Publications by authors named "Tobias Warnecke"

139 Publications

Reply to: "Laryngeal Movement Disorders in Multiple System Atrophy: A Diagnostic Biomarker?"

Mov Disord 2021 08;36(8):2000-2001

Department of Neurology, University Hospital Münster, Münster, Germany.

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http://dx.doi.org/10.1002/mds.28694DOI Listing
August 2021

Detecting myasthenia gravis as a cause of unclear dysphagia with an endoscopic tensilon test.

Ther Adv Neurol Disord 2021 11;14:17562864211035544. Epub 2021 Aug 11.

Department of Neurology and Neurorehabilitation, Hospital Osnabrueck, Osnabrueck, Germany.

Aims: The flexible endoscopic evaluation of swallowing-tensilon test (FTT) was developed to diagnose myasthenia gravis (MG) in patients with unclear pharyngeal dysphagia. The purpose of this study was to determine sensitivity and specificity of the FTT and compare its diagnostic validity with that of other diagnostic markers.

Methods: In this single-centre pragmatic clinical cohort study, a total of 100 patients with unclear pharyngeal dysphagia were eligible to undergo FTT. All patients were subjected to FTT and subsequently followed up clinically. FTT was considered positive if a significant improvement of pharyngeal swallowing function could be objectified endoscopically upon administration of edrophonium chloride. In addition, repetitive nerve stimulation test and serum MG antibody analysis were conducted.

Results: All subjects (mean age 62.5 ± 14.1 years, female 33) underwent FTT without any complications. According to the results of the diagnostic procedures and based on long-term clinical follow-up for at least 3 years, 51 patients were finally diagnosed with MG. The sensitivity and specificity for the FTT was 88.2% and 95.9%, respectively. Application of the Cochran's test showed statistically significant heterogeneity among the diagnostic tests, with results indicating FTT performance to be more accurate than the repetitive nerve stimulation results ( < 0.001) and comparable with serum antibody tests ( > 0.99).

Conclusion: FTT has excellent clinical properties to be used routinely in the assessment of dysphagia with isolated or predominant pharyngeal muscle involvement allowing rapid and accurate diagnosis of MG.
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http://dx.doi.org/10.1177/17562864211035544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361548PMC
August 2021

Slaying the last unicorn: discovery of histones in the microalga .

R Soc Open Sci 2021 Feb 10;8(2):202023. Epub 2021 Feb 10.

Medical Research Council London Institute of Medical Sciences, London, UK.

Histones are the principal constituents of eukaryotic chromatin. The four core histones (H2A, H2B, H3 and H4) are conserved across sequenced eukaryotic genomes and therefore thought to be universal to eukaryotes. In the early 1980s, however, a series of biochemical investigations failed to find evidence for histones or nucleosomal structures in the microscopic green alga . If true, derived histone loss in this lineage would constitute an exceptional case that might help us further understand the principles governing eukaryotic gene regulation. To substantiate these earlier reports of histone loss in we sequenced, assembled and quantified its transcriptome. Following a systematic search for histone-fold domains in the assembled transcriptome, we detect orthologues to all four core histones. We also find histone mRNAs to be highly expressed, comparable to the situation in other eukaryotes. Finally, we obtain characteristic protection patterns when chromatin is subjected to micrococcal nuclease digestion, indicating widespread formation of nucleosomal complexes . We conclude that previous reports of missing histones in were mistaken. By all indications, has histone-based chromatin characteristic of most eukaryotes.
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http://dx.doi.org/10.1098/rsos.202023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074811PMC
February 2021

Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients - a prospective evaluation.

Neurol Res Pract 2021 May 10;3(1):26. Epub 2021 May 10.

Klinikum Osnabrück, Department of Neurology, Am Finkenhügel 1, 49076, Osnabrück, Germany.

Background: Removal of a tracheostomy tube in critically ill neurologic patients is a critical issue during intensive care treatment, particularly due to severe dysphagia and insufficient airway protection. The "Standardized Endoscopic Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients" (SESETD) is an objective measure of readiness for decannulation. This protocol includes the stepwise evaluation of secretion management, spontaneous swallowing, and laryngeal sensitivity during fiberoptic endoscopic evaluation of swallowing (FEES). Here, we first evaluated safety and secondly effectiveness of the protocol and sought to identify predictors of decannulation success and decannulation failure.

Methods: A prospective observational study was conducted in the neurological intensive care unit at Münster University Hospital, Germany between January 2013 and December 2017. Three hundred and seventy-seven tracheostomized patients with an acute neurologic disease completely weaned from mechanical ventilation were included, all of whom were examined by FEES within 72 h from end of mechanical ventilation. Using regression analysis, predictors of successful decannulation, as well as decannulation failure were investigated.

Results: Two hundred and twenty-seven patients (60.2%) could be decannulated during their stay according to the protocol, 59 of whom within 24 h from the initial FEES after completed weaning. 3.5% of patients had to be recannulated due to severe dysphagia or related complications. Prolonged mechanical ventilation showed to be a significant predictor of decannulation failure. Lower age was identified to be a significant predictor of early decannulation after end of weaning. Transforming the binary SESETD into a 4-point scale helped predicting decannulation success in patients not immediately ready for decannulation after the end of respiratory weaning (optimal cutoff ≥1; sensitivity: 64%, specifity: 66%).

Conclusions: The SESETD showed to be a safe and efficient tool to evaluate readiness for decannulation in our patient collective of critically ill neurologic patients.
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http://dx.doi.org/10.1186/s42466-021-00124-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108459PMC
May 2021

Sensor Validation and Diagnostic Potential of Smartwatches in Movement Disorders.

Sensors (Basel) 2021 Apr 30;21(9). Epub 2021 Apr 30.

Institute of Geophysics, University of Münster, 48149 Münster, Germany.

