Standardization of surface electromyography utilized to evaluate patients with dysphagia

<p>Abstract</p> <p>Backgorund</p> <p>Patients suspected of having swallowing disorders, could highly benefit from simple diagnostic screening before being referred to specialist evaluations. We introduce surface electromyography (sEMG) to carry out rapid assessment of such patients and propose suggestions for standardizing sEMGs in order to identify abnormal deglutition.</p> <p>Methods</p> <p>Specifics steps for establishing standards for applying the technique for screening purposes (e.g., evaluation of specific muscles), the requirements for diagnostic sEMG equipment, the sEMG technique itself, and defining the tests suitable for assessing deglutition (e.g., saliva, normal, and excessive swallows and uninterrupted drinking of water) are presented in detail. A previously described normative database for single swallowing and drinking and standard approach to analysis was compared to data on the duration and electric activity of muscles involved in deglutition and with sEMG recordings in order to estimate stages of a swallow.</p> <p>Conclusion</p> <p>SEMG of swallowing is a simple and reliable method for screening and preliminary differentiation among dysphagia and odynophagia of various origins. This noninvasive radiation-free examination has a low level of discomfort, and is simple, timesaving and inexpensive to perform. With standardization of the technique and an established normative database, sEMG can serve as a reliable screening method for optimal patient management.</p

Upper limits on the isotropic diffuse flux of cosmic PeV photons from Carpet-2 observations

Isotropic diffuse gamma-ray flux in the PeV energy band is an important tool for multimessenger tests of models of the origin of high-energy astrophysical neutrinos and for new-physics searches. So far, this flux has not yet been observed. Carpet-2 is an air-shower experiment capable of detecting astrophysical gamma rays with energies above 0.1 PeV. Here we report the upper limits on the isotropic gamma-ray flux from Carpet-2 data obtained in 1999-2011 and 2018-2022. These results, obtained with the new statistical method based on the shape of the muon-number distribution, summarize Carpet-2 observations as the upgraded installation, Carpet-3, starts its operation.Comment: 5 pages, 3 figures, JETPL.cls; V2: references added, version accepted by JETP Letter

Results of different kinds of carotid endarterectomy in patients with and without type 2 diabetes mellitus

BACKGROUND: Type 2 diabetes mellitus (DM) is one of the important markers for the development of adverse cardiovascular events after carotid endarterectomy (CEE). However, studies on this issue are based on small sample of patients and do not take into account the type of surgery as an additional factor of potentially negative impact on the course of the postoperative period.AIM: Analysis of hospital and long-term results of eversion and classical CEE with plastic surgery of the reconstruction zone with a biological patch in patients with type 2 diabetes and without it.MATERIALS AND METHODS: In this multicenter retrospective study from January 2010 to December 2020. included 5731 patients. Depending on the presence / absence of type 2 diabetes and the type of implemented CEE, 4 groups were formed: group 1 — 12.2% (n = 702) — patients with type 2 diabetes and eversion CEE; Group 2 — 55.0% (n = 3153) patients without type 2 diabetes and eversion CEE; Group 3 — 8.5% (n = 484) patients with type 2 diabetes and classical CEE; Group 4 — 24.3% (n = 1392) patients without type 2 diabetes and classical CEE. The duration of postoperative follow-up was 78.6 ± 39.2 months.RESULTS: At the long-term follow-up stage, patients with type 2 diabetes after the classical surgical technique demonstrated the highest rates of all types of complications: death (p &lt;0.0001), MI (p = 0.011), ischemic stroke (p &lt;0.0001), restenosis / occlusion of the ICA (p &lt;0.0001), combined end point (p &lt;0.0001). At the same time, the group of eversion CEE with impaired carbohydrate metabolism took the second position in terms of the prevalence of adverse events. These circumstances demonstrate that patch implantation is accompanied by an increased risk of developing not only myocardial infarction, but also restenosis of the reconstruction zone, as well as the associated ischemic stroke, which was demonstrated by our results.CONCLUSION: Patients with type 2 diabetes and a history of CEE are at increased risk of ischemic stroke at the hospital stage of observation and all unfavorable cardiovascular conditions (death, myocardial infarction, ischemic stroke, restenosis or ICA occlusion in the reconstruction zone) in the long-term postoperative period

Careers of highly educated self-initiated expatriates : observations from studies among Finnish business professionals

This chapter reviews existing literature about the careers of self-initiated expatriates and analyzes the different studies carried out among university level educated Finnish business professionals. A series of studies carried out among members of the Finnish Association of Business School Graduates during the last 15 years was cross-analyzed. The studies are based on three surveys and further interviews among their expatriate members (1999, 2004 and a follow-up study in 2012) also involving SIEs. Therefore, this chapter provide an overview of what we know about the careers of Finnish SIEs and show evidence of (1) their career motives, (2) the role of family considerations in the career decision making of SIEs, (3) the development of career capital and social capital during SIE-experiences, and also (4) longer-term career impacts of SIE-experiences. Based on the literature review and analysis of above mentioned studies we highlight the gaps in in the knowledge about SIEs and suggest areas where further research is needed.fi=vertaisarvioitu|en=peerReviewed

Многоцентровое исследование по изучению течения резистентной артериальной гипертензии после классической и эверсионной каротидной эндартерэктомии

