Exploring the mechanism of action of Shuangyang houbitong granules in the treatment of acute pharyngitis based on network pharmacology and molecular docking.

BACKGROUND: Acute pharyngitis (AP) refers to the acute inflammation of the pharynx, characterized by swelling and pain in the throat. Shuangyang houbitong granules (SHG), a traditional Chinese medicine compound, have been found to be effective in providing relief from symptoms associated with AP. METHODS: The chemical components of SHG were screened using Traditional Chinese Medicine Systems Pharmacology database, HERB database, and China National Knowledge Infrastructure. The targets of the granules were predicted using SwissTargetPrediction database. A network was constructed based on the targets of AP obtained from Genecards database, and protein-protein interaction analysis was performed on the intersection targets using STRING database. Key targets were screened for Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and the binding activity of components and targets was predicted using AutoDockTools-1.5.7. RESULTS: A total of 65 components of SHG that met the screening criteria were retrieved, resulting in 867 corresponding targets. Additionally, 1086 AP target genes were retrieved, and 272 gene targets were obtained from the intersection as potential targets for SHG in the treatment of AP. Molecular docking results showed that the core components genkwanin, acacetin, apigenin, quercetin can stably bind to the core targets glyceraldehyde 3-phosphate dehydrogenase, interleukin 6, tumor necrosis factor, serine/threonine protein kinase, tumor protein 53, and epidermal growth factor receptor. CONCLUSION: The research results preliminarily predict and verify the mechanism of action of SHG in the treatment of AP, providing insights for further in-depth research.

A composition of ursolic acid derivatives from Ludwigia hyssopifolia induces apoptosis in throat cancer cells via the Akt/mTOR and mitochondrial signaling pathways and by modulating endoplasmic reticulum stress.

ETHNOPHARMACOLOGICAL RELEVANCE: Ludwigia hyssopifolia (LH), an ethnopharmacological herb used in Guangxi Zhuang medicine, is known for its extensive therapeutic use in treating throat disorders. The anti-laryngeal-cancer benefits of the ethyl acetate and petroleum ether fractions of the ethanolic extracts of LH have been shown in our prior cell-based research. Nevertheless, the specific impacts and underlying processes by which LH combats throat cancer effects have not been fully understood. AIM OF THE STUDY: This study involved the extraction of a composition containing two derivatives of ursolic acid from LH (LH-CUAD). The present study aimed to assess the anti-throat-cancer effects of these derivatives and the underlying mechanisms through in vitro and in vivo experiments. MATERIALS AND METHODS: Solvent extraction, fractionation, chromatography, and semipreparative high-performance liquid chromatography were used for the extraction, purification, and analysis of LH-CUAD. The in vitro and in vivo anti-throat-cancer effects of LH-CUAD were investigated using the throat cancer cell lines Hep-2 and FaDu as well as Hep-2 tumor-bearing nude mice. RESULTS: LH-CUAD significantly inhibited the proliferation and migration of throat cancer cells without any prominent toxicity. The Hoechst 33258 staining, Annexin V-FITC/PI double-staining assays, and flow cytometry confirmed that LH-CUAD could induce throat cancer cell death from early to late apoptosis in vitro. LH-CUAD exhibited significant antitumor activity and low toxicity in a xenograft model, and induced throat cancer cells apoptosis in vivo. The apoptotic effects of LH-CUAD therapy were validated using Western blotting, which demonstrated the activation of a caspase cascade response triggered by an imbalance between the endoplasmic reticulum and mitochondria. In addition, it was observed that LH-CUAD exhibited inhibitory effects on Akt and mTOR phosphorylation, hence promoting apoptosis. CONCLUSIONS: LH-CUAD induces apoptosis in both in vivo and in vitro models of throat cancer. This effect is achieved by activating the mitochondrial pathway, inhibiting the Akt/mTOR pathway and initiating endoplasmic reticulum stress. The findings of this study suggest that LH-CUAD has the potential to offer a novel approach to the clinical management of throat cancer.

