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BACKGROUND: Following greater than or equal to 48-h intubation, one-third of acute respiratory failure (ARF) patients aspirate. Laryngeal edema has been identified as a potentially modifiable risk factor of post-extubation aspiration. The aim of this case-control study was to characterize the anatomical distribution of post-extubation laryngeal edema and to correlate anatomical laryngeal edema severity with aspiration risk in ARF survivors. The study also assessed whether patient weakness influenced the relationship between laryngeal edema and aspiration risk. METHODS: Flexible endoscopic evaluation of swallowing (FEES) videos from 120 patients (60 aspirators, 60 non-aspirators) were obtained from a previous multicenter observational study. Laryngeal edema was rated in eight locations using the Revised Patterson Edema Scale (RPES). Aspiration status was determined by a clinical rater core, and patient weakness was assessed using peak cough flow and pharyngeal medialization outcomes. Bivariate associations with aspiration were tested using Fisher's exact tests. Logistic regression models were used to test for associations between anatomical laryngeal edema severity and risk of aspiration. Logistic regression models were fit to explore whether weakness modified the relationship between edema and aspiration risk. RESULTS: The strongest anatomic predictor of post-extubation aspiration was the presence of aryepiglottic fold edema (adjusted odds ratio, aOR = 5.74, p = 0.009, FDR-adjusted p = 0.073). Weakness independently increased aspiration risk [aOR = 3.93 (95%CI = 1.42, 11.9), p = 0.011], but without evidence of an interaction effect with edema (p = 0.15). CONCLUSION: These findings can inform future research studying the influence of laryngeal edema on aspiration risk, as well as interventional studies aimed at reducing adverse outcomes associated with laryngeal edema. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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Background: Following greater than or equal to 48-h intubation, one-third of acute respiratory failure (ARF) patients aspirate. Laryngeal edema has been identified as a potentially modifiable risk factor of post-extubation aspiration. The aim of this case–control study was to characterize the anatomical distribution of post-extubation laryngeal edema and to correlate anatomical laryngeal edema severity with aspiration risk in ARF survivors. The study also assessed whether patient weakness influenced the relationship between laryngeal edema and aspiration risk. Methods: Flexible endoscopic evaluation of swallowing (FEES) videos from 120 patients (60 aspirators, 60 non-aspirators) were obtained from a previous multicenter observational study. Laryngeal edema was rated in eight locations using the Revised Patterson Edema Scale (RPES). Aspiration status was determined by a clinical rater core, and patient weakness was assessed using peak cough flow and pharyngeal medialization outcomes. Bivariate associations with aspiration were tested using Fisher’s exact tests. Logistic regression models were used to test for associations between anatomical laryngeal edema severity and risk of aspiration. Logistic regression models were fit to explore whether weakness modified the relationship between edema and aspiration risk. Results: The strongest anatomic predictor of post-extubation aspiration was the presence of aryepiglottic fold edema (adjusted odds ratio, aOR = 5.74, p = 0.009, FDR-adjusted p = 0.073). Weakness independently increased aspiration risk [aOR = 3.93 (95%CI = 1.42, 11.9), p = 0.011], but without evidence of an interaction effect with edema (p = 0.15). Conclusion: These findings can inform future research studying the influence of laryngeal edema on aspiration risk, as well as interventional studies aimed at reducing adverse outcomes associated with laryngeal edema. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2026.
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The bacteriophage population is vast, dynamic, old, and genetically diverse. The genomics of phages that infect bacterial hosts in the phylum Actinobacteria show them to not only be diverse but also pervasively mosaic, and replete with genes of unknown function. To further explore this broad group of bacteriophages, we describe here the isolation and genomic characterization of 116 phages that infect Microbacterium spp. Most of the phages are lytic, and can be grouped into twelve clusters according to their overall relatedness; seven of the phages are singletons with no close relatives. Genome sizes vary from 17.3 kbp to 97.7 kbp, and their G+C% content ranges from 51.4% to 71.4%, compared to ~67% for their Microbacterium hosts. The phages were isolated on five different Microbacterium species, but typically do not efficiently infect strains beyond the one on which they were isolated. These Microbacterium phages contain many novel features, including very large viral genes (13.5 kbp) and unusual fusions of structural proteins, including a fusion of VIP2 toxin and a MuF-like protein into a single gene. These phages and their genetic components such as integration systems, recombineering tools, and phage-mediated delivery systems, will be useful resources for advancing Microbacterium genetics.
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