Aim of study. Analysis of the dynamics of resistant arterial hypertension (RAH) and the spectrum of adverse cardiovascular events in patients after classical carotid endarterectomy (CEE) with preservation of carotid body (CB) and eversion CEE with CB transection.Material and methods. This cohort, comparative, retrospective, open-label study from January 2014 to December 2020 included 761 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA) and RH lasting more than 3 years. Depending on the implemented revascularization strategy, 2 groups were formed: Group 1: 38.0% (n=289) — classical CEE with plasty of the reconstruction zone with a patch (made of diepoxy-treated xenopericardium or synthetic); Group 2: 62% (n=472) — eversion CEE with CB transection. To study the dynamics of systolic blood pressure (SBP) in the preoperative period for 4 days, and in the postoperative period, blood pressure was measured for 10 days (during the period when the patient was in intensive care - according to daily monitoring of blood pressure; in the department - 10 times per day, daily). The average SBP figures for all patients were taken into account when constructing a graph of BP fluctuations.Results. In the postoperative period, the groups were comparable in the frequency of the following events: death (group 1: 0.34% (n=1), group 2: 0.63% (n=3); p=0.98; OR 0.54; 95% CI 0.05–5.21), myocardial infarction (group 1: 0.34% (n=1), group 2: 0.84% (n=4); p=0.71; OR 0, 40; 95% CI 0.04–3.65), ischemic stroke (group 1: 0.34% (n=1), group 2: 1.27% (n=6); p=0.36; OR 0.26; 95% CI 0.03–2.25), hemorrhagic transformation (group 1: 0%, group 2: 0.84% (n=4); p=0.29; OR 0.17; 95% CI 0.009–3.35). However, in terms of the number of all complications (death + myocardial infarction + ischemic stroke + hemorrhagic transformation) presented as a combined endpoint, patients after eversion CEE with CB transection were three times superior to classical surgery (group 1: 1.03% (n=3 ), group 2: 3.60% (n=17); p=0.05; OR 0.28; 95% CI 0.08–0.9).Conclusion. The choice of a revascularization strategy in patients with hemodynamically significant ICA stenosis should be personalized and based on the conclusion of a multidisciplinary consultation, and not only on the preferences of the operating surgeon. In patients with RH, it is more expedient to use classical CEE with plasty of the reconstruction zone with a patch in view of the preservation of the CB during this operation. The intersection of the latter with eversion CEE provokes labile hypertension, progression of RAH and a statistically significant increase in the number of all unfavorable cardiovascular events. Thus, the use of carotid body preserving CEE in patients with RAH confirms the therapeutic mechanism of this manipulation in achieving the target SBP level. Цель. Анализ динамики резистентной артериальной гипертензии (РАГ) и спектра неблагоприятных кардиоваскулярных событий у пациентов после классической каротидной эндартерэктомии (КЭЭ) с сохранением каротидного гломуса (КГ) и эверсионной КЭЭ с отсечением КГ.Материал и методы. В данное когортное сравнительное ретроспективное открытое исследование за период с января 2014 г. по декабрь 2020 г. вошел 761 пациент с гемодинамически значимыми стенозами внутренних сонных артерий (ВСА) и РАГ длительностью более 3 лет. В зависимости от реализованной стратегии реваскуляризации были сформированы две группы: 1-я группа: 38,0% (n=289) — классическая КЭЭ с пластикой зоны реконструкции заплатой (из диэпоксиобработанного ксеноперикарда или синтетическая); 2-я группа: 62% (n=472) — эверсионная КЭЭ с отсечением КГ. Для изучения динамики систолического артериального давления (САД) в дооперационном периоде в течение 4 суток, а в послеоперационном периоде в течение 10 суток измерялось артериальное давление — АД (в период нахождения пациента в реанимации — по данным суточного мониторинга АД; в отделении — 10 раз в сутки ежедневно). Средние цифры САД по всем больным учитывали при построении графика колебания АД.Результаты. В послеоперационном периоде группы оказались сопоставимы по частоте следующих событий: смерть (группа 1: 0,34% (n=1), группа 2: 0,63% (n=3); р=0,98; ОШ 0,54; 95% ДИ 0,05–5,21), инфаркт миокарда (группа 1: 0,34% (n=1), группа 2: 0,84% (n=4); р=0,71; ОШ 0,40; 95% ДИ 0,04–3,65), ишемический инсульт (группа 1: 0,34% (n=1), группа 2: 1,27% (n=6); р=0,36; ОШ 0,26; 95% ДИ 0,03– 2,25), геморрагическая трансформация (группа 1: 0%, группа 2: 0,84% (n=4); р=0,29; ОШ 0,17; 95% ДИ 0,009–3,35). Однако по числу всех осложнений (смерть + инфаркт миокарда + ишемический инсульт + геморрагическая трансформация), представленных в виде комбинированной конечной точки, пациенты после эверсионной КЭЭ с пересечением КГ превосходили классическую операцию в 3 раза (группа 1: 1,03% (n=3), группа 2: 3,60% (n=17); р=0,05; ОШ 0,28; 95% ДИ 0,08–0,9).Заключение. Выбор стратегии реваскуляризации у пациентов с гемодинамически значимым стенозом внутренних сонных артерий должен быть персонифицированным и основываться на заключении мультидисциплинарного консилиума, а не только на предпочтениях оперирующего хирурга. У пациентов с резистентной артериальной гипертензией более целесообразно применение классической каротидной эндартерэктомии с пластикой зоны реконструкции заплатой ввиду сохранения каротидного гломуса во время данной операции. Пересечение последнего при эверсионной каротидной эндартерэктомии провоцирует лабильную артериальную гипертензию, прогрессирование резистентной артериальной гипертензии и статистически значимое возрастание числа всех неблагоприятных кардиоваскулярных событий. Таким образом, применение гломус-сберегающей каротидной эндартерэктомии у пациентов с резистентной артериальной гипертензией подтверждает лечебный механизм данной манипуляции в достижении целевого уровня систолического артериального давления.