Post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the clinical efficacy on post-stroke dysphagia treated with four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation.@*METHODS@#Sixty patients with post-stroke dysphagia were randomly divided into an observation group and a control group, with 30 cases in each group. The neuromuscular electrical stimulation was adopted in the control group. Besides the treatment as the control group, in the observation group, the four-step acupuncture therapy for opening orifices and benefiting throat was supplemented. Step 1: the three areas of scalp acupuncture on the affected side were stimulated. Step 2: pricking method was operated on the posterior pharyngeal wall. Step 3: bleeding technique was operated at Jinjin (EX-HN 12) and Yuye (EX-HN 13). Step 4: deep insertion of needle was operated at three-pharynx points. The needles were retained for 30 min at the three areas of scalp acupuncture and the three-pharynx points. The intervention of each group was delivered once daily, 6 times a week, at the interval of 1 day. One course of treatment was 1 week and 4 successive courses were required. The rating of Kubota water swallow test, the score of standardized swallowing assessment (SSA) and the rating of Rosenbek penetration- aspiration scale (PAS) were observed before and after treatment in patients of the two groups. The incidence of clinical complications and clinical efficacy were compared between the two groups.@*RESULTS@#Compared with those before treatment, the rating of Kubota water swallow test, the scores of SSA and the rating of PAS of patients in the two groups were decreased after treatment (P<0.01), and the values of the observation group were lower than those of the control group after treatment (P<0.05). The incidence of clinical complications in the observation group was 13.3% (4/30), lower than 36.7% (11/30) in the control group (P<0.05). The total effective rate in the observation group was 93.3% (28/30), which was better than 70.0% (21/30) in the control group (P<0.05).@*CONCLUSION@#The four-step acupuncture therapy for opening orifices and benefiting throat combined with neuromuscular electrical stimulation can improve the swallowing function of patients with post-stroke dysphagia and reduce the incidence of clinical complications.

Evaluación in vitro de la actividad antimicrobiana de un propóleo chileno sobre muestras clínicas de exudados bucofaríngeos y cepas ATCC / In vitro evaluation of the antimicrobial activity of a Chilean propolis on clinical samples of oropharyngeal exudates

Propolis is a substance manufactured by Apis mellifera and has been widely used in folk medicine due to its high concentration of bioactive compounds. The purpose of the following study was to characterize and evaluate in vitro the antimicrobial properties of propolis on clinical samples and ATCC strains. The chemical characterization of propolis presents a concentration of total polyphenols of 247 ± 9 mg EAG g-1 MS, flavones and flavonols 75± 4 mg EQ g-1 MS, flavanonones and flavanonols 118 ± 11 EP g-1 MS. HPLC-DAD identified apigenin, galangin, phenethyl ester of caffeic acid and pinocembrin, in addition to 16 compounds by HPLC MS/MS. Chilean propolis is a natural antimicrobial, showing effectiveness in strains ATCC Staphylococcus aureus, Candida albicans, Trichophyton rubrum and clinical samples of Staphylococcus aureus unlike Escherichia coli. These results demonstrate the antimicrobial effectiveness of the synergy of compounds present in propolis against different human pathogens.

El propóleos es una substancia fabricada por Apis mellifera y ha sido utilizado ampliamente en la medicina popular debido a su alta concentración de compuestos bioactivos. El propósito del siguiente estudio fue caracterizar y evaluar in vitro las propiedades antimicrobianas del propóleos sobre muestras clínicas y cepas ATCC. La caracterización química de propóleos presenta una concentración de polifenoles totales de 247 ± 9 mg EAG g-1 de MS, flavonas y flavonoles 75 ± 4 mg EQ g-1 de MS, flavanononas y flavanonoles 118 ± 11 EP g-1 de MS. Mediante HPLC-DAD se identificó apigenina, galangina, fenetil éster del ácido cafeico y pinocembrina, además de 16 compuestos mediante HPLC MS/MS. El propóleos chileno es un antimicrobiano natural, observándose efectividad en cepas ATCC Staphylococcus aureus, Candida albicans, Trichophyton rubrum y muestras clínicas de Staphylococcus aureus a diferencia de Escherichia coli. Estos resultados demuestran la efectividad antimicrobiana de la sinergia de compuestos presentes en el propóleos ante diferentes patógenos humanos.