Smartwatches provide technology-based assessments in Parkinson's Disease (PD). It is necessary to evaluate their reliability and accuracy in order to include those devices in an assessment. We present unique results for sensor validation and disease classification via machine learning (ML). A comparison setup was designed with two different series of Apple smartwatches, one Nanometrics seismometer and a high-precision shaker to measure tremor-like amplitudes and frequencies. Clinical smartwatch measurements were acquired from a prospective study including 450 participants with PD, differential diagnoses (DD) and healthy participants. All participants wore two smartwatches throughout a 15-min examination. Symptoms and medical history were captured on the paired smartphone. The amplitude error of both smartwatches reaches up to 0.005 g, and for the measured frequencies, up to 0.01 Hz. A broad range of different ML classifiers were cross-validated. The most advanced task of distinguishing PD vs. DD was evaluated with 74.1% balanced accuracy, 86.5% precision and 90.5% recall by Multilayer Perceptrons. Deep-learning architectures significantly underperformed in all classification tasks. Smartwatches are capable of capturing subtle tremor signs with low noise. Amplitude and frequency differences between smartwatches and the seismometer were under the level of clinical significance. This study provided the largest PD sample size of two-hand smartwatch measurements and our preliminary ML-evaluation shows that such a system provides powerful means for diagnosis classification and new digital biomarkers, but it remains challenging for distinguishing similar disorders.
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http://dx.doi.org/10.3390/s21093139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124167PMC
April 2021

Diagnosis and treatment of neurogenic dysphagia - S1 guideline of the German Society of Neurology.

Neurol Res Pract 2021 May 4;3(1):23. Epub 2021 May 4.

Klinik und Poliklinik für Hör-, Stimm- und Sprachheilkunde, Universitäres Dysphagiezentrum Hamburg, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.

Introduction: Neurogenic dysphagia defines swallowing disorders caused by diseases of the central and peripheral nervous system, neuromuscular transmission, or muscles. Neurogenic dysphagia is one of the most common and at the same time most dangerous symptoms of many neurological diseases. Its most important sequelae include aspiration pneumonia, malnutrition and dehydration, and affected patients more often require long-term care and are exposed to an increased mortality. Based on a systematic pubmed research of related original papers, review articles, international guidelines and surveys about the diagnostics and treatment of neurogenic dysphagia, a consensus process was initiated, which included dysphagia experts from 27 medical societies.

Recommendations: This guideline consists of 53 recommendations covering in its first part the whole diagnostic spectrum from the dysphagia specific medical history, initial dysphagia screening and clinical assessment, to more refined instrumental procedures, such as flexible endoscopic evaluation of swallowing, the videofluoroscopic swallowing study and high-resolution manometry. In addition, specific clinical scenarios are captured, among others the management of patients with nasogastric and tracheotomy tubes. The second part of this guideline is dedicated to the treatment of neurogenic dysphagia. Apart from dietary interventions and behavioral swallowing treatment, interventions to improve oral hygiene, pharmacological treatment options, different modalities of neurostimulation as well as minimally invasive and surgical therapies are dealt with.

Conclusions: The diagnosis and treatment of neurogenic dysphagia is challenging and requires a joined effort of different medical professions. While the evidence supporting the implementation of dysphagia screening is rather convincing, further trials are needed to improve the quality of evidence for more refined methods of dysphagia diagnostics and, in particular, the different treatment options of neurogenic dysphagia. The present article is an abridged and translated version of the guideline recently published online ( https://www.awmf.org/uploads/tx_szleitlinien/030-111l_Neurogene-Dysphagie_2020-05.pdf ).
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http://dx.doi.org/10.1186/s42466-021-00122-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094546PMC
May 2021

Using supraglottic airways by paramedics for airway management in analogue microgravity increases speed and success of ventilation.

Sci Rep 2021 Apr 29;11(1):9286. Epub 2021 Apr 29.

Department of Anaesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Hospital of Oldenburg, Medical Campus University of Oldenburg, Oldenburg, Germany.

In the next few years, the number of long-term space missions will significantly increase. Providing safe concepts for emergencies including airway management will be a highly challenging task. The aim of the present trial is to compare different airway management devices in simulated microgravity using a free-floating underwater scenario. Five different devices for airway management [laryngeal mask (LM), laryngeal tube (LT), I-GEL, direct laryngoscopy (DL), and video laryngoscopy (VL)] were compared by n = 20 paramedics holding a diving certificate in a randomized cross-over setting both under free-floating conditions in a submerged setting (pool, microgravity) and on ground (normogravity). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the time to ventilation. A total of 20 paramedics (3 female, 17 male) participated in this study. Success rate was highest for LM and LT and was 100% both during simulated microgravity and normogravity followed by the I-GEL (90% during microgravity and 95% during normogravity). However, the success rate was less for both DL (60% vs. 95%) and VL (20% vs. 60%). Fastest ventilation was performed with the LT both in normogravity (13.7 ± 5.3 s; n = 20) and microgravity (19.5 ± 6.1 s; n = 20). For the comparison of normogravity and microgravity, time to ventilation was shorter for all devices on the ground (normogravity) as compared underwater (microgravity). In the present study, airway management with supraglottic airways and laryngoscopy was shown to be feasible. Concerning the success rate and time to ventilation, the optimum were supraglottic airways (LT, LM, I-GEL) as their placement was faster and associated with a higher success rate. For future space missions, the use of supraglottic airways for airway management seems to be more promising as compared to tracheal intubation by DL or VL.
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http://dx.doi.org/10.1038/s41598-021-88008-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085007PMC
April 2021

Enhancing medication therapy in Parkinson's disease by establishing an interprofessional network including pharmacists.

Int J Clin Pharm 2021 Jun 23;43(3):441-448. Epub 2021 Apr 23.

Impac2t Research, Maximilianstr. 31-33, Münster, Germany.

