Predictive value of TCM tongue characteristics for chemotherapy-induced myelosuppression in patients with lung cancer.

This study aimed to investigate the clinical predictors, including traditional Chinese medicine tongue characteristics and other clinical parameters for chemotherapy-induced myelosuppression (CIM), and then to develop a clinical prediction model and construct a nomogram. A total of 103 patients with lung cancer were prospectively enrolled in this study. All of them were scheduled to receive first-line chemotherapy regimens. Participants were randomly assigned to either the training group (n = 52) or the test group (n = 51). Tongue characteristics and clinical parameters were collected before the start of chemotherapy, and then the incidence of myelosuppression was assessed after treatment. We used univariate logistic regression analysis to identify the risk predictors for assessing the incidence of CIM. Moreover, we developed a predictive model and a nomogram using multivariate logistic regression analysis. Finally, we evaluated the predictive performance of the model by examining the area under the curve value of the receiver operating characteristic, calibration curve, and decision curve analysis. As a result, a total of 3 independent predictors were found to be associated with the CIM in multivariate regression analysis: the fat tongue (OR = 3.67), Karnofsky performance status score (OR = 0.11), and the number of high-toxic drugs in chemotherapy regimens (OR = 4.78). Then a model was constructed using these 3 predictors and it exhibited a robust predictive performance with an area under the curve of 0.82 and the consistent calibration curves. Besides, the decision curve analysis results suggested that applying this predictive model can result in more net clinical benefit for patients. We established a traditional Chinese medicine prediction model based on the tongue characteristics and clinical parameters, which could serve as a useful tool for assessing the risk of CIM.

Metabolomic profiling of serum and tongue coating of pregnant women with intrahepatic cholestasis in pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of cesarean section and adverse fetal outcomes. Currently, ICP diagnosis depends largely on serum levels of bile acids and lacks sensitivity and specificity for accurate diagnosis. Tongue diagnosis is an important diagnostic tool in traditional Chinese medicine (TCM) and is used in our clinic as complementary treatment and personalized medicine for ICP. However, the molecular basis of the manifestation of greasy white tongue coatings in ICP remains unknown. In this study, we performed untargeted metabolomic profiling of the serum, tongue coating, and saliva of 66 pregnant women, including 22 with ICP. The metabolomic profiles of the serum and tongue coatings showed marked differences between the two clinical groups. Forty-six differentially abundant metabolites were identified, and their relative concentrations correlated with total bile acid levels. These differential metabolites included bile acids, lipids, microbiota- and diet-related metabolites, and exposomes. Conventional biochemical markers, including serum aminotransferases and bilirubin, were not significantly increased in the ICP group, whereas the total cholesterol and triglyceride levels were significantly increased as early as the first trimester. Our data provide insights into the pathophysiology of ICP and implicate the gut-liver axis and environmental exposure. Tongue coating has the potential to be a non-invasive diagnostic approach. Further studies are required to validate the clinical utility of these findings.

In vitro antimetastatic potential of pseudolaric acid B in HSC-3 human tongue squamous carcinoma cell line.

OBJECTIVE: Pseudolaric acid B (PAB) is a novel diterpenoid derived from the traditional Chinese medicinal herb Cortex pseudolaricis that exerts anticancer, anti-inflammatory, and immunomodulatory properties. While the anticancer potential of PAB has been studied, its effects on metastasis have not been well-studied. This study aims to determine the inhibitory effects of PAB on HSC-3 human tongue squamous cell carcinoma (TSCC) cell line. DESIGN: Cell viability and soft agar colony formation assays were conducted to assess cellular proliferation and in vitro tumorigenic capacity of TSCC cells, respectively. Additionally, wound healing, transwell migration, and invasion assays were conducted to monitor the aggressive behavior of TSCC cells. Furthermore, Western blotting analysis was conducted to reveal the signaling pathways involved in the modulation of epithelial-mesenchymal transition (EMT). RESULTS: The migratory and invasive capacities of HSC-3 cells were suppressed by PAB irrespective of their proliferation states. PAB's effects on EMT involved upregulation of E-cadherin expression and downregulation of Twist; these were concomitantly accompanied by downregulated phosphorylation of epidermal growth factor receptor (EGFR). CONCLUSIONS: PAB suppresses human TSCC in vitro by regulating Twist/E-cadherin through the EGFR signaling pathway. PAB may have potential as a candidate antimetastatic drug for TSCC treatment.

