181 research outputs found

    Successful Surgical Treatment for Dysphagia Secondary to Descending Necrotizing Mediastinitis

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    Descending necrotizing mediastinitis (DNM) is a life-threatening disease with a high fatality rate that occurs as a complication of deep neck abscess. DNM complicated by severe dysphagia during the postoperative period has been previously reported, but there have been no published cases of surgical treatment for severe dysphagia secondary to DNM. A 63-year-old man was diagnosed with a deep neck abscess followed by DNM. The patient had dysphagia after incision and drainage of the abscess and drainage for DNM with video-assisted thoracic surgery (VATS). A comprehensive long-term physiotherapy program with a speech and language therapist did not reduce his dysphagia. Thus, the patient underwent laryngeal elevation and cricopharyngeal myotomy, which enabled oral intake. Surgery should be considered for prolonged severe restriction of laryngeal elevation and esophageal introitus opening that is unresponsive to physiotherapy with a speech and language therapist

    Enhancing Inverse Problem Solutions with Accurate Surrogate Simulators and Promising Candidates

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    Deep-learning inverse techniques have attracted significant attention in recent years. Among them, the neural adjoint (NA) method, which employs a neural network surrogate simulator, has demonstrated impressive performance in the design tasks of artificial electromagnetic materials (AEM). However, the impact of the surrogate simulators' accuracy on the solutions in the NA method remains uncertain. Furthermore, achieving sufficient optimization becomes challenging in this method when the surrogate simulator is large, and computational resources are limited. Additionally, the behavior under constraints has not been studied, despite its importance from the engineering perspective. In this study, we investigated the impact of surrogate simulators' accuracy on the solutions and discovered that the more accurate the surrogate simulator is, the better the solutions become. We then developed an extension of the NA method, named Neural Lagrangian (NeuLag) method, capable of efficiently optimizing a sufficient number of solution candidates. We then demonstrated that the NeuLag method can find optimal solutions even when handling sufficient candidates is difficult due to the use of a large and accurate surrogate simulator. The resimulation errors of the NeuLag method were approximately 1/50 compared to previous methods for three AEM tasks. Finally, we performed optimization under constraint using NA and NeuLag, and confirmed their potential in optimization with soft or hard constraints. We believe our method holds potential in areas that require large and accurate surrogate simulators.Comment: 20 pages, 8 figure

    Sequential Evaluation of Swallowing Function During Chemoradiotherapy for Head and Neck Cancer

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    [Background] Many studies have addressed chronic dysphagia resulting from chemoradiotherapy for head and neck cancer (HNC) because of its severity, but changes in the swallowing function during chemoradiotherapy has been rarely reported. This study aimed to elucidate the changes in the swallowing function during chemoradiotherapy for HNC. [Methods] From April 2018 to July 2020, 20 patients who underwent definitive or postoperative chemoradiotherapy at our hospital for head and neck squamous cell carcinoma were evaluated by flexible endoscopy with the Hyodo scoring system for swallowing, the Penetration–Aspiration Scale (PAS), and the Functional Outcomes Swallowing Scale (FOSS). [Results] Assessments at the start of treatment, at 40 Gy, and at the end of treatment yielded these mean values: Hyodo score—0.39, 1.22, and 2.56; PAS—1.00, 1.05, and 1.5; FOSS—0.2, 0.55, and 1.1, respectively. The Dunn multiple comparison test was used for analysis to determine significance (P < 0.05). The Hyodo score and FOSS were significantly increased at the end of treatment versus initial evaluation; however, score was maintained at a tolerable level for oral intake. PAS did not show a significant increase. [Conclusion] In conclusion, changes in the swallowing function during chemoradiotherapy for HNC were mild, and swallowing function was maintained at a tolerable level for oral intake

    The effect of Hangeshashinto on Oral Mucositis Caused by Induction Chemotherapy in Patients with Head and Neck Cancer

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    [Background] Oral mucositis (OM) is a side effect of chemotherapy in head and neck cancer. Severe OM often has a large impact on quality of life. Therefore, the treatment of OM during chemotherapy is very important. It was recently reported that Hangeshashinto (TJ-14), a Japanese traditional medicine (Kampo), is effective for OM caused by fluorinated pyrimidinebased agents used in colon cancer. We investigated the efficacy of TJ-14 for OM. [Methods] We enrolled patients with head and neck cancer who were treated with induction chemotherapy between September 2014 and March 2016. In this double-blind trial, patients were randomly assigned to the TJ-14 group or placebo group. Patients were instructed to dissolve 2.5 g of TJ-14 or placebo in 100 ml of drinking water, rinse their mouths with the solution for 30 s and then spit it out. They were not allowed to eat anything for 30 minutes before or after using the mouthwash. [Results] The incidence of ≥ grade 2 OM was 37.5% (three patients) in the TJ-14 group and 50.0% (four patients) in the placebo group, with no significant difference between the two groups. The mean day of onset was 9.7 in the TJ-14 group and 6.7 in the placebo group. The mean duration of ≥ grade 2 OM was 1.3 days in the TJ-14 group and 3.7 days in the placebo group. Thus TJ-14 significantly reduced the duration of ≥ grade 2 OM. [Conclusion] Treatment of OM with TJ-14 was associated with a statistically significant reduction in the duration of ≥ grade 2 OM compared to placebo. Gargling with TJ-14 is a safe and effective method of administering the drug to patients with head and neck cancer

