Occlusal Support, Dysphagia, Malnutrition, and Activities of Daily Living in Aged Individuals Needing Long-Term Care: A Path Analysis.

OBJECTIVES: This study aimed to examine the interrelationships among occlusal support, dysphagia, malnutrition, and activities of daily living in aged individuals needing long-term care. DESIGN: Cross-sectional study and path analysis. SETTING: Long-term health care facilities, acute care hospitals, and the community. PARTICIPANTS: Three hundred and fifty-four individuals aged ≥ 65 years with dysphagia or potential dysphagia in need of long-term care. MEASUREMENTS: The modified Eichner Index, Dysphagia Severity Scale, Mini Nutritional Assessment Short Form, and Barthel index. RESULTS: The participants included 118 males and 236 females with a mean (standard deviation) age of 83 (8) years. A total of 216 participants had functional occlusal support with or without dentures. Of the total participants, 73 were within normal limits regarding the severity of dysphagia, 119 exhibited dysphagia without aspiration, and 162 exhibited dysphagia with aspiration. Only 34 had a normal nutritional status, while 166 participants were malnourished, and 154 were at risk of malnutrition. The median Barthel index score was 30. Path analysis indicated two important findings: occlusal support had a direct effect on dysphagia (standard coefficient = 0.33), and dysphagia was associated directly with malnutrition (standard coefficient = 0.50). Dysphagia and malnutrition were associated directly with impaired activities of daily living (standard coefficient = 0.57, 0.22). CONCLUSION: In aged individuals needing long-term care, occlusal support is associated directly with dysphagia and indirectly with malnutrition and activities of daily living via dysphagia.

A drug formulation using an alginate hydrogel matrix for efficient oral delivery of the manganese porphyrin-based superoxide dismutase mimic.

In order for patients to avail of the therapeutic benefits of antioxidant drugs efficiently and conveniently, a robust oral delivery system needs to be developed. However, a common problem in oral drug delivery is ensuring that the drug remains functionally intact even after it has passed through the acidic environment of the gastrointestinal (GI) tract. To protect drugs within the GI environment, we formulated a design based on encapsulating liposomal drugs by using an alginate matrix as a carrier. The liposomal drug was composed of manganese porphyrin (Mn-por), which has been developed as a mimic of superoxide dismutase (SOD), as the therapeutic agent based on the antioxidative effect, namely superoxide (O2˙(-)) inhibitory activity. A cytochrome c assay revealed that the O2˙(-) inhibitory activity of Mn-por could be maintained even after treatment with simulated gastric and intestinal fluids. We demonstrated that oral administration of the formulated drug significantly inhibited the growth of transplanted tumors in mice. The drug formulation presented in this study would be a good candidate for orally available systems, which can effectively deliver SOD mimics.

The localization of DMPO spin adducts of OH in endothelial cells exposed to hydrogen peroxide.

Examination by electron spin resonance (ESR) spectroscopy revealed the localization of 5,5-dimethyl-l-pyrroline-N-oxide (DMPO) spin adducts of hydroxyl radicals (.OH) produced by bovine endothelial cells exposed to hydrogen peroxide. Addition of 10 mM chromium oxalate, a line-broadening agent, to the reaction mixture virtually abolished the signal of DMPO-OH spin adducts. Moreover, the spin adducts were recovered in the filtrated fraction of the cell suspension. We, therefore, concluded that the location of DMPO-OH due to .OH radicals produced by endothelial cells was extracellular. Contrastingly, the site of formation of DMPO-OH was confirmed to be intracellular by the effect of Desferal, an iron chelator, and the effect of poly(ethylene glycol), an extracellular scavenger of OH radicals, as previously reported. The DMPO-OH adducts in the cell suspension mixture were degraded by a cyanide sensitive pathway and they were apparently more unstable than in the extracellular fraction. The initial amount of DMPO-OH adducts formed in endothelial cells could potentially be monitored by the DMPO-OH signals in the extracellular reaction mixture better than those in the cell suspension mixture.

Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder.