Tongue feature dataset construction and real-time detection.

BACKGROUND: Tongue diagnosis in traditional Chinese medicine (TCM) provides clinically important, objective evidence from direct observation of specific features that assist with diagnosis. However, the current interpretation of tongue features requires a significant amount of manpower and time. TCM physicians may have different interpretations of features displayed by the same tongue. An automated interpretation system that interprets tongue features would expedite the interpretation process and yield more consistent results. MATERIALS AND METHODS: This study applied deep learning visualization to tongue diagnosis. After collecting tongue images and corresponding interpretation reports by TCM physicians in a single teaching hospital, various tongue features such as fissures, tooth marks, and different types of coatings were annotated manually with rectangles. These annotated data and images were used to train a deep learning object detection model. Upon completion of training, the position of each tongue feature was dynamically marked. RESULTS: A large high-quality manually annotated tongue feature dataset was constructed and analyzed. A detection model was trained with average precision (AP) 47.67%, 58.94%, 71.25% and 59.78% for fissures, tooth marks, thick and yellow coatings, respectively. At over 40 frames per second on a NVIDIA GeForce GTX 1060, the model was capable of detecting tongue features from any viewpoint in real time. CONCLUSIONS/SIGNIFICANCE: This study constructed a tongue feature dataset and trained a deep learning object detection model to locate tongue features in real time. The model provided interpretability and intuitiveness that are often lacking in general neural network models and implies good feasibility for clinical application.

Preliminary investigation of a combined herbal extract of Aruncus dioicus, Cirsium nipponicum, and Ocimum basilicum for halitosis.

BACKGROUND: Halitosis, the unpleasant odor in the oral cavity, has garnered increased attention and concern due to the growing significance of social interaction. SGE-107, a blend of 3 botanical drugs-Korean goat's beard, Cirsium tanakae, and Basil-with caffeic acid as its indicator component. This study aims to investigate the efficacy of SGE-107 in treating halitosis in patients with mild gastrointestinal symptoms. METHODS: We enrolled 25 participants with oral malodor and dyspeptic symptoms. We assessed the severity of halitosis using the visual analog scale. Throughout a 4-week period of administering SGE-107, we evaluated both objective and subjective parameters, including the halitosis-associated life-quality test, the Korean gastrointestinal symptom rating scale, levels of volatile sulfur compounds, salivary flow rate, oral moisture, tongue index, Winkel tongue coating index, and tongue temperature. RESULTS: After the intervention period, both the visual analog scale (5.88 ±â€…1.03 vs 2.38 ±â€…0.93, P < .001) and the scores of the halitosis-associated life-quality test (31.21 ±â€…11.78 vs 13.83 ±â€…6.38, P < .001) showed significant reductions. The proportion of participants with abnormal levels of methyl mercaptan (a volatile sulfur compound) also significantly decreased (17, 70.8% vs 9, 37.5%, P = .039). Furthermore, there were significant improvements in reflux, constipation, diarrhea, and the total scores on the Korean gastrointestinal symptom rating scale. Throughout the study period, only 2 participants experienced mild adverse events. CONCLUSION: SGE-107 appears to be a safe and effective treatment for halitosis-associated with gastrointestinal symptoms; nevertheless, the limited sample size necessitates further large-scale randomized, controlled studies to confirm our findings.

Efficacy of game training combined with surface electromyography biofeedback on post-stroke dysphagia.

