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Recovery of Swallowing Function and Prognostic Factors Associated with Exacerbation of Post-stroke Dysphagia.
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-07 DOI: 10.1007/s00455-025-10804-8
Seung Jun Lee, So Young Lee, Min Kyun Sohn, Jongmin Lee, Deog Young Kim, Yong-Il Shin, Gyung-Jae Oh, Yang-Soo Lee, Min Cheol Joo, Min-Keun Song, Junhee Han, Jeonghoon Ahn, Young-Hoon Lee, Yun-Hee Kim, Won Hyuk Chang

Post-stroke dysphagia is a common and debilitating complication affecting millions of people worldwide, often leading to malnutrition, pneumonia, and reduced quality of life. This study, an interim analysis of the Korean Study Cohort for Functional and Rehabilitation, aimed to identify long-term changes and predictive factors associated with post-stroke dysphagia at 3 years after stroke. A total of 4735 patients with acute first-ever stroke, including both ischemic and hemorrhagic subgroups, were followed, and dysphagia was assessed using the ASHA-NOMS scale. All the patients were then followed up for up to 36 months. The results showed significant improvements in dysphagia up to 12 months after stroke in the total and hemorrhagic stroke group, and the decline in swallowing function after 24 months in the total stroke and ischemic stroke groups was a novel finding. The hemorrhagic stroke group showed worsening dysphagia after 30 months. It is unclear whether patients who experienced worsening of swallowing function had other conditions, including new strokes, that might have contributed to this decline. Male gender, age at stroke, K-FAST at 7 days, ASHA-NOMS scale, mRS score at 3 months, and early comprehensive rehabilitation were identified as predictors of a decrease in the ASHA-NOMS score after 24 months. Additionally, the K-MBI score at 3 months post-stroke was found to be a significant factor influencing long-term improvements in swallowing function. These findings suggest that patients should be closely monitored for dysphagia beyond 24 months after stroke onset, as swallowing function may decline over time. During follow-up, it is essential to carefully consider the multiple factors associated with this decline.

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引用次数: 0
Development and Psychometric Evaluation of the Swallowing Satisfaction Scale (SSS).
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-06 DOI: 10.1007/s00455-025-10802-w
Ali Yousefzadeh, Mozhgan Asadi, Banafshe Mansuri, Maryam Mokhlesin, Ronald Callaway Scherer, Keyhan Poorali, Seyed Abolfazl Tohidast

The purpose of the current study was to develop a new scale to assess a level of satisfaction associated directly with swallowing ability. First, by interviewing 10 adults with dysphagia, 10 experts, as well as reviewing literature, the initial version of the swallowing satisfaction scale (SSS) was developed. The content validity of the SSS was evaluated using two qualitative and quantitative methods and expert opinions. The qualitative method was also used to determine face validity through interviews with 10 adults with dysphagia. Finally, the reliability of the scale was assessed by determining the values of internal consistency and test-retest reliability. Interviews with patients with swallowing disorders and experts in the field of dysphagia, as well as a literature review, led to the development of an initial version of the SSS with 36 items. After determining content and face validity, the number of items in the scale was reduced to 24. The calculation of Cronbach's alpha coefficient with participation of 53 patients with dysphagia showed the appropriate internal consistency of the SSS (0.968). Moreover, the ICC coefficient of the scale score in the test-retest phase was 0.983 and the ICC of each scale item was between 0.87 and 0.98. In this study, a suitable tool was developed to evaluate the level of satisfaction associated directly with swallowing ability in individuals with dysphagia, and its psychometric properties were investigated. The SSS is a valid and reliable tool with 24 items that can be used by therapists and researchers for clinical or research purposes.

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引用次数: 0
Association Between Phase Angle and Tongue Pressure in Older Inpatients with Connective Tissue Diseases.
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-05 DOI: 10.1007/s00455-025-10806-6
Toshiyuki Moriyama, Mizuki Tokunaga, Ryoko Hori, Akiko Hachisuka, Hideaki Itoh, Mitsuhiro Ochi, Yasuyuki Matsushima, Satoru Saeki

