibuproxam, ibuprofen, naproxen, fenoprofen, flubiprofen and tiaprofenic acid). 2 of our patients had contact dermatitis, and the other 8 photocontact dermatitis. One of our patients showed cross-reactivity between ketoprofen and ibuproxam on patch testing. In the photopatch tests, we observed cross-reactivity between ketoprofen and tiaprofenic acid in 2 patients, and cross-reaction between ketoprofen and ibuproxam and flurbiprofen in another case. Experimental studies, including human maximization and photomaximization tests, performed in 20 healthy volunteers, showed a complete absence of sensitization, 3 volunteers showed a marked irritant reaction to ketoprofen (20% pet.) during either maximization (2 cases) or photomaximization (1 case) tests. Although ketoprofen appears not to be a sensitizing agent in human volunteers, the fact that photosensitization to this drug seems to be quite common after topical use suggests that there are some local or individual factors, at present unknown, facilitating the development of allergy