Background Optimizing therapy regimens through collaboration and combination of available resources is a promising approach to improve quality of life for patients with Parkinson's disease (PD). Aim The aim of this project was to enhance patient-oriented therapy and interprofessional collaboration by establishing a regional PD network. Setting The network is located in a rural area in Germany. It covers primary, secondary and tertiary care facilities across professional boundaries. Development Recruitment of PD specialists and patient support groups was done by the local newspaper to spread the word. The network was initially open to all healthcare professionals, who stated a focus or special interest in PD. A working group for medication was founded within the network by asking for interested participants. Problems in the medication process were discussed within the group. As a consequence, therapy recommendations (quickcards) and a specific medication plan were developed and a certified education curriculum for pharmacists was developed. Implementation The network grew to > 150 participants across all disciplines and sectors. Quickcards were adjusted, approved and implemented by the network during interquartile meetings. Certified education was implemented and became a requirement for participating pharmacists. Evaluation The quickcards on medication plan and drug-drug-interactions were approved to be useful and feasible by the network by unanimous assent. Overall satisfaction with certified education was high (mean of 1.4 on a scale between 1 = high and 6 = low). Conclusion A regional interprofessional PD network with pharmacists was established and new standards were established. Future research needs to measure the effects on patient outcomes.
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http://dx.doi.org/10.1007/s11096-021-01263-wDOI Listing
June 2021

Functional endoscopy in neurogenic dysphagia: a feasibility study focusing on the esophageal phase of swallowing.

Endosc Int Open 2021 Apr 15;9(4):E646-E652. Epub 2021 Apr 15.

Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany.

Due to demographic transition, neurogenic dysphagia has become an increasingly recognized problem. Patients suffering from dysphagia often get caught between different clinical disciplines. In this study, we implemented a defined examination protocol for evaluating the whole swallowing process by functional endoscopy. Special focus was put on the esophageal phase of swallowing. This prospective observational multidisciplinary study evaluated 31 consecutive patients with suspected neurogenic dysphagia by transnasal access applying an ultrathin video endoscope. Thirty-one patients with gastroesophageal reflux symptoms were used as a control group. We applied a modified approach including standardized endoscopic positions to compare our findings with fiberoptic endoscopic evaluation of swallowing and high-resolution manometry. The primary outcome measure was feasibility of functional endoscopy. Secondary outcome measures were adverse events (AEs), tolerability, and pathologic endoscopic findings. Functional endoscopy was successfully performed in all patients. No AEs were recorded. A variety of disorders were documented by functional endoscopy: incomplete or delayed closure of the upper esophageal sphincter in retroflex view, clearance disturbance of tubular esophagus, esophageal hyperperistalsis, and hypomotility. Analysis of results obtained with the diagnostic tools showed some discrepancies. By interdisciplinary cooperation with additional assessment of the esophageal phase of deglutition using the innovative method of functional endoscopy, the diagnosis of neurogenic disorders including dysphagia may be significantly improved, leading to a better clinical understanding of complex dysfunctional patterns. To the best of our knowledge, this is the first study to show that a retroflex view of the ultrathin video endoscope within the esophagus can be safely performed. [NCT01995929].
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http://dx.doi.org/10.1055/a-1380-3224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8050561PMC
April 2021

Predictors, outcome and characteristics of oropharyngeal dysphagia in idiopathic inflammatory myopathy.

Muscle Nerve 2021 06 24;63(6):874-880. Epub 2021 Mar 24.

Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany.

Introduction: Oropharyngeal dysphagia is a clinical hallmark of idiopathic inflammatory myopathy (IIM). This study investigated predictors, outcome, and characteristics of oropharyngeal dysphagia in patients with different types of IIM.

Methods: Flexible endoscopic evaluation of swallowing (FEES) videos of 71 IIM patients were retrospectively analyzed for bolus spillage, penetration, aspiration, and pharyngeal residue. Based on these findings, dysphagia severity was rated. Regression analyses were performed to investigate demographic and disease-specific predictors of dysphagia severity and pneumonia as outcome-relevant complications of dysphagia. A score was developed to rate the quality of the endoscopic white-out as a surrogate marker for pharyngeal muscle weakness with consecutive residue.

Results: Our analysis revealed no independent predictors of dysphagia severity. Dysphagia severity, however, was an independent predictor for pneumonia, which occurred in 24% of patients. Pharyngeal residue with risk of postdeglutitive aspiration was the most common dysphagia pattern. Attenuation of the endoscopic white-out was related to residue severity.

Discussion: Dysphagia in IIM assessed with FEES is associated with relevant complications, such as aspiration pneumonia, and must be considered independently of peripheral muscle weakness and disease duration. Swallowing impairment mainly presents with pharyngeal residue. The quality of the white-out may serve as a semi-quantitative surrogate marker for pharyngeal contractility.
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http://dx.doi.org/10.1002/mus.27225DOI Listing
June 2021

Expiratory Muscle Strength Training for Therapy of Pharyngeal Dysphagia in Parkinson's Disease.

Mov Disord 2021 08 2;36(8):1815-1824. Epub 2021 Mar 2.

Department of Neurology with Institute of Translational Neurology, University Hospital of Muenster, Muenster, Germany.

Background: Pharyngeal dysphagia in Parkinson's disease (PD) is a common and clinically relevant symptom associated with poor nutrition intake, reduced quality of life, and aspiration pneumonia. Despite this, effective behavioral treatment approaches are rare.

Objective: The objective of this study was to verify if 4 week of expiratory muscle strength training can improve pharyngeal dysphagia in the short and long term and is able to induce neuroplastic changes in cortical swallowing processing.

Methods: In this double-blind, randomized, controlled trial, 50 patients with hypokinetic pharyngeal dysphagia, as confirmed by flexible endoscopic evaluation of swallowing, performed a 4-week expiratory muscle strength training. Twenty-five participants used a calibrated ("active") device, 25 used a sham handheld device. Swallowing function was evaluated directly before and after the training period, as well as after a period of 3 month using flexible endoscopic evaluation of swallowing. Swallowing-related cortical activation was measured in 22 participants (active:sham; 11:11) using whole-head magnetencephalography.

