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Co-ordination of breathing and swallowing is essential for normal pharyngeal function and to protect the airway. To allow for safe passage of a bolus through the pharynx, respiration is interrupted (swallowing apnoea); however, the control of airflow and diaphragmatic activity during swallowing and swallowing apnoea are not fully understood. Here, we validated a new airflow discriminator for detection of respiratory airflow and used it together with diaphragmatic and abdominal electromyography (EMG), spirometry and pharyngeal and oesophageal manometry. Co-ordination of breathing and spontaneous swallowing was examined in six healthy volunteers at rest, during hypercapnia and when breathing at 30 breaths min–1. The airflow discriminator proved highly reliable and enabled us to determine timing of respiratory airflow unambiguously in relation to pharyngeal and diaphragmatic activity. During swallowing apnoea, the passive expiration of the diaphragm was interrupted by static activity, i.e. an ‘active breath holding’, which preserved respiratory volume for expiration after swallowing. Abdominal EMG increased throughout pre- and post-swallowing expiration, more so during hyper- than normocapnia, possibly to assist expiratory airflow. In these six volunteers, swallowing was always preceded by expiration, and 93 and 85% of swallows were also followed by expiration in normo- and hypercapnia, respectively, indicating that, in man, swallowing during the expiratory phase of breathing may be even more predominant than previously believed. This co-ordinated pattern of breathing and swallowing potentially reduces the risk for aspiration. Insights from these measurements in healthy volunteers and the airflow discriminator will be used for future studies on airway protection and effects of disease, drugs and ageing. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Wong et al papers. To view these articles, visit https://doi.org/10.1111/apt.16561 and https://doi.org/10.1111/apt.16783 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Wong et al papers. To view these articles, visit https://doi.org/10.1111/apt.16561 and https://doi.org/10.1111/apt.16801 [ABSTRACT FROM AUTHOR]

Aim: To explore the correlations between examination tolerance and anxiety, knowledge needs and examination cooperation in sedation‐free gastroscopy examinees. Design: Cross‐sectional survey using convenience sampling. Methods: A total of 170 healthy adults who underwent sedation‐free gastroenteroscopy were asked to complete a visual analogue scale (VAS) to rate their examination tolerance, the state anxiety questionnaire (S‐AI), a newly designed knowledge needs questionnaire and a cooperation questionnaire. Results: The VAS score was 4.47 ± 1.96, the state anxiety score was 39.46 ± 9.81, the total score for knowledge needs was 44.89 ± 11.02, and the average cooperation score was 2.47 ± 0.38. The VAS score during the examination positively correlated with the pretest state anxiety score and pretest knowledge needs score and negatively correlated with the examination cooperation score. The results of multiple linear regression analysis showed that after undergoing the examination for the first time, anxiety, body position and swallowing control were the main factors influencing the examination tolerance of sedation‐free gastroscopy examinees. Patient or Public Contribution: We would like to thank the staff and patients of the participating hospital for their assistance and cooperation in performing the current study. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Dysphagia resulting from bulbous pemphigoid is a rare but significant manifestation. A 77‐year‐old with bullous pemphigoid with no neurological history presented with severe oropharyngeal dysphagia, attributable to underlying blistering and edema, as documented on a fiberoptic endoscopic swallow examination. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Frazzoni et al and Rogers & Gyawali papers. To view these articles, visit https://doi.org/10.1111/apt.16371 and https://doi.org/10.1111/apt.16393 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Frazzoni et al papers. To view these articles, visit https://doi.org/10.1111/apt.16371 and https://doi.org/10.1111/apt.16400 [ABSTRACT FROM AUTHOR]

Background: Exercise‐based swallowing training (EBST) and transcutaneous neuromuscular electrical stimulation (TNMES) are common modalities used to treat late dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC). We aimed to investigate and compare the efficacies of EBST and TNMES as proactive treatments administered early after radiotherapy. Methods: Patients with early post‐radiotherapy NPC (n = 120) underwent either TNMES or EBST. Flexible endoscopic evaluation of swallowing (FEES), quality of life (QOL), and swallowing function questionnaires were completed before the intervention as well as immediately, 6, and 12 months after the intervention. Outcome measures included the scores for the swallowing function score (SFS), penetration and aspiration scale (PAS), dynamic imaging grade of swallowing toxicity (DIGEST), functional oral intake scale (FOIS), swallowing performance status scale (SPSS), pharyngeal motor impairment (PMI), pharyngeal function impairment (PFI), and functional assessment after cancer therapy–nasopharyngeal (FACT‐NP) questionnaire. Results: Three months after radiotherapy, 31 and 34 patients underwent TNMES and EBST, respectively, and completed swallowing assessments at all four assessment timepoints. All patients showed post‐radiotherapy impairments in the SFS, PAS, DIGEST, PMI, and PFI. Compared with the EBST group, the TNMES group showed significant improvements in the PFI and PMI scores, with small‐to‐medium effect sizes. Additionally, compared with the EBST group, the TNMES group demonstrated a trend toward slightly better improvements in the PAS, DIGEST, FOIS, and SPSS scores immediately and 6 months after the intervention. The SFS scores improved from baseline in both groups; however, the TNMES group showed an earlier improvement. Finally, the TNMES group showed better QOL according to the FACT‐NP than the EBST group. Conclusion: Proactive TMNES and EBST are safe and feasible modalities for improving swallowing in patients with NPC when administered early after radiotherapy. Although TNMES showed better results than EBST, these results should be interpreted with caution given the study limitations. Level of evidence: 1B. [ABSTRACT FROM AUTHOR]

