Our aim in this study was to evaluate hyoid bone movement trajectories and the age-related changes during swallowing in healthy subjects by ultrasonography. Data were obtained from 30 healthy volunteers (15 men, 15 women) in three age groups (20-39, 40-59, 60-79 years). The subjects were examined while sitting in an upright position, with the back against a wall to control movement. The transducer was placed in a longitudinal scan above the larynx. The subjects were then given 5 mL of mineral water. The water bolus was held in their mouth until they were forced to do a rapid swallow. The imaging was repeated five times for averaging. The movement was divided into 4 phases: slowly ascending phase (A-B, Elevation); rapidly ascending phase (B-C, Anterior); temporary pause phase (position of maximum rise, Remain); and rapidly and slowly descending shifts toward the resting position phase (C-D, Return). We easily visualized the hyoid bone trajectory by using ultrasonography. In all cases, ultrasonographic analysis of the hyoid bone was confirmed to have a similar trajectory, as determined with videofluoroscopy. The average swallowing duration measurements increased with age. The measurement of the maximally elevated point of the hyoid bone decreased with age. The movement of the hyoid bone during swallowing can be visualized by US. The trajectory of the hyoid bone in sagittal section indicated the capability of swallowing, and may detect some anomalies in swallowing.

High-resolution ultrasound may be able to detect pressure ulcers before clinical signs emerge. This retrospective study found that one such early indicator is inflammatory oedema in the subcutaneous fat, which resolves as healing occurs.

In this study, we aimed to develop a new method for detection of aspiration based on B-mode video ultrasonography and to evaluate its performance. To detect aspirated boluses by B-mode video ultrasonography in patients with dysphagia, we placed a linear array transducer above the thyroid cartilage and observed the area around the vocal folds. Forty-two ultrasonographic measurements were obtained from 17 patients with dysphagia who also underwent videofluoroscopy or videoendoscopy measurements at the same time. Aspirated boluses were observed in B-mode video ultrasonographic images as hyperechoic, long, narrow objects that passed through the vocal folds beneath the anterior wall of the trachea, with movement different from that of the surrounding structure. The sensitivity of aspiration detection was 0.64, and the specificity was 0.84. This newly developed detection method will enable patients with dysphagia to receive appropriate daily swallowing care.

Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.

The aim of this study was to assess rectal feces storage condition by a pocket-size ultrasonography (PUS) in healthy adults so as to define normal rectal defecation desire. Participants were first assessed rectum by PUS imaging immediately after defecation desire (pre-defecation). Nurses checked the amount and quality of the participants' feces using King's Stool Chart and Bristol stool scale. Finally, PUS was performed for defecation with no defecation desire (post-defecation). Pre-defecation PUS detected high echo area in all patients. All of the post-defecation PUS did not detect high echo area (perfectly no recognizable high echo area in 54.5%, high echo line in 36.4%, and low echo of entire circumference in 9.1% of the patients). Average diameter of rectal crescent was 4.22 ± 0.8 cm. Bristol Stool Scale 1 or 2 (indicating hard stool) of pre-defecation PUS indicated high echo area and acoustic shadow in 100% of the patients. This study showed that healthy adult with defecation desire had high average rectal echo area of 4.0 cm in diameter. PUS may be able to define the rectum diameter for defecation desire of elderly people. PUS is capable of assessing fecal retention of the rectum for point-of-care examinations in home care.

Purpose: In clinical settings, ultrasonography (US) has recently been used to aid in the insertion of peripheral intravenous catheters (PIVCs). This cross-sectional study aimed to verify the reliability and validity of a tablet-type device in assessing vein size and depth for catheter site selection and detecting thrombus with resultant subcutaneous edema as a cause of catheter failure using US. Methods: Adult patients receiving infusions via a PIVC at a university hospital between January and February 2017 were included. All participants underwent US at the PIVC site. An expert sonographer and a nurse blinded to all information, except for ultrasonograms, evaluated the data. Intraclass correlation with 95% confidence interval (CI) was used to evaluate interrater and intrarater reliability of US assessment. To assess criterion-related validity, a high-end US notebook device was used for reference data collection. Pearson's correlation coefficient was used to evaluate criterion-related validity. Results: We observed 21 patients with 26 catheters. Intraclass correlations (95% CI) for the measured vein diameters and depths were as follows: intrarater reliability, 0.92 (0.57–0.98) and 0.78 (0.10–0.95); interrater reliability, 0.95 (0.78–0.99) and 0.94 (0.77–0.99); and Pearson's correlation coefficient for criterion-related validity, 0.74 (P = 0.02) and 0.77 (P = 0.02), respectively. However, the analysis of causes of catheter failure did not show reliable validity. Conclusion: This pilot study suggests that the tablet-type device is useful for assessing peripheral veins in clinical settings.

Aims: Prevention of aspiration pneumonia is a great concern in the era of global aging. The assessment of pharyngeal post-swallow residue is important because remaining food and liquid in the pharyngeal area has a possibility of flowing into the lower airway which can cause aspiration pneumonia. Ultrasound examination has been recently used to assess swallowing disorders because of its noninvasiveness. The aim of this study was to investigate the performance for detecting pharyngeal post-swallow residue using an ultrasound examination by comparing with those using a fiberoptic endoscopic evaluation of a swallowing study as a reference. Material and methods: A linear array transducer attached to the thyroid cartilage to visualize the vocal folds in the sagittal plane. The pharyngeal post-swallow residue in the ultrasound movie was interpreted as a misty hyperechoic area above the vocal folds that remained after swallowing. Nineteen ultrasound images simultaneously obtained with fiberoptic endoscopic evaluation of swallowing study images from nine participants (eight men) with a median age of 70 years at a dysphagia outpatient clinic were analyzed by the montage of swallowing examinations. Results: Misty hyperechoic areas above the vocal folds that remained after swallowing were detected in 10 ultrasound images. Eight ultrasound images out of ten correctly detected pharyngeal post-swallow residue. The sensitivity for detecting pharyngeal post-swallow residue of 19 images from nine participants by ultrasound examination was 62%, and the specificity was 67%. Conclusions: The proposed detection method of pharyngeal post-swallow residue by ultrasound examination enabled the real-time assessment for swallowing of people with dysphagia. Ultrasound assessment-based daily swallowing care which detects pharyngeal residue will be useful for preventing aspiration pneumonia.

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