Results: The active group showed significant improvement in the flexible endoscopic evaluation of swallowing-based dysphagia score after 4 weeks and after 3 months, whereas in the sham group no significant changes from baseline were observed. Especially, clear reduction in pharyngeal residues was found. Regarding the cortical swallowing network before and after training, no statistically significant differences were found by magnetencephalography examination.

Conclusions: Four-week expiratory muscle strength training significantly reduces overall dysphagia severity in PD patients, with a sustained effect after 3 months compared with sham training. This was mainly achieved by improving swallowing efficiency. The treatment effect is probably caused by peripheral mechanisms, as no changes in the cortical swallowing network were identified. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28552DOI Listing
August 2021

Fitness landscape of a dynamic RNA structure.

PLoS Genet 2021 02 1;17(2):e1009353. Epub 2021 Feb 1.

Medical Research Council London Institute of Medical Sciences, London, United Kingdom.

RNA structures are dynamic. As a consequence, mutational effects can be hard to rationalize with reference to a single static native structure. We reasoned that deep mutational scanning experiments, which couple molecular function to fitness, should capture mutational effects across multiple conformational states simultaneously. Here, we provide a proof-of-principle that this is indeed the case, using the self-splicing group I intron from Tetrahymena thermophila as a model system. We comprehensively mutagenized two 4-bp segments of the intron. These segments first come together to form the P1 extension (P1ex) helix at the 5' splice site. Following cleavage at the 5' splice site, the two halves of the helix dissociate to allow formation of an alternative helix (P10) at the 3' splice site. Using an in vivo reporter system that couples splicing activity to fitness in E. coli, we demonstrate that fitness is driven jointly by constraints on P1ex and P10 formation. We further show that patterns of epistasis can be used to infer the presence of intramolecular pleiotropy. Using a machine learning approach that allows quantification of mutational effects in a genotype-specific manner, we demonstrate that the fitness landscape can be deconvoluted to implicate P1ex or P10 as the effective genetic background in which molecular fitness is compromised or enhanced. Our results highlight deep mutational scanning as a tool to study alternative conformational states, with the capacity to provide critical insights into the structure, evolution and evolvability of RNAs as dynamic ensembles. Our findings also suggest that, in the future, deep mutational scanning approaches might help reverse-engineer multiple alternative or successive conformations from a single fitness landscape.
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http://dx.doi.org/10.1371/journal.pgen.1009353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877785PMC
February 2021

Dysphagia in Patients With Severe Coronavirus Disease 2019-Potential Neurologic Etiologies.

Crit Care Explor 2021 Jan 22;3(1):e0332. Epub 2021 Jan 22.

Department of Cardiology, University Hospital Münster, 48149 Münster, Germany.

Importance: Dysphagia is a common complication of critical illness, and many known risk factors are also present in critically ill coronavirus disease 2019 victims.

Objectives: To investigate dysphagia in patients with severe coronavirus disease 2019.

Design Setting And Participants: In this case series, we report results of dedicated evaluation of swallowing function in six consecutive, tracheotomized coronavirus disease 2019 patients after they had survived acute respiratory distress syndrome and were weaned from the respirator.

Main Outcomes And Measures: Dysphagia was assessed with flexible endoscopic evaluation of swallowing.

Results: Three patients suffered from severe dysphagia and airway compromise precluding decannulation, whereas in the other, three swallowing was less critically impaired, and the tracheal cannula could be removed. Four patients presented with additional laryngeal dysfunctions not typically seen in acute respiratory distress syndrome survivors.

Conclusion And Relevance: Dysphagia with impaired airway protection is a key feature in coronavirus disease 2019 acute respiratory distress syndrome survivors. Apart from critical illness polyneuropathy, coronavirus disease 2019-related involvement of the peripheral and central nervous system may contribute to swallowing impairment and laryngeal dysfunction.
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http://dx.doi.org/10.1097/CCE.0000000000000332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837983PMC
January 2021

Effect of Capsaicinoids on Neurophysiological, Biochemical, and Mechanical Parameters of Swallowing Function.

Neurotherapeutics 2021 Apr 15;18(2):1360-1370. Epub 2021 Jan 15.

Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149, Muenster, Germany.

Oropharyngeal dysphagia is prevalent in age-related neurological disorders presenting with impaired efficacy and safety of swallowing due to a loss of muscle force and sensory deficits. Stimulating the oropharynx with capsaicin that mediates Substance P release is an emerging pharmacological treatment option which needs further scientific evidence. Our aim was to comprehensively evaluate the effect of capsaicin on biochemical, neurophysiological, and biomechanical parameters of swallowing function. In a randomized study on healthy individuals, the impact of orally administered capsaicinoids at different dosages and application durations in comparison to non-carbonated water was evaluated. Time course and magnitude of salivary Substance P increase were monitored. Magnetoencephalography was used to detect cortical swallowing network alterations. Modifications in swallowing biomechanics were measured applying high-resolution pharyngeal manometry. Capsaicinoids at 10 μmol/L improved swallowing efficacy as seen by a significant increase of pharyngeal contractile integral and upper esophageal sphincter activation and relaxation times in manometry. Significant improvement of precision in a challenging swallow task accompanied by a reduction in swallowing-related submental electromyographic power was observed with capsaicinoids preconditioning at 10 μmol/L over 5 min, but not with continuous stimulation. The cortical activation pattern remained unchanged after any intervention. A significant increase of salivary Substance P was not detected with 10 μmol/L but with 50 μmol/L and lasted for 15 min after application. Capsaicinoids mediate dose-dependent Substance P release and positively alter swallowing biomechanics in healthy subjects. The results provide supportive evidence for the value of natural capsaicinoids to improve swallowing function.
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http://dx.doi.org/10.1007/s13311-020-00996-2DOI Listing
April 2021

Time to ventilation and success rate of airway devices in microgravity: A randomized crossover manikin-trial using an underwater setting.