Objectives: This study identified the frequency and severity of dysphagia, dysphonia, and laryngopharyngeal reflux symptoms in people with Ehlers–Danlos syndromes (EDS) or hypermobility spectrum disorders (HSD) and explored differences between diagnostic groups. Methods: Participants were recruited via non‐probability convenience sampling. Information was gathered via online survey, including the Reflux Symptom Index (RSI; Belafsky et al., J Voice. 2002;16:274–277), the Eating and Drinking Assessment Tool (EAT‐10; Belafsky et al., Ann Otol Rhinol Laryngol. 2008;117:919–924), and the Voice Handicap Index (VHI; Jacobson et al., Am J Speech Lang Pathol. 1997;6(3):66–70). These were analyzed using ANOVAs. Results: There were 1620 participants (96.6% female, 2.8% male) that met the inclusion criteria. The mean age was 38.09 (SD 12.22). 75.51% had hypermobile EDS (hEDS), 17.83% had HSD and 3.33% had classic EDS (cED). The cohort's mean scores were RSI = 22.95 (SD 9.01), EAT‐10 = 11.91 (SD 9.66), and VHI score = 31.99 (SD 24.36). The hEDS group had significantly higher mean scores than the HSD group on RSI score and on some RSI items, on EAT‐10 score and on all EAT‐10 items, and on one VHI item. Conclusion: People with EDS/HSD experience symptoms of acid reflux, dysphagia, and dysphonia to varying degrees with significant differences between hEDS than HSD. Awareness of the impact of EDS/HSD on throat symptoms will enable health care professionals to anticipate throat symptoms more readily in this population, providing individualized and effective management plans. Level of Evidence: IV. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To clarify the influence of size and specific gravity of solid preparations, and the position of healthy volunteers when swallowing, for the purpose of practical use in patient consultation regarding the taking of medicines. Materials and methods: The paper reports three studies. Volunteers were asked to swallow four different capsules (A, large and heavy; B, large and light; C, small and heavy; D, small and light) in Study 1, two preparations with different positions (upright, horizontal, and chin-down) in Study 2, and two preparations before and after anesthetization of the bilateral lingual and inferior alveolar nerve in Study 3. The oral transit time (OTT) and pharyngeal transit time (PTT) were evaluated with videofluoroscopy. Results: The mean OTT became longer in the order of C, D, B, A. The mean PTT showed no statistically significant differences. The swallowing preference of the four preparations ranked by the subjects showed that difference in size but not the difference in specific gravity is a significant factor. In the chin-down position, OTT was shorter for two preparations, compared with the other two positions. The mean OTT for both the A and B preparations was significantly longer after the bilateral lingual and inferior alveolar nerves were anesthetized. Conclusion: When swallowing solid preparations, a consideration of size and the position will enable ease of swallowing of medicines. This would especially be the case when delivery of the medicines to be taken by the aged suffering from oral hypoesthesia caused by an underlying disease. [Copyright &y& Elsevier]

LINKED CONTENT This article is linked to Misselwitz et al paper. To view this article, visit https://doi.org/10.1111/apt.15658. [ABSTRACT FROM AUTHOR]

Pediatric feeding/swallowing specialists commonly observe infants and toddlers who present with gagging or significant behavior state changes as a result of touch to oral and body regions. To date, this behavior has not been fully characterized or documented experimentally. This paper describes an exploratory study aimed at filling in these lacunae and providing a possible explanation. The study compares the responses to firm tactile pressure of 40 children between the ages of 3 and 18 months. The experimental group consisted of 20 children (12 males, 8 females) with heterogeneous medical diagnoses, at least 2 weeks of alternative feedings during the first 3 months of life, and a common history of persistent feeding difficulties. The comparison group consisted of 20 children with an unremarkable medical history matched by age and sex to the experimental group. Firm, tactile pressure was applied in a predetermined sequence following dermatome regions from legs to mouth. Response was recorded in terms of presence/absence of gagging and/or behavior state changes. Fifteen of the 20 children in the experimental group showed gagging (14) or inconsolable crying (1) in response to touch. None of the matched comparison group demonstrated either gagging or behavior state changes. The experimental and comparison groups showed significant differences in response to tactile input. Further, the source of these abnormal responses must be sought in similarity of experience across heterogeneous medical diagnoses and interventions. One possible explanation is a history of oral deprivation due to alternative feedings. [ABSTRACT FROM AUTHOR]

Introduction: In the era of precision preventive medicine, susceptible genetic markers for oro‐/hypopharyngeal squamous cell carcinoma (OPSCC) have been investigated for genome‐wide associations. Materials and Methods: A case–control study including 659 male head and neck squamous cell carcinoma (HNSCC) patients, including 331 oropharyngeal cancer, treated between March 1996 and December 2016 and 2400 normal controls was performed. A single‐nucleotide polymorphism (SNP) array was used to determine genetic loci that increase susceptibility to OPSCC. Results: We analyzed the allele frequencies of 664,994 autosomal SNPs in 659 HNSCC cases; 7 SNPs scattered in loci of chromosomes 5, 7, 9, 11, and 19 were significant in genome‐wide association analysis (Pc < 1.0669 × 10−7). In OPSCCs (n = 331), two clustered regions in chromosomes 4 and 6 were significantly different from the controls. We successfully identified a missense alteration of the SNP region in alcohol dehydrogenase 1B (ADH1B) (https://genome.ucsc.edu; hg38); the top correlated locus was rs1229984 (p = 1 × 10−11). Adjusted for environmental exposure, including smoking, alcohol, and areca quid, a region in chromosome 12, related to alcohol metabolism, was found to independently increase the susceptibility to OPSCC. The ADH1B rs1229984 AA genotype had better overall survival compared to the AG and GG genotypes (p = 0.042) in OPSCC. The GG genotype in rs1229984 was significantly associated with a younger age of onset than other genotypes (p = 0.001 and <0.001, respectively) in OPSCC patients who consumed alcohol. Conclusion: ADH1B was an important genetic locus that significantly correlated with the development of OPSCCs and patient survival. [ABSTRACT FROM AUTHOR]

