Kim SH, et al. J Bone Metab. 2019 May;26(2):65-74. https://doi.org/10.11005/jbm.2019.26.2.65

To examine correlations among rating scales and findings suggestive of tracheal aspiration and pharyngeal residue between fiberoptic endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing study (VFSS) in dysphagia patients. We studied patients referred to our hospital for dysphagia assessment. Three raters judged the residue severity and laryngeal penetration or tracheal aspiration of FEES and VFSS. The raters applied the Penetration-Aspiration Scale (PAS) for tracheal aspiration and pixel-based circumscribed area ratio and Yale Pharyngeal Residue Severity for post-swallow residue in VFSS and FEES, respectively. Anatomy-physiologic findings during FEES associated with tracheal aspiration were also analyzed. A total of 178 participants were enrolled in our study. In correlation analysis, PAS (r=0.74), vallecula retention (r=0.76), and pyriform sinus retention (r=0.78) showed strong positive correlations between FEES and VFSS. Intra-rater agreement between VFSS and FEES was good for PAS (κ=0.65) and vallecula (κ=0.65) and pyriform sinus retention (κ=0.69). Among 72 patients who showed subglottic shelf residue, a suspected finding of aspiration, in FEES, 68 had concomitant tracheal aspiration during VFSS. Both vocal fold hypomobility and glottic gap during phonation were significantly associated with findings suggestive of tracheal aspiration during FEES (p<0.05). Quantitative and reliable aspiration and post swallow residue rating scales showed strong positive correlations and good agreement between VFSS and FEES.

We explored whether a mechanically-assisted squat exercise improved muscle mass, muscle function, and pulmonary function in elderly women with or without sarcopenia. In total, 76 community-dwelling elderly subjects (>60 years of age) were screened. We ultimately included 30 subjects who completed more than 80% of the six-week course of mechanically-assisted squat exercises (three days per week, 30 min per day). We measured body composition, lung function, knee extensor strength, hand grip strength, and the 3-min walk distance (3MWD) before and after the exercise program. Subjects with sarcopenia had poor hand grip strength and knee extensor strength, and a slow walking speed. Their lung function parameters, including forced vital capacity (FVC), was lower than those of the controls. After six weeks of squat exercises, the hand grip strength, knee extensor strength, and 3MWD increased significantly in both groups. Appendicular skeletal muscle mass and leg lean mass were increased in subjects without sarcopenia. The FVC (L) increased significantly only in the sarcopenia group (p = 0.019). The mechanically-assisted squat exercise program increased muscle function and lung function, including FVC, in patients with sarcopenia. Muscle mass increased in subjects without sarcopenia.

Park TS, et al. J Korean Med Sci. 2023 Oct;38(40):e325. https://doi.org/10.3346/jkms.2023.38.e325

Tracheostomy is a typical surgical procedure that has been widely practiced to address airway-related difficulties, such as airway obstruction or chronic conditions, that require long-term supportive ventilation. However, it may result in symptoms that detrimental to respiratory system. Computational fluid dynamics (CFD) is a noninvasive and efficient approach for observing the effects of tracheostomy. In this study, we introduced a CFD framework that can reveal the effects of tracheostomy tube insertion based on a comparison with the airflow of a normal airways. An automatic transformation method was developed using a patient's anatomical information to combine subject-specific airways with an artificial tracheostomy tube geometry and an idealized upper airway geometry for later comparison of characteristics of airflow and particle transport. The CFD scheme used for flow simulation in lungs was employed to achieve the behaviors of airflow. The tracheostomy tube generates a jet flow, resulting in twice greater wall shear stress (WSS) and 30 times greater viscous dissipation in the trachea compared to normal airway. The tracheostomized airway induces an intense turbulent jet, which enhances chaotic motion of the particles therein and allows particles to deposit more frequently on the surface. Subsequently, an increase in particle deposition is observed on the central airway's surface. The variation of pressure between inspiration and expiration phase was twice greater and the airflow resistance was also significantly higher compared to normal airway, implying the greater work of breathing. The novel framework could evaluate the efficiency and potential complications in performing tracheostomy beforehand by observing airflow behaviors.