To investigate the association between tongue pressure (TP) and phase angle (PhA) in patients with connective tissue diseases (CTDs) aged 65 years or older. This retrospective cross-sectional study was conducted on 189 patients with CTDs who underwent hospital rehabilitation. TP was measured using a tongue pressure measuring device, and PhA was calculated from the bioimpedance analysis readings. Statistical analyses included multivariate linear regression with TP and receiver operating characteristic curves to determine PhA cutoff values indicative of low TP, defined as < 24.3 kPa for men and < 23.7 kPa for women. A total of 189 patients with CTDs (mean age 75 years; 49 men and 140 women; mean PhA 4.0°; mean TP 27.7 kPa) were included in the analysis. Fifty-five patients had low TP. Patients with low TP had lower PhA values than those with normal TP (mean PhA values 3.5° versus 4.3°). After adjusting for confounding factors, PhA (β = 0.387, p < 0.001) was significantly associated with TP. Cutoff values for PhA predicting low TP were identified as 3.9° for men and 3.5° for women. PhA is associated with TP, independent of other factors, in older inpatients with CTDs. The identified PhA cutoff values could enable the early detection of declining TP.

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引用次数: 0
Barriers and Facilitators to implementation of the Free Water Protocol in the Acute Stroke Unit Setting: A Mixed Methods Systematic Review. 在急性卒中单元实施免费饮水方案的障碍和促进因素:混合方法系统回顾
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-05 DOI: 10.1007/s00455-025-10805-7
Sabrina A Eltringham, Nicola Martindale, Elizabeth Lightbody, Sue Pownall, Andrew Booth, Craig J Smith

Free water protocols (FWP) give patients at risk of aspiration the option to drink water between meals. Evidence is lacking about their use in acute stroke care. This systematic review evaluated the literature about barriers and facilitators to FWP implementation in acute stroke unit settings. Electronic databases and grey literature sources were systematically searched, eligible studies were critically appraised, and data extracted and mapped onto the Consolidated Framework for Implementation Research (CFIR). The results are presented in a narrative synthesis. Five studies were identified for inclusion: Two qualitative studies, 1 mixed method study, 1 randomised controlled trial and 1 pilot cohort study. Barriers and facilitators to implementation were identified across the 5 CFIR domains. Key barriers were a lack of evidence base and a standard protocol, trying to adapt and deliver a protocol designed for a different setting, complexity of patient selection and FWP design, culture of risk aversion, nursing staff availability and skills to deliver the FWP, and a greater use of agency nurses and transient workforce. Key facilitators were the existence of national guidance for research into its use, implementation of oral care protocols prior to FWP implementation, the unique characteristics of the acute stroke setting, leadership and modelling by senior clinicians, interdisciplinary working and accountability for roles and responsibilities for each discipline, regular communication and ongoing education, and involving patients in decision making and implementation. The findings of this review will guide the data collection of a feasibility study of the FWP in acute stroke.

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引用次数: 0
Effects of Thickening Agents on the Mucociliary Transport Function: Comparison by the Type of Thickening Agents and the Viscosity of Thickened Water. 增稠剂对黏膜纤毛运输功能的影响:增稠剂类型与增稠水粘度的比较
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-05-22 DOI: 10.1007/s00455-024-10704-3
Erika Matsumura, Kanji Nohara, Hikari Fukatsu, Nobukazu Tanaka, Nami Fujii, Takayoshi Sakai

Thickening agents effectively prevent liquid aspiration, but their impact on the ease of discharging aspirated liquids from the trachea remains unclear due to alterations in the physical properties of liquids. This study clarifies the effects of thickening agents, comprising various raw materials, on mucociliary transport function, focusing on the viscosities of thickened waters. The subjects were 23 healthy adults. Five types of saccharin solution were prepared: a solution without a thickening agent, a starch-based nectar-like solution, a starch-based honey-like solution, a xanthan-gum-based nectar-like solution, and a xanthan-gum-based honey-like solution. Using these five types of saccharin solutions randomly, each subject underwent five trials of the saccharine dye test to evaluate the mucociliary transport function of the respiratory tract. The saccharin time was defined as the time from the placement of the saccharin solution on the nasal vestibule of the subject to when the subject reported that they became aware of the sweetness. The saccharin transit times for all samples of thickened water were longer compared to those of water without a thickening agent (p < 0.01). A comparison between thickened water samples with different viscosities showed that the saccharin transit time was longer when thickened water samples with high viscosity were prepared using the same thickening agent (p < 0.01). This suggests that while thickening reduces aspiration, the use of thickening agents may increase the difficulty in discharging aspirated fluids from the trachea.