In this study, we combined a machine learning pipeline and human supervision to identify and label swallow and martin roost locations on data captured from 2000 to 2020 by 12 Weather Surveillance Radars in the Great Lakes region of the US. We employed radar theory to extract the number of birds in each roost detected by our technique. With these data, we set out to investigate whether roosts formed consistently in the same geographic area over two decades and whether consistency was also predictive of roost size. We used a clustering algorithm to group individual roost locations into 104 high‐density regions and extracted the number of years when each of these regions was used by birds to roost. In addition, we calculated the overall population size and analyzed the daily roost size distributions. Our results support the hypothesis that more persistent roosts are also gathering more birds, but we found that on average, most individuals congregate in roosts of smaller size. Given the concentrations and consistency of roosting of swallows and martins in specific areas throughout the Great Lakes, future changes in these patterns should be monitored because they may have important ecosystem and conservation implications. [ABSTRACT FROM AUTHOR]

IRF2BPL has recently been described as a novel cause of neurodevelopmental disorders with multisystemic regression, epilepsy, cerebellar symptoms, dysphagia, dystonia, and pyramidal signs. We describe a novel IRF2BPL phenotype consistent with progressive myoclonus epilepsy (PME) in three novel subjects and review the features of the 31 subjects with IRF2BPL‐related disorders previously reported. Our three probands, aged 28–40 years, harbored de novo nonsense variants in IRF2BPL (c.370C > T, p.[Gln124*] and c.364C > T; p.[Gln122*], respectively). From late childhood/adolescence, they presented with severe myoclonus epilepsy, stimulus‐sensitive myoclonus, and progressive cognitive, speech, and cerebellar impairment, consistent with a typical PME syndrome. The skin biopsy revealed massive intracellular glycogen inclusions in one proband, suggesting a similar pathogenic pathway to other storage disorders. Whereas the two older probands were severely affected, the younger proband had a milder PME phenotype, partially overlapping with some of the previously reported IRF2BPL cases, suggesting that some of them might be unrecognized PME. Interestingly, all three patients harbored protein‐truncating variants clustered in a proximal, highly conserved gene region around the "coiled‐coil" domain. Our data show that PME can be an additional phenotype within the spectrum of IRF2BPL‐related disorders and suggest IRF2BPL as a novel causative gene for PME. [ABSTRACT FROM AUTHOR]

To the Editor, Over the last decades, systematic reviews and meta analyses of multiple double-blind randomized placebo-controlled trials have demonstrated the efficacy and safety of both subcutaneous (SCIT) and sublingual (SLIT) allergen immunotherapy (AIT) for respiratory and insect venom allergy.[1] However, there is a wide range of AIT preparations used around the globe, and AEs are not always uniformly recorded, limiting the capability to draw safe conclusions or compare reports. Though various clinical development programs[2] have generated substantial knowledge on different AIT preparations, they have been conducted in pre-defined clinical conditions, not reflecting real-life and therefore the results may not have generalized applicability.[3] Very few pragmatic trials and observational studies have evaluated AIT safety in real-life. Adverse Events Registry is the first AIT Registry for AE piloted in different countries in Europe that uses the harmonized MedDRA terminology[9] (Table 1). [Extracted from the article]

Objectives: This study aimed to investigate the effects of interferential current electrical stimulation (IFCS) on masticatory and swallowing function. Materials and Methods: Twenty healthy young adults were enrolled. The measurement items were spontaneous swallowing frequency (SSF), voluntary swallowing frequency (VSF), saliva secretion volume (SSV), glucose elution volume (GEV), and velocity of chew (VOC). All participants underwent both IFCS and sham stimulation (without stimulation, sham). Two sets of independent IFCS electrodes were placed on the bilateral neck. The precise location of the upper electrodes was just below the angle of the mandible, while the lower electrodes were placed at the anterior border of the sternocleidomastoid muscle. The intensity of IFCS was determined to be one level below the perceptual threshold that all participants felt discomfort. Statistical analysis was performed using a two‐way repeated measures analysis of variance. Results: For IFCS, the results of each measurement before and during stimulation were SSF: 1.16 and 1.46, VSF: 8.05 and 8.45, SSV: 5.33 and 5.56 g, GEV: 171.75 and 208.60 mg/dL, and VOC: 87.20 and 95.20, respectively. SSF, GEV, and VOC during stimulation were significantly increased by IFCS (SSF, p =.009; GEV, p =.048; and VOC, p =.007). Following sham stimulation, the results were SSF: 1.24 and 1.34, VSF: 7.75 and 7.90, SSV: 5.65 and 6.04 g, GEV: 176.45 and 187.35 mg/dL, and VOC: 91.35 and 88.25, respectively. Conclusion: While no significant differences were observed in the sham group, our findings suggest that IFCS of the superior laryngeal nerve may impact not only the swallowing function but also the masticatory function. [ABSTRACT FROM AUTHOR]

Aim: To develop a set of evidence‐informed strategies to assist older people to improve swallowing functions and prevent further damage from complications. Design: A two‐round Delphi survey. Methods: An initial set of dysphagia care strategies with 74 relevant items for older people was formed based on a literature review by seven researchers. An online survey was conducted by 21 panellists, and data of experts' opinions were collected and analysed by improved Delphi method. Results: The positive coefficients in the two rounds of expert consultation were 85.71% and 83.33%, respectively. Consensus was reached with 53 items included and was allocated into the following five sections: (1) screening, (2) assessment, (3) training, (4) interventions and (5) management. These strategies were named with the acronym of each section—"SATIA". The management strategy can be applied to guide the management of older people with dysphagia. [ABSTRACT FROM AUTHOR]

