Summary
This study investigated the long-term survival and incidence of secondary fractures after fragility hip fractures. The 5-year survival rate was 62%, and the mortality risk was seen in ...patients with GNRI < 92. The 5-year incidence of secondary fracture was 22%, which was significantly higher in patients with a BMI < 20.
Background
Malnutrition negatively influences the postoperative survival of patients with fragility hip fractures (FHFs); however, little is known about their association over the long term.
Objective
This study evaluated the ability of the geriatric nutritional risk index (GNRI) as a risk factor for long-term mortality after FHFs.
Methods
This study included 623 Japanese patients with FHFs over the age of 60 years. We prospectively collected data on admission and during hospitalization and assessed the patients’ conditions after discharge through a questionnaire. We examined the long-term mortality and the incidence of secondary FHFs and assessed the prognostic factors.
Results
The mean observation period was 4.0 years (range 0–7 years). The average age at the time of admission was 82 years (range 60–101 years). The overall survival after FHFs (1 year, 91%; 5 years, 62%) and the incidence of secondary FHFs were high (1 year, 4%; 5 years, 22%). The multivariate Cox proportional hazard analysis revealed the risk factors for mortality as older age (hazard ratio HR 1.04), male sex (HR 1.96), lower GNRI score (HR 0.96), comorbidities (malignancy, HR 2.51; ischemic heart disease, HR 2.24; revised Hasegawa dementia scale ≤ 20, HR 1.64), no use of active vitamin D3 on admission (HR 0.46), and a lower Barthel index (BI) (on admission, HR 1.00; at discharge, HR 0.99). The GNRI scores were divided into four risk categories: major risk (GNRI, < 82), moderate risk (82–91), low risk (92–98), and no risk (> 98). Patients at major and moderate risks of GNRI had a significantly lower overall survival rate (
p
< 0.001). Lower body mass index (BMI) was also identified as a prognostic factor for secondary FHFs (HR 0.88
p
= 0.004).
Conclusions
We showed that older age, male sex, a lower GNRI score, comorbidities, and a lower BI are risk factors for mortality following FHFs. GNRI is a novel and simple predictor of long-term survival after FHFs.
ABSTRACT
Studies of the swallowing process are especially important for the development of care foods for dysphagia. However, the effectiveness of experiments on human subjects is somewhat limited ...due to instrument resolution, stress to the subjects and the risk of aspiration. These problems may be resolved if numerical simulation of swallowing can be used as an alternative investigative tool. On this basis, a numerical model is proposed to simulate the swallowing of a simple jelly bolus. The structure of the pharynx was modeled using a finite element method, and the swallowing movements were defined by pharynx posterior wall shift, laryngeal elevation and epiglottis retroflexion. The rheological characteristics of the jelly were investigated using an oscillatory rheometer and a compression test. A Maxwell three‐element model was applied to the rheological model of the jelly. The model constants were obtained from compression tests because the mode of deformation and the stress level of the compression tests were similar to those of the swallowed jelly. The frictional relationship between the organs and the jelly was estimated experimentally from some frictional measurements between the jelly and a wet sloping surface. The results of the simulations for the soft and hard jellies showed different patterns of swallowing that depended on their hardness, and the soft jelly produced faster swallowing because of its flexibility.
PRACTICAL APPLICATIONS
The object of this study is to develop a numerical simulation model of swallowing. Numerical modeling is suitable for the quantitative analysis of the swallowing process and may also be expected to enable a systematic study of care foods that are safe and offer some degree of comfort to patients suffering from swallowing disorders. The computer simulation can be used for evaluation without dangerous risks to the patient.
The purpose of this investigation was to use an excised human larynx to substantiate physical mechanisms of sustained vocal fold oscillation over a variety of phonatory conditions. During sustained, ...flow-induced oscillation, dynamical data was collected from the medial surface of the vocal fold. The method of Empirical Eigenfunctions was used to analyze the data and to probe physical mechanisms of sustained oscillation.
Thirty microsutures were mounted on the medial margin of a human vocal fold. Across five distinct phonatory conditions, the vocal fold was set into oscillation and imaged with a high-speed digital imaging system. The position coordinates of the sutures were extracted from the images and converted into physical coordinates. Empirical Eigenfunctions were computed from the time-varying physical coordinates, and mechanisms of sustained oscillation were explored.