Examined hypothalamic-pituitary-adrenal axis (HPA axis) function in 30 children with attention-deficit hyperactivity disorder (ADHD) by measuring the diurnal variation and response to the dexamethasone suppression test (DST) of saliva cortisol. Normal diurnal saliva cortisol rhythm was found in only 43.3% of the ADHD children. DST showed suppression in 46.7% of the ADHD children. An abnormal diurnal rhythm and nonsuppression to the DST were more frequent in the severely hyperactive group than in the mildly were more frequent in the severely hyperactive group than in the mildly hyperactive group of children with ADHD. These results suggest abnormalities in HPA axis function in some children with ADHD, especially those exhibiting severe hyperactivity.

Cytokines facilitate chemotactic motility of breast carcinoma cells.

BACKGROUND: Both growth and motility of various tumor cells have been shown to be influenced by surrounding cells such as lymphocytes, histiocytes and fibroblasts through various cytokines, growth factors and extracellular matrices. The role of cytokines and extracellular matrices produced by lymphocytes, histiocytes and fibroblasts on migration and invasion of breast carcinoma cells has not been fully investigated METHODS: We investigated the effect of hepatocyte growth factor (HGF), interleukin (IL)-6, IL-8, IL-11, soluble type IV collagen and soluble laminin on the migration of 3 human breast carcinoma cell lines, MDA-MB-231, MCF-7 and T-47D, using a cell culture insert and a biocoat matrigel invasion chamber to assess migration across a matrigel-coated polyethylene telephtalate membrane. RESULTS: HGF, IL-6, IL-11 and IL-8 induced significant migration of MDA-MB-231 cells depending on the dose of each cytokine. However, type IV collagen and laminin inhibited migration of MDA-MB-231 cells. In contrast, IL-8 inhibited migration of MCF-7 cells and IL-6 induced significant migration of T-47D cells, while no other cytokine or extracellular matrix induced significant migration of MCF-7 and T-47D cells. Only HGF induced significant invasion of MDA-MB-231 cells depending on the dose. MCF-7 and T-47D cells did not invade in response to any of the cytokines and extracellular matrices tested. CONCLUSIONS: These results suggest the possibility that the potency of chemotaxis or chemoinvasion differs according to the breast carcinoma cell line and that various cytokines and extracellular matrices secreted by lymphocytes, histiocytes and fibroblasts in the stroma of breast carcinoma can affect the invasion of breast carcinoma cells.

Experience with intraarterial infusion of styrene maleic acid neocarzinostatin (SMANCS)-lipiodol in pancreatic cancer.

A 54 year-old man was admitted to our hospital and diagnosed with inoperable cancer in the body and tail of the pancreas. The spleen was embolized at its hilum with a coil to infuse an anti-tumor agent selectively into the pancreatic parenchyma and transcatheter intraarterial infusion (TAI) of styrene maleic acid neocarzinostatin (SMANCS)-Lipiodol, 3 mg, was performed. The computed tomography (CT) scan taken immediately after TAI revealed the incorporation of SMANCS-Lipiodol into the site of the pancreatic tail. At 2 weeks, a small amount of SMANCS-Lipiodol remained and clearness of the tumor margin was lacking in the pancreatic tail, but no remarkable change was noted in the body. As for the laboratory data, pancreatic enzyme level was not elevated immediately after TAI. At 2 weeks, tumor markers showed improvement in CEA (3.9-->2.6 ng/ml) and Elastase 1 (370-->230 ng/ml), but little change was seen in CA 19-9 (1600 U/ml: no change) and DUPAN-2 (730-->740 U/ml). In pancreatic cancer, SMANCS-Lipiodol could be infused from the splenic artery into the pancreatic parenchyma by the splenic arterial embolization.

Evaluation of the biocompatibility of a new method for heparin coating of a cardiopulmonary bypass circuit.