OBJECTIVE: To explore the efficacy of game training combined with surface electromyography biofeedback (sEMG-BF) in the treatment of dysphagia after early stroke. METHODS: Ninety patients with early post-stroke dysphagia (PSD), who were diagnosed and treated from March 2021 to December 2022, were divided randomly into a control group (30 cases), experimental group 1 (30 cases) and experimental group 2 (30 cases). The control group received routine swallowing rehabilitation and transcranial direct current stimulation. Experimental group 1 received sEMG-BF in conjunction with the care provided to the control group. Experimental group 2 received sEMG-BF and game training in addition to the care provided to the control group. Before and after treatment, all three patient groups were evaluated using the WADA water swallowing test, the Functional Oral Intake Scale (FOIS), sEMG and a tongue manometer test. RESULTS: Before treatment, there was no significant difference (P > 0.05) among the three groups of patients in terms of WADA water swallowing rating, FOIS score, submandibular muscle sEMG peak, swallowing time limit and maximum tongue pressure. After treatment, all three groups exhibited improvements in these indices compared with those before treatment (P < 0.05). Experimental group 1 showed greater improvement than the control group (P < 0.05), and experimental group 2 exhibited greater improvement than experimental group 1 and the control group (P < 0.05). CONCLUSION: Game training combined with sEMG-BF can significantly improve the swallowing function of patients with PSD.

A Multi-stage Segmentation Method for Tongue Ecchymosis.

Tongue diagnosis is an important component of traditional Chinese medicine (TCM), in which tongue ecchymosis is the main diagnostic basis for the blood stasis syndrome of TCM. Most of the existing methods are unsupervised and cannot accurately segment tongue ecchymosis. In this paper, we propose a multi-stage segmentation method for tongue ecchymosis. We first employ an object detection model for rough localization of tongue ecchymosis, and then use the unsupervised clustering and the watershed transform for rough segmentation and fine segmentation of tongue ecchymosis respectively. To the best of our knowledge, we are the first to combine machine learning and deep learning to segment tongue ecchymosis. Experimental results show that the tongue ecchymoses obtained by our method are more similar to the real tongue ecchymoses compared with the existing methods, and the Intersection-over-Union (IoU) is improved by 0.12 compared with the latest method.Clinical Relevance-Tongue ecchymosis obtained by this paper is the main diagnostic basis for the blood stasis syndrome of TCM.

An Automatic Method for Sublingual Image Segmentation and Color Analysis.

Automatic segmentation of sublingual images and color quantification of sublingual vein are of great significance to disease diagnosis in traditional Chinese medicine. With the development of computer vision, automatic sublingual image processing provides a noninvasive way to observe patients' tongue and is convenient for both doctors and patients. However, current sublingual image segmentation methods are not accurate enough. Besides, the differences in subjective judgments by different doctors bring more difficulties in color analysis of sublingual veins. In this paper, we propose a method of sublingual image segmentation based on a modified UNet++ network to improve the segmentation accuracy, a color classification approach based on triplet network, and a color quantization method of sublingual vein based on linear discriminant analysis to provide intuitive one-dimensional results. Our methods achieve 88.2% mean intersection over union (mIoU) and 94.1% pixel accuracy on tongue dorsum segmentation, and achieves 69.8% mIoU and 82.7% pixel accuracy on sublingual vein segmentation. Compared with the state-of-art methods, the segmentation mIoUs are improved by 5.8% and 5.3% respectively. Our sublingual vein color classification method has the highest overall accuracy of 81.2% and the highest recall for the minority class of 77.5%, and the accuracy of color quantization is 90.5%.Clinical Relevance- The methods provide accurate and quantified information of the sublingual image, which can assist doctors in diagnosis.

Dark red tongue color formation caused by hyperglycemia is attributed to decreased blood flow of tongue tissue partially due to nuclear factor-kappa B pathway activation.