Using the method of Empirical Eigenfunctions, physical mechanisms of sustained vocal fold oscillation were substantiated. In particular, the essential dynamics of vocal fold vibration were captured by two dominant Empirical Eigenfunctions. The largest Eigenfunction primarily captured the alternating convergent/divergent shape of the medial surface of the vocal fold, while the second largest Eigenfunction primarily captured the lateral vibrations of the vocal fold.
The hemi-larynx setup yielded a view of the medial surface of the vocal folds, revealing the tissue vibrations which produced sound. Through the use of Empirical Eigenfunctions, the underlying modes of vibration were computed, disclosing physical mechanisms of sustained vocal fold oscillation. The investigation substantiated previous theoretical analyses and yielded significant data to help evaluate and refine computational models of vocal fold vibration.
Background: Vocal fold motion impairment (VFMI), especially vocal fold abductor paralysis, is frequently seen in multiple system atrophy (MSA). Since the regulation system of laryngeal function is ...closely related to swallowing function, swallowing function is considered to be more involved in MSA patients with VFMI than in patients that do not have VFMI. However, the relationship between dysphagia and VFMI in MSA patients has not been systematically explored. Objective: To elucidate the relationship between VFMI and dysphagia in MSA. Methods: We evaluated swallowing function of 36 MSA patients with and without VFMI, by videofluoroscopy, and investigated the relationship between VFMI and pharyngeal swallowing function. Results: VFMI was found in 17 patients (47.2%). Patients with VFMI had advanced severity of the disease. Although there was a tendency for bolus stasis at the pyriform sinus and the upper oesophageal sphincter opening to be more involved in patients with VFMI, statistical analysis did not show significant differences in swallowing function of MSA patients between with and without VFMI. In contrast, patients who underwent a tracheotomy ultimately required tube feeding or a laryngectomy. Conclusions: Appearance of VFMI is a sign of disease progression but does not necessary mean patients should change their way of taking nutrition. However, MSA patients who need a tracheotomy might have advanced to a high-risk group for dysphagia. Appropriate evaluation and treatment for VFMI and dysphagia are required to maintain patients’ quality of life in MSA.
This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using ...a high-speed digital imaging system.
High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken.
In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient.
High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.
The pressure-flow relationship was examined in excised canine and human larynges with and without a vocal tract. Canine and human larynges were prepared and cut in the midsagittal plane from the top ...to about 10 mm below the vocal folds. The right half was removed and replaced with an acrylic plate. The vocal tract was simulated initially with a 15-cm plastic tube and later with a vocal tract model with an area function resembling “ah.” Simultaneous recordings were made of the glottal pressure, mean subglottal pressure, and average airflow at various levels of adduction. Preliminary data indicated that the pressure-flow relationships were similar to those of a full larynx and were almost linear. The addition of the vocal tract increased the glottal resistance by moving these pressure-flow lines to the lower-flow and higher-pressure region. The human larynx appears to phonate more easily than the canine larynx on the laboratory bench and has lower phonation threshold pressures.
Hearing Loss in HIV Positive Patients Ohki, M; Katoh, O; Yamauchi, A ...
International journal of infectious diseases,
2008, Letnik:
12
Journal Article
We carried out non-contacting measurements of photocurrent distributions in GaN blue light emitting diode (LED) chips using our newly developed ultraviolet (UV) laser SQUID microscope. The UV light ...generates the photocurrent, and then the photocurrent induces small magnetic fields around the chip. An off-axis arranged HTS-SQUID magnetometer is employed to detect a vector magnetic field whose typical amplitude is several hundred femto-tesla. Generally, it is difficult to obtain Ohmic contacts for p-type GaN because of the low hole concentration in the p-type epitaxial layer and the lack of any available metal with a higher work function compared with the p-type GaN. Therefore, a traditional probecontacted electrical test is difficult to conduct for wide band gap semiconductors without an adequately annealed electrode. Using the UV-laser SQUID microscope, the photocurrent can be measured without any electrical contact. We show the photocurrent vector map which was reconstructed from measured magnetic fields data. We also demonstrate how we found the position of a defect of the electrical short circuits in the LED chip.
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