Objective: The pharyngeal phase of swallowing involves a coordinated sequence of events. Event durations may be prolonged in people with Parkinson disease (PwPD), and amyotrophic lateral sclerosis (PwALS); however, the cumulative effect of these changes is unexplored. We compared event latencies relative to hyoid burst (HYB) (time zero) to understand differences in deglutatory event timing. We hypothesized PwPD and PwALS would display similarly prolonged cumulative pharyngeal phase durations compared to healthy controls, with greater prolongations with increasing bolus viscosity. Method: We retrospectively evaluated videofluoroscopic data of healthy adults (n = 78), PwPD (n = 17), and PwALS (n = 20). Participants swallowed 15 boluses of 20% (w/v) barium across five liquid consistencies. Paired raters evaluated nine deglutitive events using the ASPEKT method. Latencies were plotted by consistency relative to HYB and compared across cohorts using Mann–Whitney U tests (p ≤.05). Cohen's d was calculated for all statistically significant results to determine effect size. Results: In PwPD, significantly prolonged latencies were observed on thin liquid boluses compared to healthy controls. Latencies to all post‐HYB events were significantly prolonged except for maximum upper esophageal sphincter distension. In PwALS, significantly prolonged latencies for events preceding and following HYB were noted on all consistencies compared to healthy controls and PwPD. Conclusion: In PwPD, event latencies for multiple components of the swallowing sequence were prolonged culminating in overall prolongation of the pharyngeal phase on thin liquid. A similar pattern, but with significantly greater prolongation, was seen in the PwALS, and extended to swallows of all liquid consistencies. [ABSTRACT FROM AUTHOR]

Objective: Postthyroidectomy voice and swallowing symptoms (PVSS) may occur even in absence of laryngeal nerve injuries, which remains poorly understood. The objective of this review was to investigate the occurrence of PVSS and the potential etiological role of laryngopharyngeal reflux (LPR). Design: Scoping review. Methods: Three investigators search PubMed, Cochrane Library, and Scopus databases for studies investigating the relationship between reflux and PVSS. The authors adhered to PRISMA statements and the following outcomes were investigated: age, gender, thyroid features, reflux diagnosis, association outcomes, and treatment outcomes. Based on the study findings and bias analysis, authors proposed recommendations for future studies. Results: Eleven studies met our inclusion criteria, accounting for 3829 patients (2964 females). Postthyroidectomy swallowing and voice disorders were found in 5.5%–64%; and 16%–42% of patients, respectively. Prospectively, some results suggested an improvement of swallowing/voice disorders postthyroidectomy, whereas others did not observe significant changes. The prevalence of reflux ranged from 16.6% to 25% of subjects who benefited from thyroidectomy. There was an important heterogeneity between studies regarding the profile of included patients, the PVSS outcomes used, the delay of PVSS assessment and reflux diagnosis, making difficult the study comparison. Some recommendations were provided to guide future studies, especially about the reflux diagnosis approach and clinical outcomes. Conclusion: The potential etiological role of LPR in PVSS is not demonstrated. Future studies are needed to demonstrate an increase of pharyngeal reflux events with objective findings from prethyroidectomy to postthyroidectomy. Level of Evidence: 3a. Reflux‐related swallowing and voice disorders may occur after thyroid surgery. [ABSTRACT FROM AUTHOR]

The diagnostic criteria of aspiration pneumonia have not been established, and it remains an underdiagnosed entity. Diagnosis and cause investigation is essential in improving the management of aspiration pneumonia. The Japanese Respiratory Society Guidelines for the Management of Pneumonia in Adults (JRS Guidelines) show a list of risk factors for aspiration pneumonia. We developed an algorithm to aid physicians in evaluating these possible underlying factors and guide their management with a focus on aspiration pneumonia. The algorithm was developed based on the JRS Guidelines. The algorithm suggested dysphagia screening, pneumococcal and influenza vaccination, and other preventative measures for pneumonia. The algorithm was implemented in the acute setting of a general hospital among older patients admitted with pneumonia. Their outcomes were compared with a historical control group constituting similar patients from the previous year. Forty patients with pneumonia were assessed with the algorithm group, and 44 patients were included in the control group. In the algorithm group, significantly more cases (95.0% vs. 15.9%, p < 0.01) underwent early screening for a swallowing disorder. Two patients in the algorithm group were diagnosed with a new condition causing aspiration pneumonia, as opposed to none in the control group. Drugs with a potential risk for aspiration were identified and discontinued in 27.5% of the patients in the algorithm group and 4.5% in the control group. In conclusion, an aspiration pneumonia cause investigation algorithm translating the JRS guideline approach into practice enhanced the rate of swallow screening and preventative measures for aspiration. [ABSTRACT FROM AUTHOR]

Refractory dysphasia could be the main symptom of Antisynthetase syndrome (ASS). IVIG may have a major impact in the successful treatment of dysphasia in patients with ASS. In our patient with ASS, IVIG treatment was an unreplaceable treatment option, and the patient regains her ability to swallow within 2 days. Refractory dysphasia could be the main symptom of Antisynthetase syndrome (ASS). IVIG may have a major impact in the successful treatment of dysphasia in patients with ASS. A cure can be possible within just 2 days of IVIG treatment. [ABSTRACT FROM AUTHOR]

Individuals who introduce illicit substances such as opioids and amphetamines into the gastrointestinal tract by swallowing or inserting them into the rectum are known as body packers. We describe a prisoner who developed severe poisoning symptoms after swallowing amphetamine packets and was promptly removed by laparotomy. In body packers and body stuffers, if these packages are opened in the gastrointestinal tract, it can be associated with severe poisoning and high mortality, which requires surgical intervention. [ABSTRACT FROM AUTHOR]

Dysphagia or difficulty swallowing in childhood necessitates multi‐disciplinary evaluation and management. This case report highlights the teamwork required for diagnostic work‐up to distinguish functional dysphagia from organic and psychiatric conditions in an adolescent girl. Treatment model based on cognitive behavioral therapy is also presented. [ABSTRACT FROM AUTHOR]

Patients with intellectual disabilities often fail to follow traditional tongue position instructions for panoramic radiographs resulting in missed pathology or unnecessary further radiation. This simple breathing technique is a new clinical instruction method for panoramic radiography developed to reduce the most common patient position error: patient failure to hold the tongue to the roof of the mouth. The technique is suitable for all patients including young patients and those with intellectual disabilities. The simple breathing technique uses 'tell‐show‐do' communication methods and does not mention the tongue but utilises the known tongue positions that occur during breathing and swallowing. This simple breathing technique instruction for panoramic radiography uses a demonstration of 'breathe‐in, breathe‐out, swallow, lips closed and hold still' to reduce the intensity of both the palatoglossal and pharyngeal airspaces on panoramic radiographs. This method, referred in this article as the simple breathing technique, can improve the diagnostic potential of panoramic radiographs and can be used with young children and patients with intellectual disabilities, and this slow breathing technique can help them further relax. [ABSTRACT FROM AUTHOR]

