The influence of size, specific gravity, and head position on the swallowing of solid preparations

AbstractAimTo clarify the influence of size and specific gravity of solid preparations, and the position of healthy volunteers when swallowing, for the purpose of practical use in patient consultation regarding the taking of medicines.Materials and methodsThe paper reports three studies. Volunteers were asked to swallow four different capsules (A, large and heavy; B, large and light; C, small and heavy; D, small and light) in Study 1, two preparations with different positions (upright, horizontal, and chin-down) in Study 2, and two preparations before and after anesthetization of the bilateral lingual and inferior alveolar nerve in Study 3. The oral transit time (OTT) and pharyngeal transit time (PTT) were evaluated with videofluoroscopy.ResultsThe mean OTT became longer in the order of C, D, B, A. The mean PTT showed no statistically significant differences. The swallowing preference of the four preparations ranked by the subjects showed that difference in size but not the difference in specific gravity is a significant factor. In the chin-down position, OTT was shorter for two preparations, compared with the other two positions. The mean OTT for both the A and B preparations was significantly longer after the bilateral lingual and inferior alveolar nerves were anesthetized.ConclusionWhen swallowing solid preparations, a consideration of size and the position will enable ease of swallowing of medicines. This would especially be the case when delivery of the medicines to be taken by the aged suffering from oral hypoesthesia caused by an underlying disease

Inhibition of neuropeptide Y Y1 receptor induces osteoblast differentiation in MC3T3-E1 cells

Neuropeptide Y (NPY) is a major neural signaling molecule. NPY is produced by peripheral tissues, such as osteoblasts, and binds to the corresponding Y1 receptor that belongs to the G-protein-coupled receptor family. Osteoblast-specific Y1 receptor knockout mice exhibit high bone mass, indicating a role of the NPY-Y1 receptor axis in the regulation of bone homeostasis. In the bone microenvironment, peripheral nerve fibers and osteoblasts produce NPY. However, the effects of the Y1 receptor on osteoblasts remain unexplored. In the present study, an RNA interference approach was employed to target the Y1 receptor, in order to determine whether it may function to regulate the growth, differentiation and viability of osteoblasts. Knockdown of the Y1 receptor by small interfering RNA (siRNA) lead to induction of alkaline phosphatase (ALP) activity and mineralization in mouse MC3T3-E1 osteoblast cells. In addition, the mRNA expression levels of ALP, osteocalcin, collagen (I) alpha 1, and bone sialoprotein were significantly increased following transfection of a Y1 receptor siRNA. Furthermore, the mRNA expression levels of Runx2 and osterix were significantly increased; however, no significant alterations in cell proliferation and caspase-3/7 activity were observed in Y1 receptor siRNA-transfected cells when compared with non-targeting controls. The results demonstrate that Y1 receptor inhibition may increase osteoblastic differentiation, which indicates a role of the Y1 receptor in the regulation of osteoblastic differentiation

The neural ELAVL protein HuB enhances endogenous proto-oncogene activation

The cytoplasmic distribution of the HuR/ELAVL1 (embryonic lethal abnormal vision 1) protein is recognized as an important prognostic factor of malignant tumors. However, the previous study suggests that exogenous over-expression of HuR is not sufficient for nuclear export. Conversely, the predominantly cytosolic distribution of neuron-specific human ELAV members, including HuB/ELAVL2, HuC/ELAVL3, and HuD/ELAVL4, has been reported. In the present study, we demonstrated the expression of HuB in several types of cancer cells, but expression of HuC and HuD was not observed. In addition, our results indicated that HuR and HuB formed a complex in the cytosolic fraction of cancer cells via the RRM3 region. Ectopic expression of HuB was capable of initiating the cytosolic translocation of HuR from the nucleus to the cytosol. Furthermore, HuB-transduced cancer cells displayed significant nuclear export of HuR, with quantitative PCR experiments revealing the simultaneous upregulation of HIF-1 alpha, c-Fos, c-MYC, and Ets2 basal mRNA expression. Phorbol 12-myristate 13-acetate (PMA)-stimulated HuB-transduced cells demonstrated significantly enhanced activation of endogenous c-Fos and CREB dependent cascades. Finally, co-transfection of HuB with the El region of type 5 human adenovirus significantly enhanced El transformation activities but that of HuR with the El region did not. Collectively, our findings suggest that the neural Hu family protein HuB plays a major role in the activation of memory-related proto-oncogenes. (C) 2019 Elsevier Inc. All rights reserved