Acta Anaesthesiol Scand 2021 05 2;65(5):681-687. Epub 2021 Feb 2.

Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.

Background: Medical support for space exploration missions must prepare for severe medical events in conditions of microgravity. A key component to managing these events is techniques of airway management. The aim of the present trial is to compare airway management devices in simulated microgravity.

Methods: In this randomized cross-over trial (RCT), four different devices were compared under simulated microgravity conditions utilizing a neutrally buoyant free-floating underwater manikin and poolside in normal gravity (control group). The primary endpoint was the successful placement of the airway device. The secondary endpoints were the number of attempts and the duration of each attempt.

Results: A total of 20 participants performed placement of each device in both gravity conditions in an Airway mannequin. The fastest time to initial ventilation in simulated microgravity was possible with the laryngeal tube (18.9 ± 8 seconds) followed by laryngeal mask (20.1 ± 9 seconds). The I-gel supraglottic airway device required substantially more time for successful insertion in simulated microgravity (35.4 ± 25 seconds) as did endotracheal tube intubation by direct laryngoscopy (70.4 ± 35 seconds). Simulated microgravity conditions prolonged time to initial ventilation by 3.3 seconds (LM), 3.9 seconds (LT), 19.9 seconds (I-gel) and 43.1 seconds (endotracheal intubation, ETI) when compared to poolside attempts in normogravity.

Conclusion: In simulated microgravity conditions, use of the laryngeal tube or laryngeal mask provided the quickest time to initial ventilation, without deliberate tethering of the mannequin and rescuer to a fixed surface. Endotracheal intubation required significantly longer procedure times and, thus, was considered insufficient for clinical use in microgravity.
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http://dx.doi.org/10.1111/aas.13780DOI Listing
May 2021

Dysphagia in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody disease as a surrogate of brain involvement?

Eur J Neurol 2021 05 12;28(5):1765-1770. Epub 2021 Jan 12.

Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany.

Background And Purpose: Neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are demyelinating disorders that typically affect the optic nerves and the spinal cord. However, recent studies have demonstrated various forms of brain involvement indicating encephalitic syndromes, which consequently are included in the diagnostic criteria for both. Swallowing is processed in a distributed brain network and is therefore disturbed in many neurological diseases. The aim of this study was to investigate the occurrence of oropharyngeal dysphagia in NMOSD and MOGAD using flexible endoscopic evaluation of swallowing (FEES) as a surrogate parameter of brain involvement.

Methods: Thirteen patients with NMOSD and MOGAD (mean age 54.2 ± 18.6 years, six men) who received FEES during clinical routine were retrospectively reviewed. Their extent of oropharyngeal dysphagia was rated using an ordinal dysphagia severity scale. FEES results were compared to a control group of healthy individuals. Dysphagia severity was correlated with the presence of clinical and radiological signs of brain involvement, the Expanded Disability Status Scale (EDSS) and the occurrence of pneumonia.

Results: Oropharyngeal dysphagia was present in 8/13 patients, including six patients without other clinical indication of brain involvement. Clinical or subclinical swallowing impairment was significantly more severe in patients with NMOSD and MOGAD compared to the healthy individuals (p = 0.009) and correlated with clinical signs of brain involvement (p = 0.038), higher EDSS (p = 0.006) and pneumonia (p = 0.038).

Conclusion: Oropharyngeal dysphagia can occur in NMOSD and MOGAD and might be associated with pneumonia and disability. FEES may help to detect subclinical brain involvement.
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http://dx.doi.org/10.1111/ene.14691DOI Listing
May 2021

Inter-rater and test-retest reliability of the "standardized endoscopic swallowing evaluation for tracheostomy decannulation in critically ill neurologic patients".

Neurol Res Pract 2020 30;2. Epub 2020 Mar 30.

Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1 A, 48149 Muenster, Germany.

Background: Removal of a tracheostomy tube in critically ill neurologic patients is a difficult issue, particularly due to the high incidence of oropharyngeal dysphagia. For an objective evaluation of decannulation readiness the "Standardized Endoscopic Swallowing Evaluation for Tracheostomy Decannulation in Critically Ill Neurologic Patients" (SESETD) - a stepwise evaluation of 'secretion management', 'spontaneous swallows' and 'laryngeal sensibility/cough' - has been introduced. With the recent study detailed data on inter-rater and test-retest reliability are presented.

Methods: To obtain inter-rater reliability levels both in a group of raters with at least 5 years of experience ('experts') and in a group of raters with no or only minor experience using the SESETD ('non-experts'), for each single item of the protocol and the sum score α-, respectively κ-levels were determined. The 'experts' assessed the same videos after a four-week interval to determine test-retest reliability. Ten videos from tracheostomized neurological patients completely weaned from mechanical ventilation were assessed independently by six 'experts'. 27 'non-experts' applied the SESETD on 5 videos from the same patient population after introduction to the protocol in a one-hour workshop.

Results: For the items 'secretion management' and 'spontaneous swallows' α-levels were identified at > 0.800 both in the group of 'experts' and 'non-experts'. With regard to the item 'laryngeal sensibility/cough' in both groups, the α-level was ≥0.667. With κ-levels of 1.0 for 'secretion management', 0.93 for 'spontaneous swallows' and 0.76 for 'laryngeal sensibility/cough' test-retest reliability showed at least substantial agreement for each item. Intraclass correlation coefficient for the sum score was excellent in both groups (α ≥ 0.90).

Conclusions: The SESETD demonstrates good to excellent agreement for each single item included as well as the sum score in experienced and unexperienced raters supporting its usefulness for implementation in daily clinical routine and as an outcome measure for clinical trials.
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http://dx.doi.org/10.1186/s42466-020-00055-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7650070PMC
March 2020

Neurogenic Dysphagia: Systematic Review and Proposal of a Classification System.

Neurology 2021 02 14;96(6):e876-e889. Epub 2020 Dec 14.