OBJECTIVE: To investigate the potential mechanisms underlying the dark red tongue color formation induced by hyperglycemia. METHODS: A high-fat diet and intraperitoneal injection of streptozotocin were used to establish a diabetes model. The color and blood flow of tongues were analyzed by the Tongue Diagnosis Analysis System and laser Doppler flowmetry, respectively. Inflammatory factors and adhesion factors were measured in the circulation and tongue tissue by an enzyme-linked immunosorbent assay. Western blotting was employed to evaluate nuclear factor-kappa B (NF-κB) p50 and inhibitor of kappa B kinase protein expression levels in the tongue. Then, the NF-κB inhibitor, pyrrolidine dithiocarbamic acid ammonium salt was utilized to repress NF-κB pathway activation to validate that the NF-κB pathway plays a key role in blood flow and dark red tongue color formation. RESULTS: The diabetic rats displayed a dark red tongue color that was accompanied by NF-κB pathway activation and decreased blood flow in the tongue. These effects could be reversed by the NF-κB inhibitor. CONCLUSIONS: Our investigation demonstrated that hyperglycemia led to dark red tongue color formation by decreasing blood flow in the tongue, which was partly due to NF-κB pathway activation.

Mirror-like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients.

OBJECTIVE: To reveal that mirror-like tongue, observed via a noninvasive inspection, is a powerful indicator of the severity and prognosis of patients with acute heart failure (AHF). METHODS: This was an observational, prospective study. A total of 408 patients who met the inclusion criteria and were diagnosed with AHF for the first time at Taicang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from August 2019 to January 2021 were selected as the research subjects. According to their tongue fur, the patients were divided into group A (mirror-like tongue group) and group B (non-mirror-like tongue group). The clinical characteristics and incidence of major adverse cardiovascular events (MACEs) within 1 year of follow-up were systematically compared between the two groups. RESULTS: Sixty-five patients were included in group A, and 343 patients were included in group B. There were 32 males and 33 females in group A and 168 males and 175 females in group B. The average age of the overall population was 64 years old, and the average age of group A was significantly higher than that of group B (74 vs 62 years, P < 0.001). Compared with that in group B, the left ventricular ejection fraction (LVEF) in group A was significantly lower (35% vs 42%, P < 0.001), and the log N-terminal pro B-type natriuretic peptide (NT-proBNP) level was significantly higher (4.0 vs 3.4, P < 0.001). The proportion of the combined application of vasoactive drugs in group A was significantly higher than that in group B (64% vs 38%, P < 0.001). Group B had a higher proportion of coronary angiography (29.5% vs 16.9%, P = 0.038). Group A was more inclined to require mechanical ventilation than group B (33.9% vs 22.5%, P = 0.049). The length of hospital stay in group A was significantly longer than that in group B (13.1 vs 7.6, P < 0.001). The incidence of MACEs, such as recurrence of AHF, new myocardial infarction and stroke, in group A within one year was higher than that in group B (P = 0.007, 0.009, < 0.001). The incidence of cumulative MACEs in group A was significantly higher than that in group B [hazard ratio = 2.76, 95% confidence interval (1.73, 4.41), P < 0.001]. Univariate and multivariate Cox regression analyses showed that mirror-like tongue, age, length of stay, LVEF and log NT-proBNP were independent predictors of MACEs in patients with AHF within one year. CONCLUSIONS: Noninvasive tongue inspection technology can be used as a powerful tool for assessing the severity of illness and predicting prognosis in patients with AHF. A mirror-like tongue is an independent risk factor for MACEs in patients with AHF during the first year and has a combination effect with age, length of hospital stay, ejection fraction and NT-proBNP on the occurrence of MACEs.

Evaluation of the effect of Matricaria recutita monotherapy or in combination with photodynamic therapy on tissue repair in the dorsum of the tongue of rats.