Oral allergy syndrome

Oral allergy syndrome (OAS) is an IgE-mediated allergy caused by cross-reacting antigenic determinants in pollens and various fruits, vegetables, and nuts which are known as the most common food allergy in adults. Cross-reactive antigenic proteins include pathogenesis-related-10 protein, profilin, cross-reactive carbohydrate determinant and lipid transfer protein. The prevalence of OAS has been reported at up to 70% of birch pollen allergy. A nationwide multicenter study in our country has recently reported that the prevalence of OAS in Korea is 41.7% of pollen allergy. Typical symptoms of OAS are tingling, itching sense and edema of lips, mouth, and throat immediately after ingestion of raw fruits, vegetables, or nuts. These can progress to systemic symptoms including anaphylaxis. The diagnosis can be made by typical clinical history in patients with pollen allergy. Skin prick test using fresh fruits extracts can be helpful in confirming sensitization to foods, which has better sensitivity than commercial skin prick test or serum specific IgE test. Treatment of OAS is to avoid causative foods. Self-injectable epinephrine should be considered in the case of anaphylaxis. Allergen-specific immunotherapy to pollens has also been tried.

Failed Deglutitive Upper Esophageal Sphincter Relaxation Is a Risk Factor for Aspiration in Stroke Patients with Oropharyngeal Dysphagia

BACKGROUND/AIMS: We attempted to examine the relationship between abnormal findings on high-resolution manometry (HRM) and videofluoroscopic swallowing study (VFSS) of the pharynx and upper esophageal sphincter (UES), and to identify the risk factors for aspiration. METHODS: We performed VFSS and HRM on the same day in 36 ischemic stroke patients (mean age, 67.5 years) with dysphagia. Pressure (basal, median intra bolus, and nadir), relaxation time interval of the UES, and mesopharyngeal and hypopharyngeal contractility (as a contractile integral) were examined using HRM. The parameters of VFSS were vallecular residue, pyriform sinus residue, vallecular overflow, penetration, and aspiration. The association between the parameters of VFSS and HRM was analyzed by the Student's t test. RESULTS: Three (8.3%) and 4 (11.1%) stroke patients with dysphagia had pyriform sinus residue and vallecular sinus residue, respectively, and 5 (13.8%) patients showed aspiration. Mesopharyngeal and hypopharyngeal contractile integrals in patients with residue in the pyriform sinus were significantly lower than those in patients without residue in the pyriform sinus (P < 0.05). Relaxation time intervals in patients with aspiration were significantly shorter than those in patients without aspiration (P < 0.05), and multivariate regression analysis revealed a shorter relaxation time interval as the main risk factor for aspiration (OR, 0.03; 95% CI, 0.01–0.65; P < 0.05). CONCLUSIONS: Manometric measurements of the pharynx and UES were well correlated with abnormal findings in the VFSS, and a shorter relaxation time interval of the UES during deglutition is an important parameter for the development of aspiration.

Quantitative Analysis of Swallowing Function Between Dysphagia Patients and Healthy Subjects Using High-Resolution Manometry

OBJECTIVE: To compare swallowing function between healthy subjects and patients with pharyngeal dysphagia using high resolution manometry (HRM) and to evaluate the usefulness of HRM for detecting pharyngeal dysphagia. METHODS: Seventy-five patients with dysphagia and 28 healthy subjects were included in this study. Diagnosis of dysphagia was confirmed by a videofluoroscopy. HRM was performed to measure pressure and timing information at the velopharynx (VP), tongue base (TB), and upper esophageal sphincter (UES). HRM parameters were compared between dysphagia and healthy groups. Optimal threshold values of significant HRM parameters for dysphagia were determined. RESULTS: VP maximal pressure, TB maximal pressure, UES relaxation duration, and UES resting pressure were lower in the dysphagia group than those in healthy group. UES minimal pressure was higher in dysphagia group than in the healthy group. Receiver operating characteristic (ROC) analyses were conducted to validate optimal threshold values for significant HRM parameters to identify patients with pharyngeal dysphagia. With maximal VP pressure at a threshold value of 144.0 mmHg, dysphagia was identified with 96.4% sensitivity and 74.7% specificity. With maximal TB pressure at a threshold value of 158.0 mmHg, dysphagia was identified with 96.4% sensitivity and 77.3% specificity. At a threshold value of 2.0 mmHg for UES minimal pressure, dysphagia was diagnosed at 74.7% sensitivity and 60.7% specificity. Lastly, UES relaxation duration of <0.58 seconds had 85.7% sensitivity and 65.3% specificity, and UES resting pressure of <75.0 mmHg had 89.3% sensitivity and 90.7% specificity for identifying dysphagia. CONCLUSION: We present evidence that HRM could be a useful evaluation tool for detecting pharyngeal dysphagia.