From the Department of Neurology, Institute of Translational Neurology (T.W., B.L., J.S., A.R., S.A., I.C., P.M., S.S.-K., R.D.), and Institute of Biomagnetism and Biosignalanalysis (B.L., P.M., S.S.-K.), University Hospital Muenster, University of Muenster; and Department of Neurology (S.L.), ZNN, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.

Objective: Introduction and validation of a phenotypic classification of neurogenic dysphagia based on flexible endoscopic evaluation of swallowing (FEES).

Methods: A systematic literature review was conducted, searching MEDLINE from inception to May 2020 for FEES findings in neurologic diseases of interest. Based on a retrospective analysis of FEES videos in neurologic diseases and considering the results from the review, a classification of neurogenic dysphagia was developed distinguishing different phenotypes. The classification was validated using 1,012 randomly selected FEES videos of patients with various neurologic disorders. Chi-square tests were used to compare the distribution of dysphagia phenotypes between the underlying neurologic disorders.

Results: A total of 159 articles were identified, of which 59 were included in the qualitative synthesis. Seven dysphagia phenotypes were identified: (1) "premature bolus spillage" and (2) "delayed swallowing reflex" occurred mainly in stroke, (3) "predominance of residue in the valleculae" was most common in Parkinson disease, (4) "predominance of residue in the piriform sinus" occurred only in myositis, motoneuron disease, and brainstem stroke, (5) "pharyngolaryngeal movement disorder" was found in atypical Parkinsonian syndromes and stroke, (6) "fatigable swallowing weakness" was common in myasthenia gravis, and (7) "complex disorder" with a heterogeneous dysphagia pattern was the leading mechanism in amyotrophic lateral sclerosis. The interrater reliability showed a strong agreement (kappa = 0.84).

Conclusion: Neurogenic dysphagia is not a symptom, but a multietiologic syndrome with different phenotypic patterns depending on the underlying disease. Dysphagia phenotypes can facilitate differential diagnosis in patients with dysphagia of unclear etiology.
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http://dx.doi.org/10.1212/WNL.0000000000011350DOI Listing
February 2021

Histone variants in archaea and the evolution of combinatorial chromatin complexity.

Proc Natl Acad Sci U S A 2020 12 7;117(52):33384-33395. Epub 2020 Dec 7.

Molecular Systems Group, Quantitative Biology Section, Medical Research Council London Institute of Medical Sciences, London W12 0NN, United Kingdom;

Nucleosomes in eukaryotes act as platforms for the dynamic integration of epigenetic information. Posttranslational modifications are reversibly added or removed and core histones exchanged for paralogous variants, in concert with changing demands on transcription and genome accessibility. Histones are also common in archaea. Their role in genome regulation, however, and the capacity of individual paralogs to assemble into histone-DNA complexes with distinct properties remain poorly understood. Here, we combine structural modeling with phylogenetic analysis to shed light on archaeal histone paralogs, their evolutionary history, and capacity to generate combinatorial chromatin states through hetero-oligomeric assembly. Focusing on the human commensal as a model archaeal system, we show that the heteromeric complexes that can be assembled from its seven histone paralogs vary substantially in DNA binding affinity and tetramer stability. Using molecular dynamics simulations, we go on to identify unique paralogs in and that are characterized by unstable interfaces between dimers. We propose that these paralogs act as capstones that prevent stable tetramer formation and extension into longer oligomers characteristic of model archaeal histones. Importantly, we provide evidence from phylogeny and genome architecture that these capstones, as well as other paralogs in the Methanobacteriales, have been maintained for hundreds of millions of years following ancient duplication events. Taken together, our findings indicate that at least some archaeal histone paralogs have evolved to play distinct and conserved functional roles, reminiscent of eukaryotic histone variants. We conclude that combinatorially complex histone-based chromatin is not restricted to eukaryotes and likely predates their emergence.
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http://dx.doi.org/10.1073/pnas.2007056117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776873PMC
December 2020

Effects of cognitive and motor dual-tasks on oropharyngeal swallowing assessed with FEES in healthy individuals.

Sci Rep 2020 11 23;10(1):20403. Epub 2020 Nov 23.

Department of Neurology with Institute for Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1; Gebäude A1, 48149, Münster, Germany.

Dysphagia is frequent in many neurological diseases and gives rise to severe complications such as malnutrition, dehydration and aspiration pneumonia. Therefore, early detection and management of dysphagia is essential and can reduce mortality. This study investigated the effect of cognitive and motor dual-task interference on swallowing in healthy participants, as dual-task effects are reported for other motor tasks such as gait and speech. 27 participants (17 females; 29.2 ± 4.1 years) were included in this prospective study and examined using flexible endoscopic evaluation of swallowing (FEES). Using a previously established FEES-based score, the paradigms "baseline swallowing", "cognitive dual-task" and "motor dual-task" were assessed. Scores of the three paradigms were compared using a repetitive measures ANOVA and post-hoc analysis. Mean baseline swallowing score in single task was 5 ± 3. It worsened to 6 ± 5 in the cognitive (p = 0.118), and to 8 ± 5 in the motor dual-task condition (p < 0.001). This change was driven by subclinical worsening of premature bolus spillage and pharyngeal residue. Oropharyngeal swallowing is not exclusively reflexive in nature but requires attention, which leads to motor dual-task interference. This has potential diagnostic and therapeutic implications, e.g. in the early screening for dysphagia or in avoiding dual-task situations while eating.
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http://dx.doi.org/10.1038/s41598-020-77421-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683567PMC
November 2020

Bilateral Vocal Fold Paralysis in Myasthenia Gravis: A Case Report and Literature Review.

Front Neurol 2020 15;11:581060. Epub 2020 Oct 15.

Clinic of Neurology With Institute of Translational Neurology, University Hospital Münster, Münster, Germany.