Management of the N0 Neck in Early Stage Oral Squamous Cell Carcinoma

Management of clinically node negative neck patients with oral squamous cell carcinoma (OSCC) remains controversial. Elective neck dissection (END) is used on an assumption of difficulty in diagnosing subclinical nodal metastases in the neck. This is also the case when early dissection allows better prognosis if nodal metastases actually exist. However, the disadvantage of prophylactic END is that truly N0 neck patients undergo unnecessary neck dissection and have to bear shoulder complaints and dysfunction. Our strategy has been a“ wait and see” policy for the management of the neck among patients with T1-2 oral cancer without clinical nodal metastases unless the neck was being opened for reconstruction requirements. The purpose of this study is to assess the outcome of patients who underwent trans-oral tumor excision and“ wait-and-see” policy for the N0 neck. 　A total of 94 previously untreated patients with T1-2N0 classification were investigated. Elective neck dissection (END) was carried out on 10 patients (10.6%) at the time of treatment of the primary resection with reconstruction (END group), and 84 patients were observed without neck dissection (Observation group). 　The 5-year disease specific survival rates were 90.0% for the END group and 95.9% for the observation group. The 5-year over all survival rates were 90.0% in the END group and 88.8% in the observation group. In the observation group of 84 patients, 16 patients (19.0%) had delayed metastasis in the neck subsequently. 15 patients underwent salvage neck dissection. The salvage rate was 86.6% (13/15 patients). 　The treatment strategy “wait and see” policy for T1-2N0 OSCC resulted in a good outcome at our institution. Unnecessary neck dissection can be avoided for the truly N0 patients

Morphology of the inferior border of the mandible: The relationship between the lowest position of the outer and inner contours of the cortex for a successful split

For a sagittal split ramus osteotomy to be secure, the relation between the outer and inner contours of the cortex at the inferior border of the mandible is critical. The lowest point of the outer contour is not always immediately below that of the inner contour, and the former is placed more lingually than the latter in about a third of all cases. This tendency is much more noticeable in skeletal class I and II malocclusions than class III. It is therefore important to examine the lowest point of the inferior border in every case, and to carry the inferior part of the buccal cut on to the lingual side if necessary

Therapeutic strategies for etiologies in the oral and maxillofacial regions

In this paper we describe our strategies for treatment of oral cancer, jaw deformity, and odontogenic tumors. Details of the strategy for cleft palate is introduced in a separate report, by Professor Mikoya. Newly applied strategies for patients with post-surgical swallowing dysfunction and dentoalveolar surgery are also introduced. Oral cancer, jaw deformity, cleft, and odontogenic tumors are the main etiologies in the oral and maxillofacial region. Early stages of oral cancer (StageI and StageII) are mainly treated with surgery or radiotherapy alone, and the 5-year survival rate is 80 to 90%. With advanced oral cancer (StageIII and StageIV) a combination of chemotherapy and radiotherapy with or without surgery is the norm, but the 5-year survival rate is below 50% overall. Therefore, there is a need for an effective combination of therapies for advanced oral squamous cell carcinomas. The treatment goal for jaw deformities is to achieve a functional and desirable occlusion. To achieve desirable occlusion, treatment by the team approach is introduced, it includes oral and maxillofacial surgeons, orthodontists, and prosthodontists. A unique method, termed the “Dredging Method” is used in the treatment strategies of odontogenic tumors. The method was introduced to remove all of the tumor and restore the form and function of the jaw through bone generation. The Dredging Method involves four steps: Deflation, Enucleation, Dredging, and Follow up.　Tooth autotransplantation in our department stands out in comparison with other facilities in the field of dentoalveolar surgery. The annual number of cases exceeds 150, and up to December of 2015 the total number of cases reached 1,100. The 5-year survival rate for cases with transplanted third molars to the molar region is 86%. Post-surgical swallowing dysfunction is strongly dependent on the extent of the surgery and type of reconstruction. Here, post-surgical swallowing dysfunction can be accurately predicted prior to the surgery, and to develop plans for individual rehabilitation programs to overcome post-surgical swallowing dysfunction is crucial