Drug therapy for the common cold

The common cold is an acute, self-limiting viral infection of the upper respiratory tract involving the nose, sinuses, pharynx and larynx. Drug therapies for the common cold are normally aimed at relieving the symptoms of the illness. Over-the-counter cough and cold medications should not be used in children younger than four years old because of potential harms and lack of benefit. Antibiotics, antitussives, anti-histamines, and inhaled corticosteroids are not effective in children. Products that may improve symptoms in children include expectorants, mucolytics, honey, vitamin C, zinc lozenges, geranium extract, and nasal saline irrigation. In adults, antihistamines, intranasal corticosteroids, codeine, intranasal ipratopium, and antibiotics are not effective. Decongestants, antihistamine/decongestant combi-nations, expectorants, and mucolytics may improve cold symptoms in adults. Nonsteroidal anti-inflammatory drugs and acetaminophen reduce pain secondary to upper respiratory tract infection in adults. Among complementary and alternative medicinetherapeutics, products containing vitamin C, zinc, or garlic may improve cold symptoms in adults. Prophylactic use of probiotics may decrease the frequency of colds in adults and children.

La palmera datilera y la palmera canaria en la medicina tradicional de España / The date palm and canary islands date palm in the traditional herbal medicine of Spain

En la actualidad son muy pocos los usos vigentes. Aunque los dátiles son la materia utilizada con mayor frecuencia, también se han empleado la savia, el polen y el cogollo tierno o palmito. Los dátiles de Phoenix dactylifera se utilizaron como analgésico y para tratar la anemia y trastornos digestivos, o para fortalecer las encías, en el tratamiento de la disfunción eréctil y como afrodisiacos, para facilitar el parto y calmar los dolores postparto, y tratar el prolapso de la matriz o para el exceso de flujo menstrual. También se utilizaron como diuréticos, para la disuria y en trastornos de la vejiga. El uso que más claramente ha persistido es el tratamiento de diversos problemas respiratorios. En uso externo se utilizaron para tratar problemas de la piel, heridas, hemorragias y hemorroides. De la palmera de Canarias (Phoenix canariensis), especialmente en la isla de la Gomera, la savia cruda o guarapo, su concentrado o miel de palma y los resultantes de su fermentación (vino de palma) se consumen como alimento y también se utilizan como diurético, remedio de trastornos génitourinarios, digestivo, para infecciones de la cavidad bucal, expectorante, antitusígeno y para las irritaciones de garganta. En el Toledo de Al-Andalus las espatas de P. dactylifera se utilizaron, hace casi mil años, en el tratamiento de la debilidad, los dolores, nefritis, las enfermedades de la vejiga, trastornos hepáticos (también como preventivo), diarrea, trastornos digestivos, dolores en el abdomen y en el estómago, excesivo sangrado menstrual, úlceras en la piel y sarna, dolores articulares y trastornos cardiacos. La fitoterapia racional debería prestar atención a este recurso, considerar la evidencia científica disponible (farmacológica e incluso clínica) e incorporarlo a nuestro repertorio terapéutico (AU)

