human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS We evaluated the effect of a novel rehabilitative exercise on restoration of deglutition in a group of patients with deglutitive failure caused by abnormal upper esophageal sphincter ( UES ) opening manifested by postswallow residue and aspiration necessitating percutaneous tube feeding . METHODS We studied a total of 27 patients by videofluoroscopy and functional assessment of swallowing scores before and after 6 weeks of a head-raising exercise program . Seven of 27 patients , assigned r and omly , participated in a sham exercise before entering the tested exercise program . Eleven of 27 were r and omized to the real exercise program . RESULTS Although there was no change in swallow function and biomechanics after the sham exercise , following 6 weeks of real exercise , all 11 patients exhibited a significant improvement in their UES opening , anterior laryngeal excursion ( P < 0.01 ) , as well as resolution of postdeglutitive aspiration and were able to resume oral feeding . Similar results were found when the 7 patients in the sham group were crossed over to the real exercise group . Comparison of before and after exercise values for anteroposterior UES opening ( P < 0.01 ) and laryngeal anterior excursion ( P < 0.05 ) , as well as functional outcome assessment of swallowing ( P < 0.05 ) in the entire group of 27 patients also showed significant improvement . Etiology and duration of dysphagia did not affect the outcome . CONCLUSIONS The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal UES opening Background Recently , reports from the West have indicated three-field lymphadenectomy ( 3FL ) for esophageal cancer increases the accuracy of tumor staging and survival . However , this cervical procedure is likely to lead to swallowing dysfunction and aspiration , which are barriers to introducing this procedure in clinical practice . Methods Our goal is to eluci date the etiology of swallowing dysfunction after 3FL and devise a remedy . First , based on evaluation of swallowing function in ten patients with two-field lymphadenectomy ( 2FL ) and ten with 3FL  , we hypothesized that the scarred sternohyoid and sternothyroid muscles might be impairing laryngeal elevation after 3FL ; thus , complete division of the bilateral infrahyoid muscles attached to the sternum ( CDBIMS ) could be an effective remedy . Next , the utility of this additive procedure was examined in 20 patients with 3FL .  Swallowing function was evaluated by the distance of total laryngeal elevation ( TLE ) and the frequency of incomplete airway protection ( IAP ) ( laryngeal penetration or aspiration ) on videofluoroscopic study . Results The average TLE and frequency of IAP were , respectively , 0.37 cm and 70 % in the 3FL group , showing significant deterioration ( p < 0.001 and 0.025 ) , in contrast to 1.79 cm and 20 % in the 2FL group . The 3FL + CDBIMS group showed significant improvements in the average TLE and the frequency of IAP ( 1.70 cm and 25 % ) , compared with the 3FL group ( p < 0.001 and 0.018 ) . Multivariate logistic regression identified additive CDBIMS as a significant suppressor of IAP after 3FL . Conclusions Laryngeal elevation was significantly impaired after 3FL . Adding CDBIMS might improve swallowing function in these patients OBJECTIVES /HYPOTHESIS Scant data exist on normal bolus dwell time assessed during flexible endoscopic evaluation of swallowing ( FEES ) . The purpose of this study was to examine bolus dwell time in healthy older adults . Because it has been previously reported that some healthy older adults aspirate , we also sought to determine if bolus dwell time varied as a function of aspiration status . STUDY DESIGN Prospect i ve . METHODS Seventy-six healthy volunteers from the seventh , eighth , and ninth decades of life participated .  Dwell times were analyzed via FEES as a function of pharyngeal location , liquid type , delivery method , purée type , viscosity , age , and gender . RESULTS Longer dwell times were evidence d with the eldest participants , straw delivery , and the smallest volume . Adults in the ninth decade were 4.8 ( P = .01 ) and 3.8 ( P = .02 ) times more likely to have longer dwell times at the vallecula and 7.1 ( P = .002 ) and 3.8 ( P = 0.02 ) at the pyriform sinus than those in the seventh and eighth decades , respectively . Longer dwell times at the vallecula and pyriform sinuses were 2 and 2.38 times ( P < .0001 ) more likely for straw than cup delivery , respectively . Boluses of 5 mL were 1.5 times ( P < .05 ) more likely to result in longer dwell times than larger volumes . Bolus dwell times did not significantly differ as a function of aspiration status . CONCLUSIONS Advanced age , straw delivery , and small volumes yielded longer dwell times . These variables should be considered before diagnosing an abnormal bolus dwell time in elder patients Purpose When swallowing efficiency is impaired , residue accumulates in the pharynx . Cued or spontaneous swallows in the head neutral position do not always successfully clear residue . We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture . Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy .  Participants were cued to perform a head-turn-plus-chin-down swallow , with the direction of head turn r and omized . Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software . Measures of % full and the Normalized Residue Ratio Scale ( NRRS ) were extracted . Univariate analyses of variance were used to detect significant reductions in residue . Results On average , pre-maneuver measures showed residue filling 56 - 73 % of the valleculae , depending on stimulus consistency ( NRRS scores : 0.2 - 0.4 ) . More than 80 % of pre-swallow measures displayed NRRS ratios > 0.06 , a threshold previously linked to increased risk of post-swallow aspiration . Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids , suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies AIMS Acute surgical complications after esophageal resection for cancer may decrease the long-term survival . Previous results on this topic are conflicting and no population -based studies are available . METHODS A prospect i ve , nationwide Swedish study was conducted in 2001 - 2010 . Eligible patients comprised those afflicted by esophageal or cardia cancer and underwent surgical resection in Sweden in 2001 - 2005 . Details concerning patient and tumor characteristics , surgical procedures , and postoperative surgical complications were collected prospect ively . Follow-up for mortality , starting from 90 days after the surgery , was done until May 2010 . Cox proportional-hazards regression was performed to estimate hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) , adjusted for age , tumor stage , sex , histology , comorbidity , surgical approach and surgical radicality . RESULTS Among 567 included patients who survived at least 90 days postoperatively , 130 ( 22.9 % ) sustained a predefined surgical complication within 30 days of surgery . The adjusted HR of mortality was increased in patients who sustained surgical complications , compared to patients without such complications ( HR 1.29 , 95 % CI 1.02 - 1.63 ) . CONCLUSIONS The occurrence of surgical complications might be an independent predictor for poorer long-term survival in patients resected for esophageal cancer , even in patients who survived the postoperative period BACKGROUND Surgical resection is regarded as the only curative option for resectable oesophageal cancer , but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern . We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy . METHODS We did a multicentre , open-label , r and omised controlled trial at five study centres in three countries between June 1 , 2009 , and March 31 , 2011 . Patients aged 18 - 75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were r and omly assigned via a computer-generated r and omisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy . R and omisation was stratified by centre . Patients , and investigators undertaking interventions , assessing outcomes , and analysing data , were not masked to group assignment . The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital . Analysis was by intention to treat . This trial is registered with the Netherl and s Trial Register , NTR TC 2452 . FINDINGS We r and omly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group . 16 ( 29 % ) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five ( 9 % ) in the minimally invasive group ( relative risk [ RR ] 0·30 , 95 % CI 0·12 - 0·76 ; p=0·005 ) . 19 ( 34 % ) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven ( 12 % ) in the minimally invasive group ( 0·35 , 0·16 - 0·78 ; p=0·005 ) . For in-hospital mortality , one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage . INTERPRETATION These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer . FUNDING Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre Although dysphagia is the predominant symptom of esophageal cancer , the nature of the swallowing deficit remains unclear , particularly regarding an oropharyngeal motor component . The present study examined the  oropharyngeal swallow in patients with esophageal cancer before and following transhiatal esophagectomy . Videofluoroscopic data were obtained from ten patients with esophageal cancer before and following transhiatal esophagectomy  as they swallowed 2- , 5- , and 10-cc aliquots of liquid and puree , and 0.5 and 1 tsp of solid . Each swallow was rated on 36 parameters by three independent judges . Swallow-related hyoid bone movement , computed from digitized segments of the videofluoroscopic data , was compared pre- and postsurgically . All patients showed at least mild abnormality of the