Summary: Background: A hierarchical approach for gastro‐oesophageal reflux disease (GERD) diagnosis by impedance‐pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics. Aims: To establish the clinical value of Lyon Consensus criteria in the work‐up of patients with proton pump inhibitory (PPI)‐refractory heartburn. Methods: Expert review of off‐therapy impedance‐pH tracings from unproven GERD patients with PPI‐refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow‐induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on‐therapy preoperative impedance‐pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases. Results: Off‐therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p < 0.0002). At the on‐therapy presurgical evaluation, abnormal/inconclusive AET and supraphysiological values of impedance metrics showed ongoing reflux in 21% and 90% of 96 cases, respectively (p < 0.00001); a relationship between on‐therapy ongoing reflux and PPI‐refractory heartburn was confirmed by the favorable surgical outcome at 3‐year follow‐up, 88% of cases being in persistent off‐PPI heartburn remission. Conclusions: Impedance‐pH monitoring, off‐ and on‐therapy, is of high clinical value in the work‐up of patients with PPI‐refractory heartburn. [ABSTRACT FROM AUTHOR]

Host–parasite dynamics often vary over time, brought about by changes in the parasite's virulence or the host's ability to resist or tolerate the parasite. Although virulence evolution in microparasites is well studied, we know little about temporal change in the pathogenicity of macroparasites such as blood‐feeding insects. Using data collected over 35 yr, we report a reduction in pathogenicity of the hematophagous swallow bug (Cimex vicarius) on its Cliff Swallow (Petrochelidon pyrrhonota) host. Relative to experimentally fumigated, parasite‐free nests, the negative effects of bugs on nestling swallow body mass and survival were less in the later years of the study than in the earlier years, and the negative relationship between nestling body mass and bug abundance became weaker over time. The survival of adult birds exposed to swallow bugs increased throughout the study, while survival of birds from parasite‐free nests decreased over time. Swallow bug abundance per nest, bug body size, and bug age ratios did not change during the study. Between‐colony transmission of bugs showed less immigration into larger colonies than in earlier studies, but there was no net change in transmission. Cliff Swallows did not reduce their exposure to bugs over time by being more likely to avoid infested nest or colony sites. Parents increased the number of food deliveries to their offspring over time in the presence of parasites, but the total amount of food delivered was unchanged. The reduced cost of swallow bug ectoparasitism does not seem related to changes in parasite narrow‐sense virulence, the host's avoidance of parasites, the presence of alternative hosts for bugs, or climate‐driven phenological mismatches. The results probably reflect the Cliff Swallow's evolving of greater tolerance to swallow bugs, brought about by the bird's shift from natural cliff nesting sites to artificial structures that may harbor more bugs than natural cliffs. This study shows that hosts can respond relatively rapidly to high levels of parasitism, and provides support for models that suggest the evolution of tolerance should be expected in some host–parasite systems. [ABSTRACT FROM AUTHOR]

Pharyngolaryngeal hypesthesia is a major reason for dysphagia in various neurological diseases. Emerging neuromodulation devices have shown potential to foster dysphagia rehabilitation, but the optimal treatment strategy is unknown. Because functional imaging studies are difficult to conduct in severely ill patients, we induced a virtual sensory lesion in healthy volunteers and evaluated the effects of central and peripheral neurostimulation techniques. In a sham‐controlled intervention study with crossover design on 10 participants, we tested the potential of (peripheral) pharyngeal electrical stimulation (PES) and (central) transcranial direct current stimulation (tDCS) to revert the effects of lidocaine‐induced pharyngolaryngeal hypesthesia on central sensorimotor processing. Changes were observed during pharyngeal air‐pulse stimulation and voluntary swallowing applying magnetoencephalography before and after the interventions. PES induced a significant (p <.05) increase of activation during swallowing in the bihemispheric sensorimotor network in alpha and low gamma frequency ranges, peaking in the right premotor and left primary sensory area, respectively. With pneumatic stimulation, significant activation increase was found after PES in high gamma peaking in the left premotor area. Significant changes of brain activation after tDCS could neither be detected for pneumatic stimulation nor for swallowing. Due to the peripheral cause of dysphagia in this model, PES was able to revert the detrimental effects of reduced sensory input on central processing, whereas tDCS was not. Results may have implications for therapeutic decisions in the clinical context. [ABSTRACT FROM AUTHOR]

Objective: Knowledge of the breastfeeding swallow is limited by practical challenges. Radiation exposure to both mother and infant and the radiolucent properties of breastmilk make videofluoroscopy an unsuitable imaging modality. Furthermore, ultrasound is not ideal for capturing the complex 3‐dimensional functional anatomy of swallowing. In this study we explore the feasibility of using real‐time MRI to capture the breastfeeding swallow. Methods: Prospective observational study: Review of imaging from 12 normal infants (<5 months of age) and their mothers while breastfeeding using real‐time MRI. Results: Static images were successfully captured in 11 infants and dynamic images in nine infants. This imaging modality confirms the dorsal surface of the infant's tongue elevates the maternal nipple to the hard palate, closing the space around the nipple with no air visible in the oral cavity during sucking and swallowing. We obtained dynamic imaging of mandibular movement with sucking, palatal elevation and pharyngeal constriction with swallowing, diaphragm movement with breathing and milk entering the stomach. Breastmilk was easily visualized, being high intensity on T2 sequences. Technical challenges were encountered secondary to infant movement and difficulties acquiring and maintaining midsagittal orientation. The similarity in tissue densities of the lips, tongue, nipple and hard palate limited definition between these structures. Conclusion: Real‐time MRI imaging was successful in capturing dynamic images of the breastfeeding swallow. However, technical and practical challenges make real‐time MRI unlikely at present to be suitable for swallow assessment in clinical practice. Advances in technology and expertise in dynamic image capture may improve the feasibility of using MRI to understand and assess the breastfeeding swallow in the near future. Level of evidence: 4. [ABSTRACT FROM AUTHOR]