O uso medicinal da tamareira e seus produtos foi relativamente comum em Espanha, tendo alcançado o topo da diversidade e importância durante a Idade Média, tanto no Al-Andalus como nos territórios cristãos da fronteira norte, mas foram-se perdendo progressivamente. Estudou-se a evolução histórica dos usos medicinais da tamareira e da tamareira das Ilhas Canárias, tanto na Península Ibérica como nas ilhas Canárias e Baleares .Actualmente, são muito poucos os usos que se mantêm. Relativamente à parte utilizada, as tâmaras são as mais referiadas, mas também existem registos para a seiva, pólen e palmito. As tâmaras de Phoenix dactylifera foram usados como analgésicos, e para o tratamento de anemia e distúrbios digestivos, ou para fortalecer as gengivas, no tratamento da disfunção eréctil e como afrodisíacos, para facilitar o parto e acalmar as dores pós-parto, para tratamento do prolapso uterino ou do fluxo menstrual excessivo. As tâmaras também foram utilizados como diuréticos em disúria e distúrbios da bexiga e são ainda utilizados para o tratamento de vários problemas respiratórios. Externamente foram usados para tratar problemas de pele, feridas, hemorragias e hemorróidas. Da tamareira das Ilhas Canárias (Phoenix canariensis), especialmente na ilha de La Gomera, a seiva (localmente conhecida por guarapo), o seu concentrado (mel de palma), e os produtos resultantes da sua fermentação (vinho de palma) consomem-se como alimentos mas também se utilizam como diuréticos, para tratamento de problemas genito-urinários e digestivos, para infecções orais, como expectorante, antitússico e para tratar irritações da garganta. Há quase mil anos, em Toledo, usavam-se as espatas de P. dactylifera no tratamento de fraqueza, dores, nefrites, doenças da bexiga, doenças do fígado (também em prevenção), diarreia, distúrbios digestivos, dores no abdômen e estômago, fluxo menstrual excessivo, úlceras de pele e sarna, dores articulares e problemas cardíacos.A fitoterapia racional deveria prestar atenção a este recurso, considerar a evidencia científica disponível (farmacológica e mesmo clínica) e incorporá-lo no nosso repertório terapêutico

In Spain the medicinal use of date palm and its products has been relatively common, reaching the highest level of diversity and importance during the Middle Ages, both in Al Andalus and the Christian territories of the northern border. However, uses have become less common since then. Here the historical evolution of medicinal uses of date palm and Canary Island palm in both the Iberian Peninsula and the Canary and Balearic islands are reviewed. At present there are very few reported uses. The dates are the most commonly used product, but the sap, pollen and tender bud of palm (palmito) are also used. The dates of Phoenix dactylifera were used as analgesic, and to treat anaemia and digestive disorders, to strengthen the gums, and in the treatment of erectile dysfunction and as an aphrodisiac, to facilitate childbirth and soothing postpartum pains and treating matrix prolapse or excessive menstrual flow. Dates were also used as diuretics in dysuria and bladder disorders and are still used for the treatment of various respiratory problems. Externally they were used to treat skin problems, wounds, bleeding and haemorrhoids. Canary Palm (Phoenix canariensis) raw juice or sap, or concentrated palm juice, or fermented juice (palm wine) are consumed, especially on the island of La Gomera, as food and are also used as diuretic, as a remedy for genitourinary, digestive, for oral infections, as an expectorant, antitussive and to treat cavity and throat irritations disorders. Almost a thousand years ago in Al-Andalus' Toledo, spathes of P. dactylifera were used, in the treatment of weakness, pain, nephritis, bladder diseases, liver disorders, diarrhea, digestive disorders, pain in the abdomen and stomach, excessive menstrual bleeding, skin ulcers and scabies , joint pain and heart disorders. Modern rational Phytotherapy should pay closer attention to this resource and its potential, considering the available scientific evidence (pharmacological and even clinical) and incorporate it into our modern therapeutic repertoire (AU)

Oral allergy syndrome caused by crown daisy and sesame leaf

Oral allergy syndrome (OAS) is a subtype of food allergy composing of itching sense and edema in the oral cavity, lips, throat, pharynx, and larynx following ingestion of some fresh fruits or vegetables. Although the major pathogenic mechanism of OAS is known to be IgE-mediated response, here we experienced a case of OAS due to crown daisy (CD) and sesame leaf (SL) mediated by a non-IgE antibody mediated mechanism. A 33-year-old female visited our clinic to evaluate numbness of the tongue and gingiva after eating fresh CD and SL for 2 years. The patient had suffered from allergic rhinitis and atopic dermatitis for 20 years and took medications intermittently. There had been a history of food allergy to crab and shrimp. The serum total IgE level was elevated (404 kU/mL). The skin prick test showed strong positive reactions to tree and weed pollens, but not to CD and SL extracts. Enzyme-linked immunosorbant assay for detecting serum specific IgE to crude extracts of CD and SL showed negative results. The basophil activation test performed with crude extracts of CD or SL showed significant up-regulation of CD63-positive basophils by both CD and SL. In conclusion, we report a case of OAS due to CD and SL, not associated with pollen allergy, which is shown to be mediated by a non-IgE mediated mechanism.