To prevent severe and potentially life-threatening consequences of bilateral vocal fold paralysis (BVFP), the identification and management of reversible causes is pivotal. Myasthenia gravis (MG) presenting with BVFP is rarely reported and remains incompletely understood. Although symptom control is achievable for most MG patients with sufficient therapy, atypical clinical presentation such as BVFP might preclude diagnosis and thus effective treatment. Here, we present a case of BVFP as leading manifestation of MG successfully treated with plasmapheresis. Moreover, we performed a literature review of the few existing cases reported between 1980 and 2020 indicating that elderly patients are particularly at risk for MG presenting with severe BVFP and that edrophonium testing with fiber optic endoscopic evaluation of swallowing (FEES) might be valuable for establishing the diagnosis. We conclude that clinicians should consider MG as possible and reversible cause for BVFP.
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http://dx.doi.org/10.3389/fneur.2020.581060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593483PMC
October 2020

Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG).

Scand J Trauma Resusc Emerg Med 2020 Nov 2;28(1):108. Epub 2020 Nov 2.

University Department for Anesthesia, Intensive and Emergency Medicine and Pain Management, Hospital Oldenburg, Oldenburg, Germany.

Background: With the "Artemis"-mission mankind will return to the Moon by 2024. Prolonged periods in space will not only present physical and psychological challenges to the astronauts, but also pose risks concerning the medical treatment capabilities of the crew. So far, no guideline exists for the treatment of severe medical emergencies in microgravity. We, as a international group of researchers related to the field of aerospace medicine and critical care, took on the challenge and developed a an evidence-based guideline for the arguably most severe medical emergency - cardiac arrest.

Methods: After the creation of said international group, PICO questions regarding the topic cardiopulmonary resuscitation in microgravity were developed to guide the systematic literature research. Afterwards a precise search strategy was compiled which was then applied to "MEDLINE". Four thousand one hundred sixty-five findings were retrieved and consecutively screened by at least 2 reviewers. This led to 88 original publications that were acquired in full-text version and then critically appraised using the GRADE methodology. Those studies formed to basis for the guideline recommendations that were designed by at least 2 experts on the given field. Afterwards those recommendations were subject to a consensus finding process according to the DELPHI-methodology.

Results: We recommend a differentiated approach to CPR in microgravity with a division into basic life support (BLS) and advanced life support (ALS) similar to the Earth-based guidelines. In immediate BLS, the chest compression method of choice is the Evetts-Russomano method (ER), whereas in an ALS scenario, with the patient being restrained on the Crew Medical Restraint System, the handstand method (HS) should be applied. Airway management should only be performed if at least two rescuers are present and the patient has been restrained. A supraglottic airway device should be used for airway management where crew members untrained in tracheal intubation (TI) are involved.

Discussion: CPR in microgravity is feasible and should be applied according to the Earth-based guidelines of the AHA/ERC in relation to fundamental statements, like urgent recognition and action, focus on high-quality chest compressions, compression depth and compression-ventilation ratio. However, the special circumstances presented by microgravity and spaceflight must be considered concerning central points such as rescuer position and methods for the performance of chest compressions, airway management and defibrillation.
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http://dx.doi.org/10.1186/s13049-020-00793-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7607644PMC
November 2020

A European Observational Study to Evaluate the Safety and the Effectiveness of Safinamide in Routine Clinical Practice: The SYNAPSES Trial.

J Parkinsons Dis 2021 ;11(1):187-198

Parkinson-Klinik Ortenau, University of Freiburg, Wolfach, Germany.

Background: Safinamide modulates both dopaminergic and glutamatergic systems with positive effects on motor and non-motor symptoms of Parkinson's disease (PD). The drug utilization study SYNAPSES was designed to investigate the use of safinamide in routine clinical practice, as recommended by the European Medicines Agency.

Objective: To describe the occurrence of adverse events in PD patients treated with safinamide in real-life conditions.

Methods: The SYNAPSES trial is an observational, European, multicenter, retrospective-prospective cohort study. Patients were followed up to 12 months with analyses performed in the overall population and in patients aged >75 years, with relevant comorbidities and with psychiatric conditions.

Results: Of the 1610 patients included, 82.4% were evaluable after 12 months with 25.1% of patients >75 years, 70.8% with relevant comorbidities and 42.4% with psychiatric conditions. During observation 45.8% patients experienced adverse events, 27.7% patients had adverse drug reactions and 9.2% patients had serious adverse events. The adverse events were those already described in the patients' information leaflet. The majority were mild or moderate and completely resolved and no differences were detected between the subgroup of patients. Clinically significant improvements were seen in the UPDRS motor score and in the UPDRS total score in ≥40% of patients, according to the criteria developed by Shulman et al.Conclusion:The SYNAPSES study confirms the good safety profile of safinamide even in special groups of patients. Motor complications and motor scores improved with clinically significant results in the UPDRS scale maintained in the long-term.
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http://dx.doi.org/10.3233/JPD-202224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990425PMC
January 2021

Effect of cognitive and motor dual-task on oropharyngeal swallowing in Parkinson's disease.

Eur J Neurol 2021 03 2;28(3):754-762. Epub 2020 Dec 2.

Department of Neurology with Institute of Translational Neurology, University of Muenster, Muenster, Germany.

Background: Dysphagia frequently occurs in patients with Parkinson's disease (PD) and is associated with severe complications. However, the underlying pathology is poorly understood at present. This study investigated the effect of cognitive and motor dual-task interference on oropharyngeal swallowing in PD.

Methods: Thirty PD patients (23 men, mean age 65.90 ± 9.32 years, mean Hoehn and Yahr stage 2.62 ± 0.81, mean UPDRS 18.00 ± 7.18) were examined using flexible endoscopic evaluation of swallowing (FEES). FEES was performed during three paradigms: at baseline without interference, during a cognitive dual-task, and during a motor dual-task. Oropharyngeal swallowing function was rated using a score which was validated to detect changes in PD related dysphagia. The three paradigms were compared using a two-way-repetitive-measures-ANOVA and a post-hoc-analysis.