Conditions during early life can have dramatic effects on adult characteristics and fitness. However, we still know little about the mechanisms that mediate these relationships. Telomere shortening is one possibility. Telomeres are long sequences of DNA that protect the ends of chromosomes. They shorten naturally throughout an individual's life, and individuals with short telomeres tend to have poorer health and reduced survival. Given this connection between telomere length (TL) and fitness, natural selection should favor individuals that are able to retain longer telomeres for a greater portion of their lives. However, the ability of natural selection to act on TL depends on the extent to which genetic and environmental factors influence TL. In this study, we experimentally enlarged broods of Tree Swallows (Tachycineta bicolor) to test the effects of demanding early‐life conditions on TL, while simultaneously cross‐fostering chicks to estimate heritable genetic influences on TL. In addition, we estimated the effects of parental age and chick sex on chick TL. We found that TL is highly heritable in Tree Swallow chicks, and that the maternal genetic basis for TL is stronger than is the paternal genetic basis. In contrast, the experimental manipulation of brood size had only a weak effect on chick TL, suggesting that the role of environmental factors in influencing TL early in life is limited. There was no effect of chick sex or parental age on chick TL. While these results are consistent with those reported in some studies, they are in conflict with others. These disparate conclusions might be attributable to the inherent complexity of telomere dynamics playing out differently in different populations or to study‐specific variation in the age at which subjects were measured. [ABSTRACT FROM AUTHOR]

Background: Idiopathic esophageal dysmotility (ED) is increasingly recognized in young dogs of brachycephalic breeds. Few studies have objectively associated specific videofluoroscopic swallowing study (VFSS) features with brachycephaly, leading to under‐recognition of ED in brachycephalic breeds. Hypothesis/objectives: To describe and compare VFSS in brachycephalic dogs versus non‐brachycephalic dogs presented for dysphagia or regurgitation, and to investigate associations between these imaging findings and patient signalment. Methods: Retrospective analysis of VFSS of dogs presented for dysphagia or regurgitation (not megaesophagus) from 2006 to 2017. Cases were divided into brachycephalic and mesaticephalic breeds. The VFSS were reviewed using a standardized protocol by 2 examiners. Esophageal motility was assessed using specific criteria, and particular imaging features were noted and graded. Fisher's exact test was used to determine associations among signalment (including brachycephaly), final diagnosis, outcomes, and ED features. Results: Thirty‐six dogs were included (n = 10 normal, n = 26 presumed ED). Twenty dogs (77%) with presumed ED were brachycephalic with a median age of 1 year (range, 0.2‐10.5 years). Most common were prolonged esophageal transit time (ETT; n = 21/26), decreased propagation of secondary peristaltic waves (n = 20/26), and gastroesophageal reflux (GER; n = 18/28). Eight dogs (all brachycephalic) had hiatal herniation (HH). Morphological esophageal variations were only observed in brachycephalic dogs. Brachycephaly was significantly associated with ED (P =.005), prolonged ETT (P =.41), GER (P =.02), and HH (P =.03). Conclusions and Clinical Importance: The majority of dogs with presumed ED was young and brachycephalic and had specific abnormalities that were less frequent in mesaticephalic dogs with regurgitation or dysphagia. [ABSTRACT FROM AUTHOR]

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Hippos are gregarious animals, generally occurring as pods comprising females and their young, a dominant male and subordinate males (Klingel, [14]). There are photographs/videos showing hippos interacting with hippo carcasses (Breen, [4]; Harris, [10]; Hippo keeps crocs from dead juvenile, [11]; Hippopotamus (Hippopotamus amphibius), [12]; ViralHog, [20]) and defending carcasses from other animals (Csaba, [6]; Harris, [10]; Hippo keeps crocs from dead juvenile, [11]); providing anecdotal evidence that hippos may also display epimeletic behaviour towards dead conspecifics. The aggressive behaviour of the hippo towards the crocodiles (VideoS2) is also uncommon; hippos and crocodiles generally share this pool without conflict (personal observation). [Extracted from the article]

Aim: This cross-sectional investigation aimed to assess the value of non-invasive measures of temporal respiratory-swallow coupling in individuals with ataxic swallowing.Method: Twenty participants (11 males, 9 females; range 9-21y) with ataxia telangiectasia were presented with water and pudding boluses. Their 193 swallows were compared with 2200 swallows from 82 age-matched healthy controls. The two components of airway protection during swallowing that were analyzed were: direction of peri-deglutitive airflow and duration of deglutitive inhibition of respiratory airflow (DIORA).Results: Safe expiratory patterns of peri-deglutitive airflow occurred significantly less often in participants with ataxia telangiectasia than in age-matched control participants (younger p<0.015 and older p<0.001). The frequency of an expiratory pattern of peri-deglutitive airflow increased with age in participants in the comparison group (p=0.006), but not in those with ataxia telangiectasia (p=0.234). With age, mean duration of DIORA decreased in controls (p<0.001) but was unchanged in participants with ataxia telangiectasia (p=0.164).Interpretation: Non-invasive quantitative measures of respiratory-swallow coupling capture temporal relationships that plausibly contribute to airway compromise from dysphagia. Changes in respiratory-swallow coupling observed with advancing age in control participants were not seen in participants with ataxia telangiectasia. Measures of perturbations may herald swallowing problems prior to development of pulmonary and nutritional sequelae. [ABSTRACT FROM AUTHOR]