oropharyngeal swallow preoperatively . Abnormalities involved all stages of swallowing in nine of the ten patients ; however , the oral preparatory/oral stage was relatively more impaired than the pharyngeal stage in the majority of patients . Postsurgically , all patients exhibited at least a mild oropharyngeal swallowing impairment . New or increased postoperative deficits involved the pharyngeal stage of swallowing , whereas oral stage abnormalities were generally improved or unchanged following surgery . Swallow-related hyoid kinematics were highly variable both before and following surgery . Anterior hyoid bone excursion was significantly reduced postoperatively in one patient and significantly increased in one patient . Patients with esophageal cancer exhibit oropharyngeal dysphagia , with different profiles of abnormality before and following esophagectomy OBJECTIVES To determine the effect of the chin-down maneuver after  esophagectomy with 3-field lymphadenectomy ( 3FL ) on pharyngeal residue , upper esophageal sphincter ( UES ) opening , and laryngeal closure . DESIGN Prospect i ve data were collected from a pharyngeal videofluoroscopic swallowing study . SETTING Dysphagia clinics . PARTICIPANTS Patients selected according to the inclusion criteria ( N=14 ; mean age , 65.9y ) from a total of 43 patients who underwent esophagectomy with 3FL from May to December 2014 were enrolled . INTERVENTIONS Videofluoroscopy was conducted in head-neutral and chin-down positions to measure the pharyngeal constriction ratio ( PCR ) , amount of residue in the vallecula and pyriform sinus after the first swallow , UES opening diameter , duration of UES opening , and duration of laryngeal vestibule closure . MAIN OUTCOME MEASURES The aforementioned parameters were compared statistically between the head-neutral and chin-down positions . RESULTS In comparison with the neutral group , the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group ( P<.01 ) . However , the residue in the vallecula did not differ significantly from that of the neutral group ( 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND & AIMS We evaluated the effect of a novel rehabilitative exercise on restoration of deglutition in a group of patients with deglutitive failure caused by abnormal upper esophageal sphincter ( UES ) opening manifested by postswallow residue and aspiration necessitating percutaneous tube feeding . METHODS We studied a total of 27 patients by videofluoroscopy and functional assessment of swallowing scores before and after 6 weeks of a head-raising exercise program . Seven of 27 patients , assigned r and omly , participated in a sham exercise before entering the tested exercise program . Eleven of 27 were r and omized to the real exercise program . RESULTS Although there was no change in swallow function and biomechanics after the sham exercise , following 6 weeks of real exercise , all 11 patients exhibited a significant improvement in their UES opening , anterior laryngeal excursion ( P < 0.01 ) , as well as resolution of postdeglutitive aspiration and were able to resume oral feeding . Similar results were found when the 7 patients in the sham group were crossed over to the real exercise group . Comparison of before and after exercise values for anteroposterior UES opening ( P < 0.01 ) and laryngeal anterior excursion ( P < 0.05 ) , as well as functional outcome assessment of swallowing ( P < 0.05 ) in the entire group of 27 patients also showed significant improvement . Etiology and duration of dysphagia did not affect the outcome . CONCLUSIONS The proposed suprahyoid muscle strengthening exercise program is effective in restoring oral feeding in some patients with deglutitive failure because of abnormal UES opening Background Recently , reports from the West have indicated three-field lymphadenectomy ( 3FL ) for esophageal cancer increases the accuracy of tumor staging and survival . However , this cervical procedure is likely to lead to swallowing dysfunction and aspiration , which are barriers to introducing this procedure in clinical practice . Methods Our goal is to eluci date the etiology of swallowing dysfunction after 3FL and devise a remedy . First , based on evaluation of swallowing function in ten patients with two-field lymphadenectomy ( 2FL ) and ten with 3FL  , we hypothesized that the scarred sternohyoid and sternothyroid muscles might be impairing laryngeal elevation after 3FL ; thus , complete division of the bilateral infrahyoid muscles attached to the sternum ( CDBIMS ) could be an effective remedy . Next , the utility of this additive procedure was examined in 20 patients with 3FL .  