    Application of an Immobilization Device for the Modified Killian’s Method

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    [Background] The hypopharynx is a closed space that is difficult to observe. The modified Killian’s (MK) method was introduced to obtain wider exposure. However, this method requires keeping the head forward during the examination. Postural maintenance might be problematic. To use the MK method safely for a thorough endoscopic examination, we introduced a new body immobilization device. The aim of this study was to evaluate the effectiveness of this body immobilization device. [Methods] Twenty-five patients underwent transnasal laryngoscopy using the MK method with the immobilization device. This device consists of a board to place the chest and a shaft. We classified hypopharynx visualization using a 5-point scale, in various combinations of head torsion, Valsalva maneuver, and MK position. Furthermore, we classified the feasibility of the MK method for 54 patients. Age, BMI, and performance status were evaluated by MK position feasibility class. [Results] The MK method with the body immobilization device was completed in all patients. It was significantly associated with higher hypopharyngeal visibility score. BMI and performance status were significantly associated with MK method feasibility. There were no significant differences in hypopharynx visualization scores with versus without this device for the patients that could maintain the MK position on their own. [Conclusion] For patients with poor nutrition or poor ability to perform activities of daily living, it was difficult to maintain the MK position. Thus, this immobilization device might be useful to complete the MK method and provide accurate detection of hypopharyngeal lesions in these patients

    Use of Cervical Ultrasonography in Globus Sensation Investigation: A Retrospective Cohort Study

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    Background: A globus sensation is one of the most common complaints in otolaryngological practice. Patients with no associated abnormalities detected during the usual examinations performed in ENT clinics, are being diagnosed with globus sensation. Cervical ultrasonography is usually not performed in ENT clinics; however, it is useful in screening diseases of the subcutaneous tissue/organs, whose detection is not possible with the routine ENT examinations. The purpose of our study was to elucidate whether cervical ultrasound examination identifies abnormalities in patients with globus sensation. Methods: A single-centre retrospective cohort study. Cervical ultrasonographic examinations were performed on patients with globus sensation at the Department of Otolaryngology, Head and Neck Surgery of Tottori university hospital, a tertiary care centre, from January 2013 to September 2017. The subjects were 74 patients who complained of globus sensation with no abnormality in general otolaryngological examination including laryngoscopy. Results: Ultrasonography detected structural abnormalities in 60.8% of the patients with globus sensation: thyroid disorders in 41 patients, including: 35 patients with thyroid nodules, 4 patients with Hashimoto’s disease, 1 patient with Grave’s disease, and 1 patient with subacute thyroiditis; Sjögren syndrome in 2 patients; and cervical lipoma in 1 patient. Furthermore, 2 patients with thyroid disorders had concomitant esophageal cancer. Conclusion: Cervical ultrasonography identified thyroid disorders in patients with globus sensation, despite the normal ENT status. Therefore, it would be appropriate to adopt cervical ultrasonography as a routine examination at ENT clinics for patients with globus sensation

    Unseiin, a Kampo medicine, Reduces the Severity and Manifestations of Skin Toxicities Induced by Cetuximab: A Case Report

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    Cetuximab is an effective drug used to treat patients with recurrent or metastatic head and neck squamous cell carcinoma. Skin toxicities such as paronychia and skin exsiccation are common adverse events caused by cetuximab. Skin toxicities may cause significant physical and psychosocial discomfort. The goal of managing skin toxicities is to minimize the detrimental effects on quality of life and continue the treatment. In one patient, skin toxicities became severe, up to grade 2, during treatment. The pain induced by paronychia and skin exsiccation made daily life difficult. Ten days after starting Unseiin, symptoms and finger findings resolved significantly. The patient could resume daily activities. No adverse effects induced by Unseiin were observed during treatment. Unseiin was effective on paronychia and skin exsiccation in this case and may contribute to successful treatment of skin toxicities induced by cetuximab

    Maternal Gut Microbiome Decelerates Fetal Endochondral Bone Formation by Inducing Inflammatory Reaction