Videofluoroscopic and Manometric Evaluation of Pharyngeal and Upper Esophageal Sphincter Function During Swallowing

BACKGROUND/AIMS: The purpose of this study was to determine important manometric metrics for the analysis of pharyngeal and upper esophageal sphincter (UES) function and to investigate the effect of viscosity and other confounding factors on manometric results. METHODS: Manometric studies were performed on 26 asymptomatic volunteers (12 men and 14 women; age, 19-81 years). The manometric protocol included 5 water swallows (5 mL), 5 barium swallows (5 mL) and 5 yogurt swallows (5 mL). Evaluation of high-resolution manometry parameters including basal pressure of the UES, mesopharyngeal contractile integral (mesopharyngeal CI, mmHg . cm . sec), CI of the hypopharynx and UES (hypopharyngeal CI), relaxation interval of UES, median intrabolus pressure and nadir pressure at UES was performed using MATLAB. RESULTS: Mesopharyngeal CIs for barium and yogurt swallows were significantly lower than those for water swallows (both P < 0.05). Hypopharyngeal CIs for water swallows were significantly lower than those for barium swallows (P = 0.004), and median bolus pressure at UES for barium swallows was significantly higher than that for water and yogurt swallows (both P < 0.05). Furthermore, hypopharyngeal CI and median intrabolus pressure at UES were significantly related to age for 3 swallows (all P < 0.01 and P < 0.05, respectively). A significant negative correlation was also noted between nadir pressure at UES and age for water and yogurt swallows (all P < 0.05). CONCLUSIONS: Manometric measurement of the pharynx and UES varies with respect to viscosity. Moreover, age could be a confounding variable in the interpretation of pharyngeal manometry.

Cricopharyngeal achalasia in an old dog / 대한수의학회지

A 10-year-old castrated male papillon presented with nasal discharge, coughing and chronic dysphagia. On physical examination, the dog exhibited sneezing, gurgling and movement of the throat with repeated attempts to swallow fluids. A diagnosis of cricopharyngeal achalasia (CPA) was made based on video fluoroscopic demonstration of failure of relaxation of the upper esophageal sphincter. This report describes the diagnosis of CPA in an old dog, which is rarely diagnosed in older animals.

Auto-LPG (Liquefied Petroleum Gas) and its health outcomes: A review

The use of auto-LPG (Liquefied Petroleum Gas) has spread globally due to its economic and environmental advantages over gasoline and diesel. The growing popularity of auto-LPG in the country has been challenged by reported health complaints from its use instigating alarms among taxi drivers and passengers. This paper aims to review documented health outcomes of auto-LPG among drivers. Health outcomes of auto-LPG are classified to inhalation effects and burns. Auto-LPG is expected to have inhalational effects such as headache, dizziness, dry throat, nausea and dry cough during prolonged exposure caused by leakage from faulty conversions. Fire and explosion causing significant burns were documented in relation to auto-LPG use. Cases of cold burns or frostbite were also reported. Human factors and technical malfunctions causing leakage were implicated on the reported adverse health event. Limited studies on auto-LPG and health outcomes require the development and use of objective assessment of health outcomes and presence of auto-LPG in the driver's environment to make relevant correlations. Regulations governing auto-LPG should be reviewed to formulate strategic interventions to promote health and safety of drivers as well as the passengers.

Oral Allergy Syndrome to Watermelon and Melon / 대한피부과학회지

Oral allergy syndrome (OAS) usually presents as an immediate swelling and itching sensation of the mouth and throat after ingestion of a food allergen. OAS may be the most common food allergy-related manifestation. Watermelon and melon belong to the Cucurbitaceae family and often show allergenic cross reactivity. Profilin is a 13 kda protein that is identified as a relevant pollen allergen in airborne pollen and related plant food allergies. Profilin is found in both watermelon and melon. Here we report a case of OAS to watermelon and melon in an 11 year-old boy. He was positive to the skin prick test, patch test and oral challenge test with watermelon and melon.