Swallowing function was evaluated by the distance of total laryngeal elevation ( TLE ) and the frequency of incomplete airway protection ( IAP ) ( laryngeal penetration or aspiration ) on videofluoroscopic study . Results The average TLE and frequency of IAP were , respectively , 0.37 cm and 70 % in the 3FL group , showing significant deterioration ( p < 0.001 and 0.025 ) , in contrast to 1.79 cm and 20 % in the 2FL group . The 3FL + CDBIMS group showed significant improvements in the average TLE and the frequency of IAP ( 1.70 cm and 25 % ) , compared with the 3FL group ( p < 0.001 and 0.018 ) . Multivariate logistic regression identified additive CDBIMS as a significant suppressor of IAP after 3FL . Conclusions Laryngeal elevation was significantly impaired after 3FL . Adding CDBIMS might improve swallowing function in these patients OBJECTIVES /HYPOTHESIS Scant data exist on normal bolus dwell time assessed during flexible endoscopic evaluation of swallowing ( FEES ) . The purpose of this study was to examine bolus dwell time in healthy older adults . Because it has been previously reported that some healthy older adults aspirate , we also sought to determine if bolus dwell time varied as a function of aspiration status . STUDY DESIGN Prospect i ve . METHODS Seventy-six healthy volunteers from the seventh , eighth , and ninth decades of life participated .  Dwell times were analyzed via FEES as a function of pharyngeal location , liquid type , delivery method , purée type , viscosity , age , and gender . RESULTS Longer dwell times were evidence d with the eldest participants , straw delivery , and the smallest volume . Adults in the ninth decade were 4.8 ( P = .01 ) and 3.8 ( P = .02 ) times more likely to have longer dwell times at the vallecula and 7.1 ( P = .002 ) and 3.8 ( P = 0.02 ) at the pyriform sinus than those in the seventh and eighth decades , respectively . Longer dwell times at the vallecula and pyriform sinuses were 2 and 2.38 times ( P < .0001 ) more likely for straw than cup delivery , respectively . Boluses of 5 mL were 1.5 times ( P < .05 ) more likely to result in longer dwell times than larger volumes . Bolus dwell times did not significantly differ as a function of aspiration status . CONCLUSIONS Advanced age , straw delivery , and small volumes yielded longer dwell times . These variables should be considered before diagnosing an abnormal bolus dwell time in elder patients Purpose When swallowing efficiency is impaired , residue accumulates in the pharynx . Cued or spontaneous swallows in the head neutral position do not always successfully clear residue . We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture . Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy .  Participants were cued to perform a head-turn-plus-chin-down swallow , with the direction of head turn r and omized . Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software . Measures of % full and the Normalized Residue Ratio Scale ( NRRS ) were extracted . Univariate analyses of variance were used to detect significant reductions in residue . Results On average , pre-maneuver measures showed residue filling 56 - 73 % of the valleculae , depending on stimulus consistency ( NRRS scores : 0.2 - 0.4 ) . More than 80 % of pre-swallow measures displayed NRRS ratios > 0.06 , a threshold previously linked to increased risk of post-swallow aspiration . Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids , suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies AIMS Acute surgical complications after esophageal resection for cancer may decrease the long-term survival . Previous results on this topic are conflicting and no population -based studies are available . METHODS A prospect i ve , nationwide Swedish study was conducted in 2001 - 2010 . Eligible patients comprised those afflicted by esophageal or cardia cancer and underwent surgical resection in Sweden in 2001 - 2005 . Details concerning patient and tumor characteristics , surgical procedures , and postoperative surgical complications were collected prospect ively . Follow-up for mortality , starting from 90 days after the surgery , was done until May 2010 . Cox proportional-hazards regression was performed to estimate hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) , adjusted for age , tumor stage , sex , histology , comorbidity , surgical approach and surgical radicality . RESULTS Among 567 included patients who survived at least 90 days postoperatively , 130 ( 22.9 % ) sustained a predefined surgical complication within 30 days of surgery . The adjusted HR of mortality was increased in patients who sustained surgical complications , compared to patients without such complications ( HR 1.29 , 95 % CI 1.02 - 1.63 ) . CONCLUSIONS The occurrence of surgical complications might be an independent predictor for poorer long-term survival in patients resected for esophageal cancer , even in patients who survived the postoperative period BACKGROUND Surgical resection is regarded as the only curative option for resectable oesophageal cancer , but pulmonary complications occurring in more than half of patients after open oesophagectomy