增稠剂可有效防止液体吸入,但由于液体物理性质的改变,增稠剂对吸入液体从气管排出的难易程度的影响仍不明确。本研究阐明了由各种原料组成的增稠剂对粘液纤毛运输功能的影响,重点是增稠水的粘度。研究对象为 23 名健康成年人。我们制备了五种糖精溶液:不含增稠剂的溶液、淀粉基花蜜样溶液、淀粉基蜂蜜样溶液、黄原胶基花蜜样溶液和黄原胶基蜂蜜样溶液。每个受试者随机使用这五种糖精溶液,进行五次糖精染色试验,以评估呼吸道的粘膜运输功能。糖精时间是指从将糖精溶液放置在受试者鼻前庭到受试者报告说感觉到甜味的时间。与不含增稠剂的水相比,所有增稠水样本的糖精转运时间都更长(p
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引用次数: 0
Can Voice Parameters Provide Cutoff Values to Predict Dysphagia in Individuals with Multiple Sclerosis? 语音参数能否为预测多发性硬化症患者吞咽困难提供临界值?
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-06-13 DOI: 10.1007/s00455-024-10720-3
Merve Sapmaz Atalar, Gençer Genç, Elif Ezgi Işık, Mehmet Emrah Cangi, Beyza Pehlivan, Serpil Bulut

In dysphagia assessment, along with well-defined measurements and signs, voice parameters can potentially support clinical decision as a marker, but more evidence is needed. This study aims to determine the voice parameters that can predict the risk of dysphagia and to determine optimal cutoff values in individuals with multiple sclerosis (IwMS). Seventy-six adults participated in the study, including 39 IwMS and 37 healthy individuals (HI). The study used the Dysphagia in Multiple Sclerosis Questionnaire (DYMUS), Gugging Swallowing Screen (GUSS), and Voice Handicap Index (VHI-10) and recorded voice samples using Praat programme. Voice recordings were taken pre- and post-swallowing. The voice parameters analysed are fundamental frequency (F0), standard deviation F0 (SD F0), jitter (local), shimmer (local), and harmonic-to-noise ratio (HNR). Roc analysis was performed to examine the diagnostic accuracy performance of the risk for dysphagia/penetration. The parameters of IwMS pre-swallowing differed significantly from those of HI on the VHI-10, DYMUS, GUSS scores, and jitter (local), shimmer (local), and HNR. IwMS but not HI exhibited significant differences in shimmer (local) and HNR between the pre- and post-swallowing measurements. In IwMS, GUSS revealed significant differences in shimmer (local) pre- and post-swallowing between the groups with and without dysphagia/penetration. In the ROC analysis results, the area under the curve (AUC) for shimmer (local) pre-swallowing was 73.1% (cutoff = 1.69); post-swallowing, it was 78.6% (cutoff = 1.57). In conclusion, IwMS can be associated with differences in shimmer (local) and HNR parameters, low quality of life-related to voice, and dysphagia/penetration risk. The AUC values for shimmer (local) in IwMS pre- and post-swallowing may help to strengthen diagnostic decisions of dysphagia risk.

在吞咽困难评估中,除了定义明确的测量值和体征外,语音参数还可以作为一种标记物为临床决策提供潜在支持,但还需要更多的证据。本研究旨在确定可预测吞咽困难风险的嗓音参数,并确定多发性硬化症患者(IwMS)的最佳临界值。76 名成人参与了这项研究,其中包括 39 名多发性硬化症患者和 37 名健康人(HI)。研究使用了多发性硬化症吞咽困难问卷(DYMUS)、Gugging 吞咽筛查(GUSS)和嗓音障碍指数(VHI-10),并使用 Praat 程序录制了语音样本。语音记录在吞咽前和吞咽后进行。分析的语音参数包括基频(F0)、标准偏差 F0(SD F0)、抖动(局部)、颤动(局部)和谐噪比(HNR)。Roc 分析用于检验吞咽困难/穿孔风险的诊断准确性。在 VHI-10、DYMUS、GUSS 评分以及抖动(局部)、闪烁(局部)和 HNR 方面,IwMS 吞咽前参数与 HI 有显著差异。在吞咽前和吞咽后的测量中,IwMS 在抖动(局部)和 HNR 方面与 HI 没有显著差异。在 IwMS 中,GUSS 显示吞咽困难/吞咽困难组和无吞咽困难/吞咽困难组在吞咽前和吞咽后的微光(局部)有显著差异。在 ROC 分析结果中,吞咽前的微光(局部)曲线下面积(AUC)为 73.1%(临界值 = 1.69);吞咽后的微光曲线下面积(AUC)为 78.6%(临界值 = 1.57)。总之,IwMS 可能与微光(局部)和 HNR 参数的差异、与嗓音相关的低生活质量以及吞咽困难/穿透风险有关。吞咽前和吞咽后 IwMS 的微光(局部)AUC 值可能有助于加强吞咽困难风险的诊断决策。
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引用次数: 0
Accuracy of Dysphagia Screening by Non-clinical Research Staff in the Emergency Department. 急诊科非临床研究人员进行吞咽困难筛查的准确性。
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-05-30 DOI: 10.1007/s00455-024-10710-5
Ryan J Burdick, Nicole Rogus-Pulia, Rebecca Schwei, Sara Gustafson, Raele Donetha Robison, Rosemary Martino, Michael Pulia