How to Perform and Interpret Upper Esophageal Sphincter Manometry

Manometry of the pharynx and the upper esophageal sphincter (UES) provides important information on the swallowing mechanism, especially about details on the pharyngeal contraction and relaxation of the UES. However, UES manometry is challenging because of the radial asymmetry of the sphincter, and upward movement of the UES during swallowing. In addition, the rapidity of contraction of the pharyngoesophageal segment requires high frequency recording for capturing these changes in pressure; this is best done with the use of solid state transducers and high-resolution manometry. UES manometry is not required for routine patient care, when esophageal manometry is being performed. The major usefulness of UES manometry in clinical practice is in the evaluation of patients with oropharyngeal dysphagia.

Diagnosis With Manometry and Treatment With Repetitive Transcranial Magnetic Stimulation in Dysphagia

Videofluoroscopic swallowing study (VFSS) used for the diagnosis of dysphagia has limitations in objectively assessing the contractility of the pharyngeal muscle or the degree of the upper esophageal sphincter relaxation. With a manometer, however, it is possible to objectively assess the pressure changes in the pharynx caused by pharyngeal muscle contraction during swallowing or upper esophageal sphincter relaxation, hence remedying the limitations of VFSS. The following case report describes a patient diagnosed with lateral medullar infarction presenting a 52-year-old male who had dysphagia. We suggested that the manometer could be used to assess the specific site of dysfunction in patients with dysphagia complementing the limitations of VFSS. We also found that repetitive transcranial magnetic stimulation was effective in treating patients refractory to traditional dysphagia rehabilitation.

Specific Movement of Esophagus During Transient Lower Esophageal Sphincter Relaxation in Gastroesophageal Reflux Disease

BACKGROUND/AIMS: Transient lower esophageal sphincter relaxation (TLESR) is the main mechanism of gastroesophageal reflux disease (GERD). The aim of this study was to investigate the characteristics of transient lower esophageal sphincter movement in patients with or without gastroesophageal reflux by high-resolution manometry (HRM). METHODS: From June 2010 to July 2010, we enrolled 9 patients with GERD (GERD group) and 9 subjects without GERD (control group), prospectively. The manometry test was performed in a semi-recumbent position for 120 minutes following ingestion of a standardized, mixed liquid and solid meal. HRM was used to identify the frequency and duration of TLESR, esophageal shortening length from incomplete TLESR, upper esophageal sphincter (UES) response, and the related esophageal motor responses during TLESR. RESULTS: TLESR occurred in 33 in the GERD group and 34 in the control group after 120 minutes following food ingestion. Duration of TLESR and length of esophageal shortening did not differ between 2 groups. UES pressure increase during TLESR was mostly detected in patients with GERD, and UES relaxation was observed frequently in the control group during TLESR. TLESR-related motor responses terminating in TLESR were predominantly observed in the control group. CONCLUSIONS: Increased UES pressure was noted frequently in the GERD group, suggesting a mechanism for preventing harmful reflux, which may be composed mainly of fluid on the larynx or pharynx. However, patients with GERD lacked the related motor responses terminating in TLESR to promote esophageal emptying of refluxate.

Antibiotics Susceptability of Streptococcus pneumoniae Isolated from Pharynx in Healthy Korean Children and Choice of Proper Empirical Oral Antibiotics Using Pharmacokinetics/Pharmacodynamics Model / 소아감염

PURPOSE: Pneumococcus is one of the most important causes of invasive infection through the childhood period. In January 2008, the Clinical and Laboratory Standards Institute (CLSI) published revised penicillin breakpoints for Streptococcus pneumoniae and penicillin susceptibility rates of S. pneumoniae increased in Korea. This study was performed to determine the probability of oral amoxicillin for the empirical treatment achieving bactericidal exposure against pneumococcus using pharmacodynamics model. METHODS: Twenty-three isolates of pneumococci were subjected to determine minimum inhibitory concentration (MIC) for beta-lactams and macrolide. For the beta-lactams, exposure of fT >MIC (time that free drug concentrations remain above the MIC) for 50% of the administration interval have determined the probability of target attainment (PTA), and regimens that had a PTA >90% were considered optimal. An analysis was performed by applying MIC of 23 isolates to a 5000-patient Monte Carlo simulation model. RESULTS: Among 23 isolates from healthy children, 7 (30.4%) isolates were MIC 90% at MIC < or =1.0 microg/mL but PTA decreased to 52% at MIC 2 microg/mL, whereas amoxicillin 90 mg/kg/day can predict 97% of PTA at MIC 2 microg/mL. Overall, oral amoxicillin 90 mg/kg/day for the empirical treatment against pneumococcus can expect more successful response in Korean children. CONCLUSION: Considering the resistantce pattern of pneumococci in Korean children, we estimate that oral amoxicillin 90 mg/kg/day will provide a pharmacodynamic advantage for the empirical treatment against pneumococcus. And low dose amoxicillin or macrolide are expected to have higher chance of treatment failure than high dose oral amoxicillin.