are a great concern . We assessed whether minimally invasive oesophagectomy reduces morbidity compared with open oesophagectomy . METHODS We did a multicentre , open-label , r and omised controlled trial at five study centres in three countries between June 1 , 2009 , and March 31 , 2011 . Patients aged 18 - 75 years with resectable cancer of the oesophagus or gastro-oesophageal junction were r and omly assigned via a computer-generated r and omisation sequence to receive either open transthoracic or minimally invasive transthoracic oesophagectomy . R and omisation was stratified by centre . Patients , and investigators undertaking interventions , assessing outcomes , and analysing data , were not masked to group assignment . The primary outcome was pulmonary infection within the first 2 weeks after surgery and during the whole stay in hospital . Analysis was by intention to treat . This trial is registered with the Netherl and s Trial Register , NTR TC 2452 . FINDINGS We r and omly assigned 56 patients to the open oesophagectomy group and 59 to the minimally invasive oesophagectomy group . 16 ( 29 % ) patients in the open oesophagectomy group had pulmonary infection in the first 2 weeks compared with five ( 9 % ) in the minimally invasive group ( relative risk [ RR ] 0·30 , 95 % CI 0·12 - 0·76 ; p=0·005 ) . 19 ( 34 % ) patients in the open oesophagectomy group had pulmonary infection in-hospital compared with seven ( 12 % ) in the minimally invasive group ( 0·35 , 0·16 - 0·78 ; p=0·005 ) . For in-hospital mortality , one patient in the open oesophagectomy group died from anastomotic leakage and two in the minimally invasive group from aspiration and mediastinitis after anastomotic leakage . INTERPRETATION These findings provide evidence for the short-term benefits of minimally invasive oesophagectomy for patients with resectable oesophageal cancer . FUNDING Digestive Surgery Foundation of the Unit of Digestive Surgery of the VU University Medical Centre Although dysphagia is the predominant symptom of esophageal cancer , the nature of the swallowing deficit remains unclear , particularly regarding an oropharyngeal motor component . The present study examined the  oropharyngeal swallow in patients with esophageal cancer before and following transhiatal esophagectomy . Videofluoroscopic data were obtained from ten patients with esophageal cancer before and following transhiatal esophagectomy  as they swallowed 2- , 5- , and 10-cc aliquots of liquid and puree , and 0.5 and 1 tsp of solid . Each swallow was rated on 36 parameters by three independent judges . Swallow-related hyoid bone movement , computed from digitized segments of the videofluoroscopic data , was compared pre- and postsurgically . All patients showed at least mild abnormality of the oropharyngeal swallow preoperatively . Abnormalities involved all stages of swallowing in nine of the ten patients ; however , the oral preparatory/oral stage was relatively more impaired than the pharyngeal stage in the majority of patients . Postsurgically , all patients exhibited at least a mild oropharyngeal swallowing impairment . New or increased postoperative deficits involved the pharyngeal stage of swallowing , whereas oral stage abnormalities were generally improved or unchanged following surgery . Swallow-related hyoid kinematics were highly variable both before and following surgery . Anterior hyoid bone excursion was significantly reduced postoperatively in one patient and significantly increased in one patient . Patients with esophageal cancer exhibit oropharyngeal dysphagia , with different profiles of abnormality before and following esophagectomy OBJECTIVES To determine the effect of the chin-down maneuver after  esophagectomy with 3-field lymphadenectomy ( 3FL ) on pharyngeal residue , upper esophageal sphincter ( UES ) opening , and laryngeal closure . DESIGN Prospect i ve data were collected from a pharyngeal videofluoroscopic swallowing study . SETTING Dysphagia clinics . PARTICIPANTS Patients selected according to the inclusion criteria ( N=14 ; mean age , 65.9y ) from a total of 43 patients who underwent esophagectomy with 3FL from May to December 2014 were enrolled . INTERVENTIONS Videofluoroscopy was conducted in head-neutral and chin-down positions to measure the pharyngeal constriction ratio ( PCR ) , amount of residue in the vallecula and pyriform sinus after the first swallow , UES opening diameter , duration of UES opening , and duration of laryngeal vestibule closure . MAIN OUTCOME MEASURES The aforementioned parameters were compared statistically between the head-neutral and chin-down positions . RESULTS In comparison with the neutral group , the PCR and residue in the pyriform sinus were significantly smaller in the chin-down group ( P<.01 ) . However , the residue in the vallecula did not differ significantly from that of the neutral group ( 
    Output:
    