Although the emergency department (ED) is the initial care setting for the majority of older adults requiring hospital admission, there is a paucity of ED-based dysphagia research in this at-risk population. This is driven by barriers to dysphagia evaluation in this complex care environment. Therefore, we assessed the reliability of trained, non-clinical ED research staff in administering dysphagia screening tools compared to trained speech pathologists (SLPs). We also aimed to determine perceptual screening discrepancies (e.g. voice change) between clinical and non-clinical staff. Forty-two older adults with suspected pneumonia were recruited during an ED visit and underwent dysphagia (Toronto Bedside Swallow Screening Tool; TOR-BSST©) and aspiration (3-oz water swallow test; 3-oz WST) screening by trained non-clinical research staff. Audio-recordings of screenings were re-rated post-hoc by trained, blinded SLPs with discrepancies resolved via consensus. Cohen's kappa (unweighted) revealed moderate agreement in pass/fail ratings between clinical and non-clinical staff for both the TOR-BSST© (k = 0.75) and the 3 oz WST (k = 0.66) corresponding to excellent sensitivity and good specificity for both the TOR-BSST (SN = 94%, SP = 85%) and the 3 oz WST (SN = 90%, SP = 81%). Further analysis of TOR-BSST perceptual parameters revealed that most discrepancies between clinicians and non-clinicians resulted from over-diagnosis of change in vocal quality (53%). These results support the feasibility of non-clinical research staff administering screening tools for dysphagia and aspiration in the ED. Dysphagia screening may not necessitate clinical staff involvement, which may improve feasibility of large-scale ED research. Future training of research staff should focus on perceptual assessment of vocal quality.

尽管急诊科(ED)是大多数需要入院治疗的老年人的初始治疗场所,但针对这一高风险人群的基于急诊科的吞咽困难研究却很少。这是因为在这种复杂的护理环境中进行吞咽困难评估存在障碍。因此,我们评估了受过训练的非临床 ED 研究人员与受过训练的语言病理学家 (SLP) 相比,在使用吞咽困难筛查工具时的可靠性。我们还旨在确定临床和非临床工作人员之间的感知筛查差异(如变声)。我们在急诊室就诊时招募了 42 名疑似肺炎的老年人,由经过培训的非临床研究人员进行吞咽困难(多伦多床边吞咽筛查工具;TOR-BSST©)和吸入(3 盎司水吞咽试验;3 盎司 WST)筛查。筛查录音由经过培训的盲人辅助语言治疗师进行事后重新评分,不一致之处通过协商一致的方式解决。Cohen's kappa(未加权)显示,临床和非临床工作人员对 TOR-BSST© (k = 0.75)和 3 盎司 WST(k = 0.66)的通过/未通过评级的一致性适中,相应地,TOR-BST(SN = 94%,SP = 85%)和 3 盎司 WST(SN = 90%,SP = 81%)的灵敏度极高,特异性良好。对 TOR-BSST 感知参数的进一步分析表明,临床医生和非临床医生之间的大多数差异都是由于对声乐质量变化的过度诊断造成的(53%)。这些结果支持非临床研究人员在急诊室使用吞咽困难和吸入障碍筛查工具的可行性。吞咽困难筛查可能不需要临床人员的参与,这可能会提高大规模急诊室研究的可行性。今后对研究人员的培训应侧重于对发声质量的感知评估。
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引用次数: 0
Fiberoptic Endoscopy Evaluation of Swallowing (FEES) Findings Associated with High Pneumonia Risk in a Cohort of Patients at Risk of Dysphagia. 纤维内窥镜吞咽评估 (FEES) 结果与吞咽困难高危患者队列中的高肺炎风险有关。
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-07-03 DOI: 10.1007/s00455-024-10727-w
Luis F Giraldo-Cadavid, Diego Insignares, Valentina Velasco, Natalia Londoño, Ana María Galvis, María Leonor Rengifo, Alirio R Bastidas-Goyes

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia.