Recovery from Postsurgical Swallowing Dysfunction in Patients With Oral Cancer

Patients and Methods: The swallowing function was assessed in 25 patients (18 males and 7 females) with oral cancer. The swallowing function was assessed preoperatively and 1, 6, and 12 months and in some cases more than 24 months after surgery. Assessment of the swallowing function consisted of videofluoroscopic evaluation (oropharyngeal swallow efficiency; OPSE) and details of the method of nutrition, diet level, nutritional condition, and occurrence of pneumonia. Results: Postsurgically, OPSE did not recover to the preoperative level more than 12 months after surgery. Twenty-one patients (84%) had full oral intake and only 3 patients (12%) showed poorer nutritional conditions compared with the presurgery state. Aspiration pneumonia did not occur more than 12 months after surgery. Conclusions: The patients in the present study showed stable medical status and functional swallowing at the final evaluation despite insufficient recovery of OPSE revealed by videofluoroscopic evaluation

Does Swallowing Function Recover in the Long Term in Patients With Surgically Treated Tongue Carcinomas?

Purpose: The present study aims to measure the post-surgical swallowing function in patients five years after operative treatment of tongue carcinoma. Patients and Methods: Using a retrospective cohort study design, the investigators enrolled post-surgical patients treated for tongue carcinomas in Hokkaido University Hospital. The primary outcome variable was the Oropharyngeal Swallow Efficiency (OPSE) determined by videofluoroscopic evaluation and the OPSE at present was compared with that at discharge. Other variables included present nutritional status (Body Mass Index: BMI, Serum Albumin), dietary intake, self-rating of the present swallowing function, and occurrence of pneumonia. Statistical analysis used the paired t-test and Spearman's rank correlation. Results: The swallowing function was assessed in 20 patients (11 males and 9 females) subjected to surgical treatment of tongue carcinomas; the median age was 70 years (range 56-90 years) at the present evaluation. The mean values of the liquid OPSE and paste OPSE at present were 26.6±21.2 and 21.9±22.5, respectively. The mean values for BMI and serum albumin at present were 22.2±3.4 and 4.5±0.3g/dl respectively. All patients had a full oral intake of foods, with a mean self-rated value of 6.4±2.5, an acceptable value as evaluated by the patients. Pneumonia requiring hospitalization had not occurred in these patients. Conclusions: Long-term follow-up of patients following operative treatment of tongue carcinomas demonstrate acceptable levels of oral function and nutritional status despite objective measures of poor swallowing efficiency assessed using a videofluoroscopy

Modified "Dredging Method" for complicated solid/multicystic ameloblastoma in the mandible: Report of a case treated by fractionated enucleation

The purpose of this paper is to describe the treatment procedures for a solid/multicystic ameloblastoma which was treated with the "Dredging Method" modified by fractionated enucleation adopted to avoid the pathologic fracture because of the complicated expansive nature in the mandible. Ameloblastoma is defined as a benign epithelial odontogenic tumor with progressive growth potential. Currently employed surgical treatment as curative treatment is resection with adequate margins because of the characteristics of high recurrence rates with conservative treatment. In this article, a 38-year-old male with swelling on the right mandible was referred to our hospital. Image analysis showed an expansile partially honeycombed multilocular radiolucent lesion from the body to the ascending ramus of the mandible. A follicular ameloblastoma was diagnosed by the biopsy. The paper also details the management of the ameloblastoma with the "Dredging Method" to remove the tumor completely and maintain the form and function of the mandible and the 13-year follow-up post treatment