OBJECTIVE: The search for treatments that accelerate the healing of lesions is of constant interest. Matricaria recutita (chamomile) is a plant with antimicrobial, anti-inflammatory, and healing properties, and antimicrobial Photodynamic Therapy (aPDT) eradicates microorganisms, which favors tissue repair. This study aimed to evaluate the effect of the topical use of chamomile with or without aPDT on tissue repair in rats' tongues. METHODOLOGY: A total of 75 male Wistar rats underwent standardized ulceration on the dorsum of the tongue using a punch of 5 mm diameter and were randomly allocated into the following groups: control (G1), chamomile fluid extract (G2), chamomile infusion (G3), aPDT (G4), and chamomile infusion + aPDT (G5). On the 3rd, 7th, and 14th days postoperatively, euthanasia was performed, and the ulcers were measured using calipers. The presence of edema, inflammatory infiltrate, cellularity, re-epithelialization, and characterization of total collagen were evaluated using sections stained with Hematoxylin and Eosin and Red Sirius. Histomorphometry analyses of the percentage of total collagen, the distance from the basal layer to the epithelial surface, and the thickness of the stratum corneum were performed. Descriptive (absolute/relative frequencies and modes) and exploratory analyses were performed. The associations between the groups and the presence of ulcers were analyzed with Fisher's exact test. All analyses were performed using the R program and statistical significance was set at p=0.05. RESULTS: The G2 positively modulated the exudative and proliferative phases of repair, both clinically (p<0.0001) and histologically, whether in descriptive or inferential analyses (p<0.05). The G3 showed a significant difference in clinical parameters compared with G1 (p<0.0001). The G4 and G5 did not positively modulate tissue repair. CONCLUSION: The chamomile fluid extract showed better outcomes for tissue repair in the rat tongue.

Maternal folic acid supplementation and the risk of ankyloglossia (tongue-tie) in infants; a systematic review.

BACKGROUND: Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. This study aimed to review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants. METHODS: We searched the databases MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus. We searched for observational, and interventional studies, and systematic reviews investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. The search was registered on PROSPERO on 01/12/2022, ID: CRD42022375862. RESULTS: The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia. This study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question. CONCLUSIONS: Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.

Black hairy tongue treated with traditional Chinese medicine: A case report.

RATIONALE: Black hairy tongue (BHT) is a rare condition that is conventionally managed by discontinuing associated medications or habits and practicing good oral hygiene, including tongue brushing. Previous studies have indicated that black tongue coating is often associated with gastrointestinal discomfort, which traditional Chinese medicine (TCM) could be a potentially effective option for treating this condition with minimal side effects. We present a case of BHT diagnosed and treated within 2 weeks by using TCM methods. PATIENT CONCERNS: A 73-year-old woman presented with a chief concern of a black tongue that had persisted for 2 weeks and was accompanied by thirst and diarrhea. These symptoms were initially observed during her hospitalization for the treatment of staghorn calculi, xanthogranulomatous pyelonephritis, and urosepsis. Using the "four diagnostic methods" of TCM, we observed that her tongue had a thick black coating surrounded by a thick white coating; her tongue was of medium size with tooth marks, and its body color was light red. DIAGNOSES, INTERVENTIONS, AND OUTCOMES: On the basis of TCM theory, we made a clinical diagnosis of BHT and "spleen Qi deficiency with turbid dampness," which may have been caused by the antibiotic treatment during hospitalization. Subsequently, we administered a Chinese herbal medicine (CHM) formula comprising a combination of Wu-Ling-San () and a modification of Da-Yuan-Yin (). After 2 weeks of CHM treatment, the patient's BHT was nearly eliminated, and the thick white coating and the corresponding symptoms were ameliorated. After 4 weeks of CHM treatment, the BHT was completely resolved. LESSON AND CONCLUSION: We present a case of BHT, a benign condition that may be caused by antibiotics. The literature does not contain reports on TCM-based diagnosis and treatment strategies for BHT. Using the 4 diagnostic methods of TCM, we observed that BHT was associated with gastrointestinal symptoms, which is consistent with the TCM theory. Moreover, CHM treatment rapidly relieved BHT and related symptoms without adverse events.

Correlation between findings of the oral myofunctional clinical assessment, pressure and electromyographic activity of the tongue during swallowing in individuals with different orofacial myofunctional disorders. / Correlação entre achados da avaliação clínica miofuncional orofacial, a pressão e a atividade eletromiográfica da língua na deglutição em indivíduos com diferentes alterações da motricidade orofacial.