The biocompatibility of the Terumo (Terumo Corporation, Tokyo, Japan) covalent heparin coating method in a cardiopulmonary bypass (CPB) circuit was evaluated in ex vivo and in vivo experiments. In the ex vivo experiment, fresh human heparinized blood primed both a miniature heparin coated circuit (HCC) and the identical noncoated circuit (NCC), and was circulated simultaneously for 2 hr (n = 6). In the in vivo experiment, 10 rabbits underwent 2 hr of CPB under systemic heparinization (ACT > 400 sec) with HCC (n = 5) and with NCC (n = 5). In the ex vivo study, thrombin/anti-thrombin III complex, thromboglobulin, platelet factor IV, granulocyte elastase, and C3a were significantly lower in the HCC than in the NCC at 60 and 120 min of circulation (p < 0.05). In the in vivo study, platelet counts (percent of value at 10 min of CPB) were significantly higher in the HCC than NCC (HCC:NCC 87 +/- 10:71 +/- 12 at 60 min, 81 +/- 17:56 +/- 16 at 120 min). Scanning electron microscopic examination of the circuits showed less significant adhesion and pseudopod formation of platelets in the HCC than NCC in both ex vivo and in vivo situations. These results demonstrate that this heparin coated CPB circuit provides superior biocompatibility compared with a noncoated circuit by reducing the activation of the coagulation cascade, platelets, leukocytes, and complement.

Microradiographic and microscopic investigation of a rare case of complex odontoma.

An extremely rare case of odontoma that erupted into the oral cavity is presented. The lesion was surgically removed from a 14-year-old girl and examined by soft x-ray radiography, microradiography, and microscopy to determine whether the lesion was complex or compound. Macroscopically, the surface of the lesion was slightly lobular and solid, resembling the surface of an osteoma. The soft x-ray radiograph obtained from the surgical specimen showed radially arranged radiopaque spicules. Microradiographically, dentin was shown to be present in relatively large quantities and to form the bulk of the tumor, with irregular enamel and cementum in small quantities. There were numerous, comparatively well-formed, enamel-free, toothlike structures in the peripheral region of the tumor. Microscopically, the toothlike structures were seen to be arranged radially; this corresponded to the microradiographic findings. Each structure consisted of a central core of pulp tissue encased in a shell of dentin. In the central area of the mass, there was an irregular conglomerate of dentin, enamel, cementum, and pulp tissue. The findings showed that the lesion was a complex odontoma.

Conditions required for a hybrid artificial liver support system using a PUF/hepatocyte-spheroid packed-bed module and it's use in dogs with liver failure.

We studied the effects of a hybrid artificial liver support system we developed on dogs with hepatic failure. The system consisted of a multi-channel polyurethane foam packed-bed culture module, including primary dog hepatocyte spheroids. Blood ammonia was well metabolized by 20 g hepatocytes, but the other functions such as glucose concentration, total bile acid concentration, and survival time required 30 g hepatocytes to improve conditions. We found that we should use a culture substratum that easily forms spheroids, and that an artificial liver module should be used as soon as possible after spheroid formation by hepatocytes in the module.

Development of a hybrid artificial liver using a polyurethane foam/hepatocyte-spheroid packed-bed module.

Primary dog hepatocytes spontaneously formed spheroids in the pores of polyurethane foam (PUF) within 1-2 days of stationary culture. The spheroids, about 100-150 microm in diameter, partly attached to the surface and immobilized inside these pores. The lidocaine disappearance rate decreased to about 4 microg/10(5) viable cells/day for 10 days, while in the PUF/spheroid culture the rate was maintained at almost the initial level of 8 microg/10(5) viable cells/day for 10 days. Then, two scales of PUF packed-bed modules were designed. A small module (PUF volume; 14.5 cm3) was used for in vitro culture to investigate optimum culture conditions, and a large module (PUF volume; 300 cm3) was designed for dog experiments. Hepatocytes inoculated in these modules also formed spheroids and maintained almost the same activity of albumin secretion rate (111 microg/cm3 PUF/day in the small module and 87.7 microg/cm3 PUF/day in the large module). These results indicate that the PUF packed-bed module containing hepatocyte-spheroids is promising as a hybrid artificial liver.