纤维内窥镜吞咽评估(FEES)中检测到的吸入与肺炎的相关性并不一致,没有证据表明 FEES 中检测到的其他吞咽安全改变会导致肺炎风险。我们在一家三级甲等大学医院开展了一项动态、非定向队列研究,涉及 148 名有吞咽困难风险的受试者。我们的目的是确定在 FEES 中检测到的吞咽安全性改变所导致的肺炎风险。我们使用多变量负二项回归模型来调整潜在的混杂因素。任何浓度的气管吸入患者的肺炎发病密度率(IR)为 26.6/100人年(RR 7.25; 95% CI: 3.50-14.98; P
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引用次数: 0
Clinical Conundrum: Swallowing Virtual Reality as a Novel Diagnostic Tool for Severe Dysphagia after Deep Neck Infection. 临床难题:将吞咽虚拟现实技术作为深部颈部感染后严重吞咽困难的新型诊断工具。
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-11-25 DOI: 10.1007/s00455-024-10786-z
Takahiro Katsuno, Rumi Ueha, Kana Nanjo, Kazuaki Matsuda, Cathrine Miura, Taku Sato, Takao Goto, Kenji Kondo
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引用次数: 0
Reliability of Measuring Geniohyoid Cross-Sectional Area with B-Mode Ultrasound. 用 B 型超声波测量腮腺横截面积的可靠性
IF 2.2 3区 医学 Q1 OTORHINOLARYNGOLOGY Pub Date : 2025-02-01 Epub Date: 2024-05-24 DOI: 10.1007/s00455-024-10712-3
Barbara R Pauloski, Kacey M Yahnke

B-mode ultrasound is a safe noninvasive procedure that has been used to characterize aspects of the oropharyngeal swallow. The submental suprahyoid muscles are often investigated with ultrasound because of their contributions to hyolaryngeal elevation. There are several techniques for positioning the ultrasound transducer in the coronal plane, however, there is limited research on how reliability of measurement of the cross-sectional area (CSA) of the geniohyoid differs across transducer placement technique. This study examined three methods of transducer placement in the coronal plane by two examiners to determine the reliability of measurement of CSA of the geniohyoid muscle. Forty healthy adults participated in the study. Each participant's geniohyoid muscles were imaged using B-mode ultrasound under three transducer placement conditions in the coronal plane by two examiners. Geniohyoid CSA was measured from each ultrasound image. A three-way mixed-methods ANOVA was used to determine whether there were significant differences in geniohyoid CSA among transducer position conditions, trials, and examiners. There were significant differences among the transducer placement conditions, indicating that each condition was measuring a different portion of the muscle. There were no significant differences among repeated trials nor between examiners within each method of transducer placement. All three conditions of transducer placement were reliable at measuring geniohyoid CSA across trials and examiners. This study emphasizes the need for consistency of placement, whichever method is selected. It also highlights the need for researchers to provide a precise description of methods for positioning the transducer so that placement is reproducible.

B 型超声波是一种安全的无创检查方法,已被用于描述口咽吞咽的各个方面。由于下颌舌骨上肌对舌咽抬高有一定的作用,因此经常使用超声波检查下颌舌骨上肌。在冠状面上定位超声波换能器的技术有多种,但是,关于不同换能器定位技术对测得舌骨横截面积(CSA)的可靠性有何不同的研究却很有限。本研究考察了两名检查者在冠状面上放置探头的三种方法,以确定测量舌骨肌横截面积的可靠性。40 名健康成年人参加了这项研究。在冠状面上的三种换能器放置条件下,由两名检查人员使用 B 型超声波对每位参与者的舌骨肌进行成像。根据每张超声波图像测量膝状肌CSA。采用三方混合方差分析来确定在不同的换能器位置条件、试验和检查者之间,膝状肌CSA是否存在显著差异。探头位置条件之间存在明显差异,表明每种条件测量的是肌肉的不同部分。在每种传感器放置方法中,重复试验之间或检查者之间没有明显差异。在不同的试验和检查者之间,所有三种传感器放置条件在测量舌侧肌CSA方面都是可靠的。这项研究强调,无论选择哪种方法,都需要保持放置位置的一致性。它还强调了研究人员对传感器定位方法进行精确描述的必要性,以便使定位具有可重复性。
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引用次数: 0
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Dysphagia
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