PURPOSE: To correlate the findings regarding the myofunctional orofacial examination, tongue pressure and surface electromyography (sEMG) of deglutition in individuals with different orofacial myofunctional disorders. METHODS: 44 patients (20 males and 24 females, aged between 17 and 63 years old) with different orofacial myofunctional changes were clinically assessed using the Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES-E). In addition, the range of mandibular movements and facial anthropometry were measured, along with the assessment of the tongue pressure (tip and dorsum) and of the electrical activity of the suprahyoid muscles during deglutition, using surface electromyography (sEMG). RESULTS: The statistical analysis found weak correlations between tongue dorsum pressure values, suggesting that the greater the measurement of the lower third of the face, the lower the pressure of the tongue dorsum; the greater the measurement of the overlaps (vertical and horizontal), the higher the pressure of the tongue dorsum; the higher the score from the orofacial evaluation and orofacial functions assessment, the higher the pressure of the tongue dorsum; and the higher the pressure of the tongue dorsum, the higher the pressure of the tongue tip. CONCLUSION: The present study results indicate that the orofacial myofunctional changes found in different groups of patients are more related to the maxillomandibular discrepancies than to the pathologies investigated herein.

OBJETIVO: correlacionar os achados da avaliação clínica miofuncional orofacial, pressão de língua e da eletromiografia de superfície (EMGs) da deglutição de grupos de pacientes com diferentes alterações da motricidade orofacial. MÉTODO: 44 pacientes (20 homens e 24 mulheres com idades entre 17 e 63 anos), com diferentes alterações miofuncionais orofaciais foram avaliados por meio da Avaliação Miofuncional Orofacial com Escores Expandido (AMIOFE-E), avaliação da amplitude mandibular e antropometria facial, mensuração da pressão de língua (ponta e dorso) e exame de Eletromiografia de Superfície (EMGs) em região supra hioidea na tarefa de deglutição de saliva e diferentes volumes de água. RESULTADOS: a análise estatística encontrou algumas correlações fracas que envolvem a pressão do dorso de língua e sugerem que quanto maior for a medida do terço inferior, menor será a pressão do dorso da língua; quanto maior for a medida dos trespasses (vertical e horizontal) maior será a pressão do dorso da língua; quanto maior for a pontuação da avaliação de postura e funções orofaciais, maior será a pressão do dorso de língua e quanto maior for a pressão do dorso de língua, maior será a pressão da ponta da língua. CONCLUSÃO: os resultados sugerem que as alterações miofuncionais orofaciais encontradas nos diferentes grupos de pacientes estão mais relacionadas às discrepâncias maxilomandibulares do que às patologias pesquisadas no presente estudo.

Orofacial-Myofunctional therapy after lingual frenectomy in patient with tongue-tie: a systemic postural approach with mezieres method and postural bench.

AIM: In this study we present the new postoperative oro-myofunctional protocol following frenectomy by atmospheric plasma associated with a systemic postural approach, which determines functional recovery through body symmetry restoration based on the concepts of the French "Mezieres Method" and postural bench. METHODS: A total of 130 patients (76 female, 54 male) affected by ankyloglossia of class III/IV, according to Kotlow's Tongue Tie Classification have been treated with atmospheric plasma followed by oro-myofunctional therapy associated with a systemic postural approach. The overall change, improved/worsened speech, feeding, or sleep has been evaluated through the 10 points Parents Speech Satisfaction (PSS) Score after one week and two months. CONCLUSION: Based on the findings of the current investigation, myofunctional therapy in tongue-tie results in a consistent significant functional ameliorating of feeding capability, speech and sleeping of subject treated as reported with traditional oro-myofunctional therapy.

ODQN-Net: Optimized Deep Q Neural Networks for Disease Prediction Through Tongue Image Analysis Using Remora Optimization Algorithm.

