A novel dysphagia screening method using panoramic radiography

The purpose of this study was to establish a screening method for dysphagia using panoramic radiography. Seventy patients who had undergone panoramic radiography and videofluorographic swallowing study（VF）were selected. Exclusion criteria were surgery related to tumors, jaw deformity, and poor-quality panoramic radiograph images. Patients were diagnosed with dysphagia based on VF findings and accordingly categorized into Dysphagia（＋）or Dysphagia（−）groups. The control group consisted of 129 individuals who had undergone panoramic radiography for dental treatment. Exclusion criteria were the same as in the Dysphagia（＋）and Dysphagia（−）groups. Two maxillofacial radiologists assessed the vertical and horizontal position of the hyoid bone and measured the distance from the tongue to the palate. The vertical hyoid bone position was significantly lower in the Dysphagia（＋）group than in the control group. The distance from the tongue to the palate was significantly shorter in the control group, measuring 8.5±5.9mm as compared to 15.0±9.5 in the Dysphagia（＋）group and 14.9±10.0 in the Dysphagia（−）group. At least 77％ of patients were diagnosed with dysphagia or suspected of dysphagia because the hyoid body was below the mandibular line on panoramic radiography. Panoramic radiography may be a useful tool for predicting the risk of dysphagia as it reveals the vertical hyoid bone position and the distance from the tongue to the palate

Potential of Panoramic Radiography as a Screening Method for Oral Hypofunction in the Evaluation of Hyoid Bone Position

The hyoid bone is located in the middle of the cervical muscles involved in oral masticatory function. The position of the hyoid bone is commonly determined by lateral cephalometric analysis. Although cephalometric radiography is commonly used in orthodontic treatment, the modality remains rare; routine dental care would benefit from precise identification of hyoid bone location using a more common modality, such as panoramic radiography. The purpose of this study was to investigate the usefulness of panoramic radiography compared to lateral cephalometric radiography for evaluating hyoid bone position as a potential screening method for oral hypofunction. The study included 347 patients referred for both a panoramic radiograph and a lateral cephalometric radiograph. The patients were divided into the following five groups according to the appearance of the hyoid bone in the panoramic radiograph: Group 1: hyoid bone could not be observed, or part of the greater horn was observed; Group 2: part of the hyoid body was observed, but not the most supero-anterior point of the hyoid bone; Group 3: the most supero-anterior point of the hyoid bone was observed; Group 4: all of the hyoid body was observed; Group 5: the hyoid body overlapped the mandible. The gold standard for measurement of hyoid bone position is the lateral cephalometric radiograph. Hyoid bone position as revealed by lateral cephalometric radiograph was compared among the groups. Hyoid bones that were observed in higher positions on lateral cephalometric radiograph were also observed in higher positions on panoramic radiograph. Hyoid bone position can be assessed by panoramic radiography, and this modality might be useful as a screening method for oral hypofunction

Systemic Corticosteroids and Early Administration of Antiviral Agents for Pneumonia with Acute Wheezing due to Influenza A(H1N1)pdm09 in Japan

BACKGROUND: Pneumonia patients with wheezing due to influenza A(H1N1)pdm09 were frequently treated with systemic corticosteroids in Japan although systemic corticosteroid for critically ill patients with pneumonia caused by influenza A(H1N1)pdm09 has been controversial. Applicability of systemic corticosteroid treatment needs to be evaluated. METHODS/PRINCIPAL FINDINGS: We retrospectively reviewed 89 subjects who were diagnosed with influenza A(H1N1)pdm09 and admitted to a national hospital, Tokyo during the pandemic period. The median age of subjects (45 males) was 8 years (range, 0-71). All subjects were treated with antiviral agents and the median time from symptom onset to initiation of antiviral agents was 2 days (range, 0-7). Subjects were classified into four groups: upper respiratory tract infection, wheezing illness, pneumonia with wheezing, and pneumonia without wheezing. The characteristics of each group was evaluated. A history of asthma was found more frequently in the wheezing illness (55.6%) and pneumonia with wheezing (43.3%) groups than in the other two groups (p = 0.017). Corticosteroid treatment was assessed among subjects with pneumonia. Oxygen saturation was lower in subjects receiving corticosteroids (steroid group) than in subjects not receiving corticosteroids (no-steroid group) (p<0.001). The steroid group required greater oxygen supply than the no-steroid group (p<0.001). No significant difference was found by the Kaplan-Meier method between the steroid and the no-steroid groups in hours to fever alleviation from the initiation of antiviral agents and hospitalization days. In logistic regression analysis, wheezing, pneumonia and oxygen saturation were independent factors associated with using systemic corticosteroids. CONCLUSION: Patients with wheezing and a history of asthma were frequently found in the study subjects. Systemic corticosteroids together with early administration of antiviral agents to pneumonia with wheezing and possibly without wheezing did not result in negative clinical outcomes and may prevent progression to severe pneumonia in this study population

Total parenteral nutrition on energy metabolism in children undergoing autologous peripheral blood stem cell transplantation