Tongue pressure data taken from healthy subjects during normal oral activities such as mastication, speech and swallowing are providing us with new ways of understanding the role of the tongue in craniofacial growth and function. It has long been recognized that the sequential contact between the tongue and the palate plays a crucial role in the oropharyngeal phase of swallowing. However, because the focus of most research on intraoral pressure has been on the generation of positive pressure by the tongue on the hard palate and teeth, generation and coordination of absolute intraoral pressures and regional pressure gradients has remained unexplored. Ongoing research in our laboratory has uncovered highly variable individual pressure patterns during swallowing, which can nonetheless be divided into four stages: preparatory, primary propulsive, intermediate and terminal. These stages may further be sub-classified according to pressure patterns generated at the individual level as tipper or dipper patterns in the preparatory stage, roller or slapper in the primary propulsive and monophasic or biphasic during the intermediate stage. Interestingly, while an increase in bolus viscosity can result in significant changes to pressure patterns in some individuals, it has little effect in others. Highly individual responses to increased viscosity are also observed with swallowing duration. The above, together with other findings, have important implications for our understanding of the aetiology of widely differing conditions such as protrusive and retrusive malocclusions, dysphagia and sleep apnoea, as well as the development of novel food products. [ABSTRACT FROM AUTHOR]

Keywords: brain swallowing function; metaplasticity; oropharyngeal dysphagia EN brain swallowing function metaplasticity oropharyngeal dysphagia 5003 5004 2 11/16/20 20201115 NES 201115 This issue of I The Journal of Physiology i publishes a "proof of concept" study with evidence on the metaplasticity of the human pharyngeal motor cortex induced by repetitive transcranial magnetic stimulation (rTMS) (Cheng I et al i . 2020). Post-stroke OD has been associated with neural damage to the dominant swallowing hemisphere leading to a global motor cortex hypoexcitability (Cabib I et al i . 2019) and lack of capacity to develop neuroplastic modifications in the unaffected hemisphere to restore the swallow function (Hamdy I et al i . 1998). [Extracted from the article]

We treated the liquid refusal of a 15-month-old girl using 2 antecedent manipulations: flipped spoon and chin prompt. Use of the chin prompt in the absence of the flipped spoon failed to produce increases in mouth clean (a product measure of swallowing). By contrast, modest increases in mouth clean resulted from the implementation of the flipped spoon alone. The greatest increases in mouth clean resulted from the combination of the 2 manipulations. [ABSTRACT FROM AUTHOR]

The article identifies the neural activation sites of different components of deglutition in healthy elders and investigates age differences in the neural control of swallowing. The researchers concluded that swallowing requires larger and more widespread areas for neural control than the combination of the component tasks examined, such as planning, tongue tap, and throat clearing tasks. The study also showed decreased activations in older adults as compared to their younger counterparts.

Aim The aim of this unregistered evidence-based systematic review was to determine the state and quality of evidence on the effects of oral motor exercises (OME) on swallowing physiology, pulmonary health, functional swallowing outcomes, and drooling management in children with swallowing disorders. Method A systematic search of 20 electronic databases was completed to identify relevant peer-reviewed literature published in English between 1960 and 2007. Experimental or quasi-experimental design studies examining OME as a treatment for children with swallowing disorders were appraised for methodological quality by two assessors and reviewed by a third. Results Sixteen studies of varying methodological quality were included. No study examining the effects of OME on pulmonary health in children was identified. The included studies incorporated a wide variety of OME, and mixed findings were noted across all of the outcomes targeted in this review. Interpretation Based on the results of this evidence-based systematic review, there is insufficient evidence to determine the effects of OME on children with oral sensorimotor deficits and swallowing problems. Well-designed studies are needed to provide clinicians with evidence that can be incorporated into the preferences of the client and the clinicians' knowledge of anatomy, physiology, and neurodevelopment in the management of this group of children. [ABSTRACT FROM AUTHOR]

Understanding of eating behaviors associated with obesity requires objective and accurate monitoring of food intake patterns. Accurate methods are available for measuring total energy expenditure and its components in free-living populations, but methods for measuring food intake in free-living people are far less accurate and involve self-reporting or subjective monitoring. We suggest that chews and swallows can be used for objective monitoring of ingestive behavior. This hypothesis was verified in a human study involving 20 subjects. Chews and swallows were captured during periods of quiet resting, talking, and meals of varying size. The counts of chews and swallows along with other derived metrics were used to build prediction models for detection of food intake, differentiation between liquids and solids, and for estimation of the mass of ingested food. The proposed prediction models were able to detect periods of food intake with >95% accuracy and a fine time resolution of 30 s, differentiate solid foods from liquids with >91% accuracy, and predict mass of ingested food with >91% accuracy for solids and >83% accuracy for liquids. In earlier publications, we have shown that chews and swallows can be captured by noninvasive sensors that could be developed into a wearable device. Thus, the proposed methodology could lead to the development of an innovative new way of assessing human eating behavior in free-living conditions. [ABSTRACT FROM AUTHOR]

Background and purpose: Transient lower oesophageal sphincter relaxations (TLESRs) are the main mechanism underlying gastro-oesophageal reflux and are a potential pharmacological treatment target. We evaluated the effect of the CB1/CB2 receptor agonist Δ9-tetrahydrocannabinol (Δ9-THC) on TLESRs in dogs. Based on these findings, the effect of Δ9-THC was studied in healthy volunteers. Experimental approach: In dogs, manometry was used to evaluate the effect of Δ9-THC in the presence and absence of the CB1 receptor antagonist SR141716A on TLESRs induced by gastric distension. Secondly, the effect of 10 and 20 mg Δ9-THC was studied in 18 healthy volunteers in a placebo-controlled study. Manometry was performed before and for 3 h after meal ingestion on three occasions. Key results: In dogs, Δ9-THC dose-dependently inhibited TLESRs and reduced acid reflux rate. SR141716A significantly reversed the effects of Δ9-THC on TLESRs. Similarly, in healthy volunteers, Δ9-THC significantly reduced the number of TLESRs and caused a non-significant reduction of acid reflux episodes in the first postprandial hour. In addition, lower oesophageal sphincter pressure and swallowing were significantly reduced by Δ9-THC. After intake of 20 mg, half of the subjects experienced nausea and vomiting leading to premature termination of the study. Other side-effects were hypotension, tachycardia and central effects. Conclusions and implications: Δ9-THC significantly inhibited the increase in meal-induced TLESRs and reduced spontaneous swallowing in both dogs and humans. In humans, Δ9-THC significantly reduced basal lower oesophageal sphincter pressure. These findings confirm previous observations in dogs and indicate that cannabinoid receptors are also involved in the triggering of TLESRs in humans. Mandarin translation of abstract [ABSTRACT FROM AUTHOR]

