ObjectiveGastroesophageal reflux disease comprises heterogeneous phenotypes, and symptom severity does not always correlate with endoscopic findings. This retrospective observational study aimed to characterize serum proteomic alterations in gastroesophageal reflux disease and to explore whether nonerosive reflux disease and reflux esophagitis exhibit distinct circulating protein signatures.MethodsSeventy individuals were included, comprising 26 controls, 14 patients with nonerosive reflux disease, and 30 with reflux esophagitis. For exploratory group-level proteomic discovery, pooled serum samples from each group were analyzed using liquid chromatography-tandem mass spectrometry. Clinical characteristics, upper gastrointestinal endoscopy, high-resolution manometry, and 24-h pH-impedance monitoring were assessed as appropriate. Differentially expressed proteins were identified using a fold change threshold of 1.3 together with nominal statistical significance, followed by functional annotation and enrichment analyses.ResultsAge and sex were comparable among the groups. Nonerosive reflux disease and reflux esophagitis showed no significant differences in gastroesophageal reflux disease questionnaire score, disease duration, body mass index, or most reflux-monitoring parameters. However, patients with reflux esophagitis had more gas reflux episodes, lower distal contractile integral values, and a higher frequency of esophageal motility disorders, suggesting impaired motor function. Proteomic profiling identified 872 proteins, including 666 quantified proteins. Differential expression analysis identified 48 proteins in nonerosive reflux disease versus controls, 43 in reflux esophagitis versus controls, and 7 in nonerosive reflux disease versus reflux esophagitis. The exploratory nonerosive reflux disease-associated protein profile was mainly characterized by cytoskeletal remodeling, adhesion-related regulation, redox adaptation, and selective immune rearrangement, whereas the exploratory reflux esophagitis-associated profile showed features related to actin remodeling, injury-defense responses, and alterations in lipid homeostasis.ConclusionsNonerosive reflux disease and reflux esophagitis exhibited distinct but partially overlapping serum proteomic profiles in this exploratory pooled serum analysis. These preliminary findings suggest phenotype-related biological differences beyond reflux burden alone; however, they should be interpreted as hypothesis-generating and require validation in independent, individual-level cohorts.

In recent decades, the advent of revascularization treatments (RVTs), such as intravenous thrombolysis (IVT) and endovascular therapy, has significantly improved clinical outcomes in patients with acute ischemic stroke (AIS). However, stroke-associated pneumonia (SAP) remains a common complication that has a negative impact on the prognosis. This review addresses the mechanisms underlying the development of SAP in patients with AIS, evaluates risk factors, and discusses therapeutic and preventive measures in the era of RVTs. Despite advances in acute stroke care, the incidence of SAP remains high, particularly in patients who receive endovascular treatment (EVT), possibly because of prolonged mechanical ventilation, the effects of anesthesia, and stays in the intensive care unit. Immunodepression, dysphagia, lung damage, and changes in the gut microbiota are central to the pathogenesis of SAP. Current prevention strategies, including screening for dysphagia, oral hygiene, and immunomodulation, show promise but require further validation. Future research should focus on integrating biomarkers and imaging markers for early prediction of SAP and developing targeted interventions to improve patient outcomes.

Oropharyngeal stenosis is a rare condition that can develop following head and neck cancer treatment, leading to progressive dyspnea, dysphagia, and dysphonia. Patients with symptomatic dyspnea may benefit from endoscopic surgery. However, head and neck cancer survivors can have severe trismus, limited neck extension, and altered laryngeal landmarks, which make rigid endoscopic surgery under general anesthesia high-risk or potentially not feasible without a tracheostomy tube. We describe an awake approach for the management of oropharyngeal stenosis for 2 head and neck cancer survivors with high-risk airways. Briefly, under monitored anesthesia care in the operating room, a flexible channeled nasolaryngoscope was utilized to perform awake blue light laser excision of stenosis followed by balloon dilation. Postoperatively, both patients reported symptomatic improvement, and objective increases in airway patency were noted at clinic follow-up. This operative technique represents a feasible, well-tolerated approach for high-risk airway patients with oropharyngeal stenosis.

Iatrogenic subcutaneous emphysema (SE) is an uncommon but potentially life-threatening dental complication that can rapidly progress into deep cranio-cervicothoracic compartments. This retrospective cohort study systematically evaluated 74 consecutive patients treated at a tertiary referral center over an 11-year period to identify clinical predictors of deep fascial spread and develop a management algorithm. All patients underwent computed tomography (CT) to delineate the volumetric extent of air. Critical compartment involvement (CCI), including deep cervical, orbital, or mediastinal extension, was identified in 48.6% of cases. Multivariate logistic regression identified high-speed air-driven handpieces (OR 4.5, p = 0.002) and procedures involving posterior mandibular teeth (OR 2.8, p = 0.031) as independent predictors of CCI. Clinically, dysphagia served as a significant indicator of deeper fascial extension. While management was predominantly conservative with a mean hospital stay of 2.2 days, pneumomediastinum was confirmed in 16.2% of patients. Systematic CT imaging proved essential for detecting subclinical spread. These findings informed a practical risk-stratified management algorithm designed to enhance patient safety by providing clinicians with a structured framework for early risk recognition and optimized diagnostic and therapeutic pathways.

Immune-mediated necrotizing myopathy (IMNM) is a variant of inflammatory myopathies, characterized by muscle fiber necrosis and regeneration with minimal inflammatory infiltration, associated with a potentially severe clinical course and difficult management. We report the case of a 64-year-old woman with a history of type 2 diabetes mellitus who presented with progressive proximal weakness, dysphagia, and prostration of one month's duration. She developed severe muscle involvement requiring subsequent mechanical ventilation. Initial studies showed markedly elevated creatine phosphokinase (CPK) levels (>10 000 U/L), and muscle biopsy revealed fiber necrosis and regeneration with scant inflammatory infiltrate, consistent with IMNM. Intensive treatment with methylprednisolone pulses and intravenous immunoglobulin was initiated, followed by the addition of methotrexate, azathioprine, and rituximab. Under this combined regimen, the patient showed a favourable evolution with progressive decline of CPK, functional recovery of muscle strength, and improvement of dysphagia, being discharged in ambulatory conditions with minimal assistance. An interdisciplinary approach and early implementation of intensive immunosuppression are essential to reverse unfavourable progression and optimize the functional prognosis of these patients.

This systematic review aims to synthesize the best available evidence on oral health care for patients with post‑stroke dysphagia, and to provide an evidence‑based framework for clinical nursing staff to reduce the risk of aspiration pneumonia. Following PRISMA guidelines, we systematically searched computerized decision systems, guideline websites, professional association websites, and comprehensive databases from inception to December 2025 for clinical decisions, guidelines, evidence summaries, best practices, expert consensuses, systematic reviews, and meta‑analyses. Three researchers trained in evidence‑based methodology independently evaluated literature quality, extracted data, and graded the evidence. Seventeen publications were included (10 guidelines, 3 expert consensuses, 1 clinical decision aid, and 3 evidence summaries), yielding 21 pieces of best evidence across four domains: team formation, screening and assessment, nursing interventions, and health education. Key evidence includes nurse‑led multidisciplinary collaboration, standardized oral and swallowing assessments, twice‑daily oral care with a soft‑bristled toothbrush, cautious use of chlorhexidine mouthwash, and systematic caregiver training before discharge. This systematic review provides a comprehensive, nurse‑centred framework; a multidisciplinary approach, structured interventions, and caregiver education are essential to lower aspiration risk and improve patient outcomes.