The resting energy expenditure (REE) and the respiratory quotient (RQ) were measured longitudinally using indirect calorimetry to examine the effects of total parenteral nutrition (TPN) on energy metabolism in children undergoing autologous peripheral blood stem cell transplantation (PBSCT). There were six children (two males and four females) and the age ranged from five to 13 years (median, eight yrs.). The diagnosis included acute lymphocytic leukemia (ALL ; 4), neuroblastoma (NBL ; 1) and primitive neuroectodermal tumor (PNET ; 1). TPN was started after the patients were stabilized following PBSCT (group A ; n=3) or before the initiation of high-dose cytoreductive chemotherapy (HCC) (group B ; n=3). Duration of HCC before PBSCT was identical between the two groups (six to eight days). Average total calorie and protein intake during HCC was significantly higher for group B than for group A. The %REE, the percentage of REE to the predicted basal energy expenditure (BEE), in group A showed 133±19%, 129±14% and 146±11% during three periods of HCC (days -8 to -1 of PBSCT), bone marrow suppression (days 0 to 11 of PBSCT) and bone marrow recovery (days 12 to 22 of PBSCT), respectively. In contrast, those in group B were 10% to 20% lower than those in group A at all periods. Carbohydrate oxidation rates during HCC in group A were significantly lower than those in group B, and those were not different between both groups during post-PBSCT periods. Fat oxidation rates in both groups were similar at all stages of periods. In contrast, protein degradation rates in group A were significantly higher than those in group B at all stages of the period. From these results, we concluded that commencement of TPN administration prior to HCC in the patients undergoing PBSCT provides beneficial effects to maintain better energy metabolic and nutritional status

Comparison of energy metabolism in Insulin-Dependent and Non-Insulin-Dependent diabetes mellitus

To compare the metabolic consequences of insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), glycemic control and energy metabolism were evaluated in 18 children displaying IDDM and 19 NIDDM adult patients. With rising concentrations of fasting blood glucose (FBG), hemoglobin A1C and free fatty acid, the percentage of the ratio of resting energy expenditure (REE) to predicted REE expressed as %REE increased and the respiratory quotient (RQ) decreased. The linear regression between RQ and FBG showed the same gradient in IDDM and NIDDM although the RQ in IDDM was always 0.07 lower than that in NIDDM given various FBG concentrations. Those patients whose RQ values were less than 0.7, indicating ketone body production, included 8 (44%) IDDM and 2 (11%) NIDDM patients. These results may explain the relatively greater manifestation of ketoacidosis in IDDM

Measurement of inclusive electron cross section in γγ\gamma \gamma collisions at TRISTAN

We have studied open charm production in $\gamma \gamma$ collisions with the TOPAZ detector at the TRISTAN $e^{+}e^{-}$ collider. In this study, charm quarks were identified by electrons (and positrons) from semi-leptonic decays of charmed hadrons. The data corresponded to an integrated luminosity of 95.3 pb$^{-1}$ at a center-of-mass energy of 58 GeV. The results are presented as the cross sections of inclusive electron production in $\gamma \gamma$ collisions with an anti-tag condition, as well as the subprocess cross sections, which correspond to resolved-photon processes. The latter were measured by using a sub-sample with remnant jets. A comparison with various theoretical predictions based on direct and resolved-photon processes showed that our data prefer that with relatively large gluon contents in a photon at small $x (x \le 0.1)$, with the next-to-leading order correction, and with a charm-quark mass of 1.3 GeV.Comment: 26 pages, Latex format (article), 5 figures included, to be published in Phys. Lett.

About the time-shrinking illusion in the tactile modality

The aim of this study was to examine the occurrence of a so-called time-shrinking illusion in the tactile modality, while it had been tested so far mainly with auditory and visual stimuli. We examined whether the perception of an empty time interval marked by two brief tactile stimuli, S (240 ms), would be influenced by the presence of a preceding time interval, P (160, 240, or 320 ms). Results showed that S was underestimated when P was shorter than S. This underestimation appeared as a kind of perceptual assimilation between P and S, but S was not overestimated when P was longer. The underestimation was rather interpreted as a manifestation of the time-shrinking illusion.Keywords: Perceived duration Empty interval Time shrinking Assimilation Somatosensory modalit

A Basic Study for Predicting Dysphagia in Panoramic X-ray Images Using Artificial Intelligence (AI)&mdash;Part 1: Determining Evaluation Factors and Cutoff Levels

Background: Dysphagia relates to quality of life; this disorder is related to the difficulties of dental treatment. Purpose: To detect radiographic signs of dysphagia by using panoramic radiograph with an AI system. Methods: Seventy-seven patients who underwent a panoramic radiograph and a videofluorographic swallowing study were analyzed. Age, gender, the number of remaining teeth, the distance between the tongue and the palate, the vertical and horizontal hyoid bone position, and the width of the tongue were analyzed. Logistic regression analysis was used. For the statistically significant factors, the cutoff level was determined. The cutoff level was determined by using analysis of the receiver operations characteristic (ROC) curve and the Youden Index. Results: A significant relationship with presence of dysphagia was only observed for the vertical hyoid bone position. The area under the curve (AUC) was 0.72. The cutoff level decided for the hyoid bone was observed to be lower than the mandibular border line. Conclusions: In cases where the hyoid bone is lower than the mandibular border line on a panoramic radiograph, it suggests the risk of dysphagia would be high. We will create an AI model for the detection of the risk of dysphagia by using the assessment of vertical hyoid bone position