Individual rhythms of suck, swallow, and respiration are disrupted in preterm infants with bronchopulmonary dysplasia (BPD). Integration of respiration into suck–swallow efforts is critical for establishing coordinated suckle feeding. This study quantitatively assessed the coordination of respiration and swallow in infants with and without BPD. Thirty-four preterm infants of 26 to 33 weeks' gestational age were included: 14 participants with BPD (eight males, six females)and 20 comparison participants without BDP (10 males, 10 females). Participants were studied at postmenstrual age 32 to 40 weeks and postnatal age 2 to 12 weeks using digital recordings of pharyngeal pressure, nasal thermistor flow, and thoraco-abdominal plethysmography. The coefficients of variation (COV; standard deviation/mean) of the swallow–breath (SW–BR) and breath–breath (BR–BR) intervals during swallow runs, the percentage of ‘apneic swallows’ (runs of 3 swallows without interposed breaths), and phase relationships of respiration and swallow were used to quantify rhythmic coordination and integration of respiration into feeding episodes. Apneic swallows were significantly increased after 35 weeks in infants with BPD (mean 13.4% [SE 2.4]) compared with non-BDP infants (6.7% [SE 1.8] p<0.05), as were SW–BR phase relationships involving apnea. The BPD cohort also had significantly higher SW–BR COV and BR–BR COV than non-BPD infants, indicating less rhythmic coordination of swallowing and respiration during feeding. Results emphasize the need for frequent rests and closer monitoring when feeding infants with respiratory compromise. Quantitative assessment of the underlying rhythms involved in feeding may be predictive of longer-term feeding and neurological problems. [ABSTRACT FROM AUTHOR]

1. To minimize study-area artefacts in a study of natal dispersal distances in tree swallows, we intensively banded nestlings and adults in nest-boxes in upstate New York and recruited and trained 70 volunteer banders within a 400 km radius of Ithaca. We banded 26 567 nestlings in the years 1985 through 1998, and captured 4774 adults at the nest, 630 of which had been banded as nestlings and were recaptured the year after fledging. 2. To correct for spatial variation in capture intensity, we resampled the distribution of all boxes where an adult capture was made under uniform, exponential and Cauchy null hypotheses. Compared to the null distributions, the frequency of observed dispersal events was significantly higher at 0–10 km and lower for all larger dispersal distances. The Cauchy distribution came closest to approximating the observed dispersal distance distribution. 3. Dispersal distances were sensitive to the distribution of nesting sites, and all measurements of dispersal distance distributions must be seen as being habitat-specific. We could detect no effect of dispersal distance on the subsequent timing of breeding and no effect of the timing of fledging on dispersal distance. The sexual differences in raw mean dispersal distances (8·38 km for females, 2·44 km for males) are similar to those reported for other species. 4. While it is tempting to conclude that studies in smaller areas have not missed a great deal, even a study area of 10 km extent (substantially larger than most) would have missed 11% of the dispersing birds detected and 95% of the range of distances recorded. Despite this sizeable component that would have been missed with a smaller study area, the relatively low frequencies of long-distance dispersal overall reinforce the conclusion that tree swallows, and probably most other migratory passerines, generally disperse much less far from their natal sites than the distances of their annual migrations might lead one to expect. [ABSTRACT FROM AUTHOR]

Cervical accelerometry with digital signal processing (DSP) can identify signals that are consistently associated with swallowing during feeding of infants. It is shown that these signals, called initial discrete sounds (IDSs), become more uniform with advancing postmenstrual age (PMA) in healthy preterm infants. The objectives of this study were to determine if cervical accelerometry and DSP at a higher sample rate than previously used (22kHz versus 16kHz), in conjunction with a DSP software package that allows manipulation of the sound files, would improve the accuracy of the previously developed variance index (VI) method of analyzing accelerometric information. The modified VI method was then used to measure developmental differences in the IDS morphology of infants with and without bronchopulmonary dysplasia (BPD). VIs were calculated for 24 feeding studies of infants of between 32 and 39 weeks PMA: 12 studies on healthy preterm infants (n=10: three males, seven females; mean gestational age [GA] 28.6 weeks, SD 0.4; mean birthweight [BW] 1080g, SD 82; PMA mean 35.2 weeks, SD 0.6) and 12 studies on infants with BPD (n=7: five males, two females; GA 27.1 weeks, SD 0.4; BW 911g, SD 71; PMA 36.2 weeks, SD 0.6). There was a significant inverse correlation between VI and PMA for the healthy preterm group (r=0.66, m=–2.31/week, p=0.02). There was no significant correlation between VI and PMA for the BPD cohort. The VI of infants with BPD was significantly different from that of infants without BPD (p<0.007, multiple regression analysis, interaction PMA×Group). Additionally, using our modified VI technique, 100% of swallows were found to have the expected IDS signals. [ABSTRACT FROM AUTHOR]

The effect of varying amount and concentration of a sucrose solution on swallowing and sucking activity of newborns was studied. Swallowing activity increased relative to the number of sucks, and sucking rate slowed as amount and concentration of sucrose was increased. Sucking interresponse times associated with swallowing were approximately 200 msec longer than interresponse times not associated with swallows. The results are discussed in relation to previous studies of sucking in the newborn. [ABSTRACT FROM AUTHOR]