Tongue analysis plays the major role in disease type prediction and classification according to Indian ayurvedic medicine. Traditionally, there is a manual inspection of tongue image by the expert ayurvedic doctor to identify or predict the disease. However, this is time-consuming and even imprecise. Due to the advancements in recent machine learning models, several researchers addressed the disease prediction from tongue image analysis. However, they have failed to provide enough accuracy. In addition, multiclass disease classification with enhanced accuracy is still a challenging task. Therefore, this article focuses on the development of optimized deep q-neural network (DQNN) for disease identification and classification from tongue images, hereafter referred as ODQN-Net. Initially, the multiscale retinex approach is introduced for enhancing the quality of tongue images, which also acts as a noise removal technique. In addition, a local ternary pattern is used to extract the disease-specific and disease-dependent features based on color analysis. Then, the best features are extracted from the available features set using the natural inspired Remora optimization algorithm with reduced computational time. Finally, the DQNN model is used to classify the type of diseases from these pretrained features. The obtained simulation performance on tongue imaging data set proved that the proposed ODQN-Net resulted in superior performance compared with state-of-the-art approaches with 99.17% of accuracy and 99.75% and 99.84% of F1-score and Mathew's correlation coefficient, respectively.

The effects of lingual training: a systematic review with meta-analysis. / Efeitos do treinamento da língua: revisão sistemática com metanálise.

PURPOSE: To assess the effectiveness of myotherapy exercises in increasing tongue pressure and strength. A secondary aim was to analyze the exercise types, training parameters, and functional results. RESEARCH STRATEGIES: This systematic literature review was based on the Prisma protocol guidelines. SELECTION CRITERIA: The review included clinical trials that assessed the effects of tongue muscle training, with no restriction on the language or year of publication. DATA ANALYSIS: The steps included eliminating duplicates; reading abstracts and excluding studies that did not meet the inclusion criteria; reading selected articles in full text, extracting important data, and gathering them in a table; and meta-analysis, using the inverse variance method. The methodological quality of the studies was assessed with the Joanna Briggs Institute's tool. The quality of evidence was assessed with the Grading System of Recommendations Assessment, Development and Evaluation. RESULTS: The meta-analysis indicated a significant increase in maximum anterior and posterior pressure as an effect of training. The most performed exercise was tongue pressure against the palate. However, training parameters varied between studies, and whether exercises alone led to functional improvement cannot be stated. The quality of the evidence was considered low. CONCLUSION: Myotherapy exercises increased anterior and posterior tongue pressure in adults, but the quality of this evidence is low. The studies used various exercise types and training parameters. It cannot be stated whether exercises alone led to functional improvement.

OBJETIVO: Avaliar a eficácia de exercícios mioterápicos no aumento da pressão e da força lingual. Buscou-se, de forma secundária, analisar quais os tipos de exercícios utilizados, os parâmetros de treinamento e os resultados funcionais obtidos. ESTRATÉGIA DE PESQUISA: Revisão sistemática da literatura guiada conforme as diretrizes do protocolo Prisma. CRITÉRIOS DE SELEçÃO: Foram incluídos ensaios clínicos que avaliaram efeitos do treinamento muscular da língua, sem limite quanto ao idioma ou ano de publicação. ANÁLISE DOS DADOS: Incluiu as etapas de eliminação de artigos duplicados; leitura de resumos e exclusão de estudos que não contemplaram os critérios de elegibilidade; leitura na íntegra dos artigos selecionados com extração de informações importantes, reunidas em tabela; e metanálise, realizada por meio do método do inverso da variância. A avaliação da qualidade metodológica dos estudos foi realizada pela ferramenta do Joanna Briggs Institute. A qualidade da evidência foi avaliada pelo Sistema Grading of Recommendations Assessment, Development and Evaluation. RESULTADOS: A metanálise indicou aumento significativo da pressão máxima anterior e posterior como efeito do treinamento. O exercício mais utilizado foi pressão de língua contra o palato, mas os parâmetros de treinamento variaram entre estudos, não sendo possível afirmar que exercícios isolados promovem melhora funcional. A qualidade da evidência foi considerada baixa. CONCLUSÃO: Os exercícios mioterápicos promovem o aumento da pressão anterior e posterior da língua de indivíduos adultos, porém a qualidade dessa evidência é baixa. Há variabilidade quanto aos tipos de exercícios utilizados e parâmetros de treinamento. Não é possível afirmar que os exercícios promovem melhora funcional.