Results: Mean swallowing score in baseline FEES was 10.67 ± 5.89. It significantly increased (worsened) to 15.97 ± 7.62 (p < 0.001) in the motor dual-task and to 14.55 ± 7.49 (p < 0.001) in the cognitive dual-task. Premature bolus spillage and pharyngeal residue both significantly increased during both of the dual-task conditions whereas penetration/aspiration events did not change.

Conclusion: Oropharyngeal swallowing in patients with PD is not purely reflexive but requires mental capacity. Additional allocation of attentional resources in the central control of swallowing seems to be an effective compensatory mechanism in PD-related dysphagia: The proposed dual-task protocol may be useful to challenge swallowing functional reserve. Conversely, as a therapeutic strategy, it could be beneficial to focus attention on swallowing and to avoid dual-task situations.
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http://dx.doi.org/10.1111/ene.14603DOI Listing
March 2021

Targeting the sensory feedback within the swallowing network-Reversing artificially induced pharyngolaryngeal hypesthesia by central and peripheral stimulation strategies.

Hum Brain Mapp 2021 02 17;42(2):427-438. Epub 2020 Oct 17.

Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany.

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.
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http://dx.doi.org/10.1002/hbm.25233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776007PMC
February 2021

Pre- and Post-Surgical Dysphagia in Adults with Tumors of the Posterior Fossa: A Prospective Blinded Study.

Cancers (Basel) 2020 Sep 9;12(9). Epub 2020 Sep 9.

Department of Neurosurgery, University Hospital Frankfurt, 60528 Frankfurt, Germany.

Background: While swallowing disorders are frequent sequela following posterior fossa tumor (PFT) surgery in children, data on dysphagia frequency, severity, and outcome in adults are lacking. The aim of this study was to investigate dysphagia before and after surgical removal of PFT. Additionally, we tried to identify clinical predictors for postsurgical swallowing disorders. Furthermore, this study explored the three-month outcome of dysphagic patients.

Methods: In a cohort of patients undergoing PFT surgery, dysphagia was prospectively assessed pre- and postoperatively using fiberoptic endoscopic evaluation of swallowing. Patients with severe dysphagia at discharge were re-evaluated after three months. Additionally, clinical and imaging data were collected to identify predictors for post-surgical dysphagia.

Results: We included 26 patients of whom 15 had pre-operative swallowing disorders. After surgery, worsening of pre-existing dysphagia could be noticed in 7 patients whereas improvement was observed in 2 and full recovery in 3 subjects. New-onset dysphagia after surgery occurred in a minority of 3 cases. Postoperatively, 47% of dysphagic patients required nasogastric tube feeding. Re-evaluation after three months of follow-up revealed that all dysphagic patients had returned to full oral intake.

Conclusion: Dysphagia is a frequent finding in patients with PFT already before surgery. Surgical intervention can infer a deterioration of impaired swallowing function placing affected patients at temporary risk for aspiration. In contrast, surgery can also accomplish beneficial results resulting in both improvement and full recovery. Overall, our findings show the need of early dysphagia assessment to define the safest feeding route for the patient.
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http://dx.doi.org/10.3390/cancers12092561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564918PMC
September 2020

Structured Care and Self-Management Education for Persons with Parkinson's Disease: Why the First Does Not Go without the Second-Systematic Review, Experiences and Implementation Concepts from Sweden and Germany.

J Clin Med 2020 Aug 28;9(9). Epub 2020 Aug 28.

Department of Neurology, University Hospital Dresden, 01307 Dresden, Germany.

Integrated care is regarded as a key for care delivery to persons with chronic long-term conditions such as Parkinson's disease. For persons with Parkinson's disease, obtaining self-management support is a top priority in the context of integrated care. Self-management is regarded as a crucial competence in chronic diseases since the affected persons and their caregivers inevitably take up the main responsibility when it comes to day-to-day management. Formal self-management education programs with the focus on behavioral skills relevant to the induction and maintenance of behavioral change have been implemented as a standard in many chronic long-term conditions. However, besides the example of the Swedish National Parkinson School, the offers for persons with Parkinson's disease remain fragmented and limited in availability. Today, no such program is implemented as a nationwide standard in Germany. This paper provides (1) a systematic review on structured self-management education programs specifically designed or adopted for persons with Parkinson's disease, (2) presents the Swedish National Parkinson School as an example for a successfully implemented nationwide program and (3) presents a concept for the design, evaluation and long-term implementation of a future-orientated self-management education program for persons with Parkinson's disease in Germany.
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http://dx.doi.org/10.3390/jcm9092787DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563525PMC
August 2020

Building a Parkinson-Network-Experiences from Germany.

J Clin Med 2020 Aug 25;9(9). Epub 2020 Aug 25.

Department of Neurology, University Hospital Marburg, 35033 Marburg, Germany.

Parkinson's disease is a complex neurodegenerative disease that can be best treated with a multi-disciplinary care approach. Building care networks has been shown as a useful tool to facilitate the integration of care services and improve outcomes for patients and care providers. However, experiences and practices relating to building a network are very limited in the field of Parkinson's disease. This paper portrays existing Parkinson networks in Germany. With the help of a standardized template, description of networks and their building-blocks, so-called modules, were collected from all over Germany. Modules were rated in terms of their expected benefit and the required effort when implementing them, with the help of an expert survey. The rating showed that some modules were perceived as more important than others, but all modules were recognized as beneficial for patients and care providers. Overall, the German experience shows that building a Parkinson network facilitates the integration of care and provides a benefit to all stakeholders involved.
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http://dx.doi.org/10.3390/jcm9092743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563415PMC
August 2020

Specialized Staff for the Care of People with Parkinson's Disease in Germany: An Overview.

J Clin Med 2020 Aug 10;9(8). Epub 2020 Aug 10.

Department of Nursing, University Hospital Frankfurt, Goethe University, 60590 Frankfurt, Germany.

Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed.
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http://dx.doi.org/10.3390/jcm9082581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463847PMC
August 2020
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