A Case of Anaphylaxis after the First Dose of Sublingual Immunotherapy with House Dust Mite / 소아알레르기및호흡기학회지

The advantages of sublingual immunotherapy (SLIT) are its friendly route of administration and less frequent occurrence of severe side-effects. The most frequently reported events were irritation of the throat and oral itching. According to the recent data, the number of side effects seems to be dose-dependent. We report on one case of anaphylaxis after the first dose of SLIT with house dust mite drop. A 10-year-old girl suffered from severe allergic rhinitis with perennial symptoms and asthma for which a low dose inhaled corticosteroid was used. Her allergy workup disclosed a positive skin prick test to Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, hazel tree, alder, dog, cat, platane, and acacia pollens. We started SLIT (Pangramin SLIT, ALKAbello, Madrid, Spain) with D. pteronyssinus and D. farinae. Fifteen minutes after the first dose taken at home, she experienced local irritation, lip swelling, facial rash, rhinorrhea and cough. Provocation test was performed in the clinic with the same drug (0.00015 microg/drop, 1.6 STU/mL of D. pteronyssinus and D. farinae, respectively). After twenty minutes, she reported lip swelling, perioral wheals, rash and cough. Wheezing was aggravated, and peak expiratory flow rate (PEFR) dropped by 13% compared to prechallenge PEFR. We stress to have the first dose of SLIT taken in the clinic with an observation period.

The Effect of Relaxation Music on Anxiety in Subjects Performed Unsedated Esophagogastroduodenoscopy / 가정의학회지

BACKGROUND: Esophagogastroduodenoscopy is a very important method to detect gastroduodenal lesions. But the investigation might be delayed due to its own discomfort and anxiety. This study was performed to evaluate the effect of relaxation music on relief of anxiety and physical discomfort during unsedated esophagogastroduodenoscopy. METHODS: From March 3 to May 14 2009, 104 clients who have undergone unsedated esophagogastroduodenoscopy more than once in the past were enrolled in this study. The subjects were randomly assigned to receive either relaxation music (music, N = 52) or no music (control, N = 52) before esophagogastroduodenoscopy. The subjects recorded their anxiety and physical discomfort about latest and today endoscopy by visual analogue scale (VAS). At pre and post music listening, systolic, diastolic blood pressure and heart rate were measured. RESULTS: There was a significant difference of anxiety VAS between music and control group (music, decrease 1.1 +/- 2.1; control, increase 0.0 +/- 1.9; P = 0.008). Throat discomfort VAS was not significant (music, decrease 0.9 +/- 1.8; control, decrease 0.5 +/- 2.7; P = 0.33). Dyspnea VAS decreased in both groups (music, 0.6 +/- 2.2; control, 0.4 +/- 2.5; P = 0.68). Nausea & vomitting VAS also decreased in both group (music, 0.9 +/- 2.2; control, 1.1 +/- 2.1, P = 0.71). There were no significant vital sign changes premusic and postmusic, In both group vital signs increased. Mean differences of systolic pressure(1.0 +/- 11.4 vs. 1.6 +/- 11.1) and diastolic pressure (0.7 +/- 7.3 vs. 1.3 +/- 5.7) were lower in music group, and mean difference of heart rate (1.8 +/- 9.5 vs. 1.5 +/- 8.0) was lower in control group. But There were no significant vital sign changes premusic and postmusic (each P = 0.8, P = 0.62, P = 0.89). CONCLUSION: Listening relaxation music before unsedated esophagogastroduodenoscopy may reduced anxiety.