Simultaneous rehabilitation of the tongue and breathing: a physiological necessity / Rééducation concomitante de la langue et de la respiration : une nécessité physiologique

Introduction: Pr. Delaire has understood since 2005 that functional therapy shouldn't try to rehabilitate a praxis but instead focus on the whole created by different oro-facial functions to ensure the creation of a global dynamic balance. That's why rehabilitation of the right tongue posture is a necessary condition for automation as nasal breathing; in the same meaning that rehabilitation of nasal breathing is a necessary condition for automation of the right tongue posture. Fortunately, nature can help us if we respect and follow physiological processes that take into account key points of « connectionism ¼. As a reminder that « learning isn't only the ability to produce an action, a behaviour that was unknown before, it's a process that need to inhibate automatical mental processes ¼. Materials and Methods: The author will develop his philosophy of « connectionism ¼, based on his personal research, his readings on neuroscience and oro-facial functions and his forty years of clinical practice. Conclusion: Orofacial functions influence each other and inhibition of each dysfunction is necessary to automate the newly obtained myofunctional balance.

Introduction: Le Pr Delaire avait compris, dès 2005, que ce n'est pas la rééducation d'une praxie qui doit être prise en charge dans les rééducations fonctionnelles mais l'ensemble des praxies oro-faciales pour assurer un équilibre dynamique global. Ainsi, la rééducation de la respiration est une condition nécessaire à la rééducation de la langue, qui est une condition nécessaire à la rééducation respiratoire. Heureusement, la nature peut nous venir en aide si l'on respecte des processus physiologiques qui intègrent l'apport du connexionnisme sans oublier qu'« apprendre ne relève pas uniquement de la capacité à produire un comportement qui nous était inconnu, c'est aussi une démarche qui vise à inhiber des processus mentaux automatiques ¼. Matériels et méthodes: L'auteur va développer sa philosophie du « connexionisme ¼, basée sur ses recherches personnelles, ses lectures sur les neurosciences et sur les fonctions oro-faciales et ses quarante années de pratiques cliniques. Conclusion: Les fonctions oro-faciales s'influencent entre elles et l'inhibition des différentes dysfonctions est nécessaire pour automatiser l'équilibre nouvellement obtenu.

[Effect of maxillary expansion combined with orofacial myofunctional therapy on the position of the tongue of children with mouth breathing].

Objective:This study aimed to investigate the change of the position of the tongue before and after combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion. Methods:A total of 30 children with skeletal class Ⅱ malocclusion and unobstructed upper airway were selected. The 30 children were divided into mouth-breathing group（n=15） and nasal-breathing group（n=15） and CBCT was taken. The images were measured by Invivo5 software. The measurement results of the tongue position of the two groups were analyzed by independent samples t-test. 15 mouth-breathing children with skeletal class Ⅱ malocclusion were selected for maxillary expansion and orofacial myofunctional therapy. CBCT was taken before and after treatment, the measurements were analyzed by paired sample t test with SPSS 27.0 software package. Results:The measurement of the tongue position of the mouth-breathing and nasal-breathing groups were compared, the differences were statistically significant（P<0.05）. The measurement of the tongue position showed significant difference after the combined treatment of maxillary expansion and orofacial myofunctional therapy in children with mouth-breathing and skeletal class Ⅱmalocclusion（P<0.05）. Conclusion:Skeletal class Ⅱ malocclusion children with mouth-breathing have low tongue posture. The combined treatment of maxillary expansion and orofacial myofunctional therapy can change the position of the tongue.