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    To investigate the effect of the maternal gut microbiome on fetal endochondral bone formation, fetuses at embryonic day 18 were obtained from germ-free (GF) and specific-pathogen-free (SPF) pregnant mothers. Skeletal preparation of the fetuses' whole bodies did not show significant morphological alterations; however, micro-CT analysis of the tibiae showed a lower bone volume fraction in the SPF tibia. Primary cultured chondrocytes from fetal SPF rib cages showed a lower cell proliferation and lower accumulation of the extracellular matrix. RNA-sequencing analysis showed the induction of inflammation-associated genes such as the interleukin (IL) 17 receptor, IL 6, and immune-response genes in SPF chondrocytes. These data indicate that the maternal gut microbiome in SPF mice affects fetal embryonic endochondral ossification, possibly by changing the expression of genes related to inflammation and the immune response in fetal cartilage. The gut microbiome may modify endochondral ossification in the fetal chondrocytes passing through the placenta

    Association Between Tooth Loss and Longitudinal Changes in B-Type Natriuretic Peptide Over 5 Years in Postmenopausal Women: The Nagahama Study

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    BACKGROUND: There is disparity between the sexes in cardiovascular diseases including heart failure (HF). This study aimed to investigate the effect of periodontal disease (PD) on plasma B-type natriuretic peptide (BNP) concentration across sex, age, and menopausal status, as well as the interaction effect of MT and diabetes mellitus (DM) on BNP. METHODS: This large-scale prospective cohort study enrolled 7, 539 individuals with no myocardial infarctions or angina pectoris at baseline from the general Japanese population. The association between baseline number of missing teeth (MT) and the longitudinal changes in BNP over 5 years (ΔBNP) was evaluated according to sex and menopausal status. RESULTS: Among 7, 539 participants, 3, 190 were postmenopausal women with a mean age ± standard deviation of 61.1 ± 7.6 at baseline. Multivariate analysis revealed a positive association between MT and ΔBNP among postmenopausal women even after adjusting for covariates, including traditional HF risk factors (coefficient, 0.210; 95% confidence interval [CI], 0.107 to 0.312; P 50. Including an interaction term (MT × DM) in the multivariate model revealed a positive interaction between MT and DM in ΔBNP among postmenopausal women (coefficient for interaction, 1.365; 95% CI, 0.902 to 1.827; P for interaction <0.001). CONCLUSIONS: Our study showed a positive association between MT and ΔBNP, as well as a positive effect of the interactive association between MT and DM, among postmenopausal women. Our results suggest a sex difference of an adverse effect of PD on initial myocardial wall stress in the ventricles

    Validation of the Japanese Society for Surgery of the Hand Version of the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH-JSSH) questionnaire

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    AbstractBackgroundThe Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire is a region-specific, selfadministered questionnaire, which consists of a disability/symptom (QuickDASH-DS) scale, and the same two optional modules, the work (DASH-W) and the sport/music (DASHSM) modules, as the DASH. After the Japanese version of DASH (DASH-JSSH) was cross-culturally adapted and developed, we made the Japanese version of QuickDASH (QuickDASH-JSSH) by extracting 11 out of 30 items of the DASH-JSSH regarding disability/symptoms. The purpose of this study was to test the reliability, validity, and responsiveness of QuickDASH-JSSH.MethodsA series of 72 patients with upper extremity disorders completed the QuickDASH-JSSH, the 36-Item Short-Form Health Survey (SF-36), and the Visual Analog Scale (VAS) for pain. Thirty-eight of the patients were reassessed for test–retest reliability 1 or 2weeks later. Reliability was investigated by the reproducibility and internal consistency. To analyze the validity, a principal component analysis and the correlation coefficients between the QuickDASH-JSSH and the SF-36 were obtained. The responsiveness was examined by calculating the standardized response mean (SRM; mean change/SD) and effect size (mean change/SD of baseline value) after carpal tunnel release of the 17 patients with carpal tunnel syndrome.ResultsCronbach’s alpha coefficient in the QuickDASH-DS was 0.88. The intraclass correlation coefficient (ICC) for the same was 0.82. The unidimensionality of the QuickDASH-DS was confirmed. The correlation coefficients between the QuickDASH-DS and the DASH-DS, DASH-W, or the DASH-SM were 0.92, 0.81, or 0.76, respectively. The correlation coefficients between the QuickDASH-DS score and the subscales of the SF-36 ranged from −0.29 to −0.73. The correlation coefficient between the QuickDASH-DS score and the VAS for pain was 0.52. The SRM/effect size of QuickDASHDS was −0.54/−0.37, which indicated moderate sensitivity.ConclusionThe Japanese version of QuickDASH has equivalent evaluation capacities to the original QuickDASH
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