Contribution of conformational change of polymer structure to electrochemomechanical deformation based on polyaniline.

The pH dependencies of electrochemomechanical deformation (ECMD) including the cyclic voltammetry and the expansion ratio in conducting polymers, polyaniline (PANI), and poly(o-methoxyaniline) film were studied to elucidate the mechanisms. It was found that the ECMD is governed by the conformational change of polymer structure as well as the insertion of bulky ions in the manner of comparable magnitude. Expansion ratios >20% in the ECMD were demonstrated for the thickness direction of PANI film. The results suggest that the magnitude of ECMD can be improved by choosing the preparation method of films.

Associated injuries and mechanism of atlanto-occipital dislocation caused by trauma.

Injuries associated with traumatic atlanto-occipital dislocation (AOD) leading to death were analyzed in 11 patients, nine injured by traffic accidents, of which five were victims of car-pedestrian accidents. On admission, unconsciousness and respiratory arrest were noted in all patients, and cardiac arrest in nine. Skull and cervical roentgenograms revealed enlargement of the retropharyngeal space due to injury of the vertebral artery or its branches in nine patients, atlanto-axial dislocation (C-1-C-2 separation) in four, and skull fracture in four. Computed tomography demonstrated subarachnoid hemorrhage (SAH) in the upper cervical and posterior fossa in nine patients, fourth ventricular hematoma in seven, and atlas fracture in three. SAH and ventricular hematoma were due to craniocervical injury. Other common injuries were injury of face and head excluding the mandibular region in 10 patients, mandibular fracture in three, severe chest injuries in eight, and intraperitoneal bleeding in two. The overall outcome was poor. Nine patients died within 13 hours of admission, one was diagnosed as brain dead 8 days after the accident, and the other one survived in a persistent vegetative state. Early death is probably caused by associated severe injuries, i.e. chest injuries and intraperitoneal bleeding rather than AOD. Although injury of the mandibular region is known to be associated with AOD, head, breast, and abdominal trauma may also lead to neck hyperextension-flexion in various directions. Whatever the direct cause, a distractive force to the craniocervical joint by hyperextension-flexion appears to be important in the mechanism of AOD.

Neuron-immune interactions in the sensitized thalamus induced by mustard oil application to rat molar pulp.

We have reported that mustard oil application to the rat dental pulp induces neuronal activation in the thalamus. To address the mechanisms involved in the thalamic changes, we performed neuronal responsiveness recording, immunohistochemistry, and molecular biological analysis. After mustard oil application, neuronal responsiveness was increased in the mediodorsal nucleus. When MK801 (an N-methyl-D-aspartate receptor antagonist) was applied to the mediodorsal nucleus, the enhanced responsiveness was decreased. N-methyl-D-aspartate receptor 2D, glial fibrillary acidic protein, and antigen-presenting cell-related gene mRNAs in the contralateral thalamus were up-regulated at 10 minutes after mustard oil application, but were down-regulated within 10 minutes after the antagonist application. OX6-expressing microglia and glial fibrillary acidic protein-expressing astrocytes did not increase until 60 minutes after mustard oil application. These results suggested that the thalamic neurons play some roles in regulating the glial cell activation in the mediodorsal nucleus via N-methyl-D-aspartate receptor 2D during pulp inflammation-induced central sensitization.

High cervical disc lesions in elderly patients--presentation and surgical approach.

The incidence of high cervical disc lesions is extremely rare, and the mechanism of their development is unclear. We report these three cases, and discuss the possible mechanisms. We also describe surgical strategies for these lesions. The first and second cases were an 82-year-old male and an 84-year-old male with retro-odontoid disc hernia. The third was an 83-year-old female with a herniated disc at C2/C3. To investigate Aetiological mechanisms of these lesions, we examined the findings on cervical images in extension and flexion, and compared the results in a younger than 80-year-old group and an older than 80-year-old group. The patients underwent surgery via a posterolateral intradural approach. Wide laminectomy and incision of the dentate ligaments enabled access to the ventral space of the upper cervical spinal canal and sufficient decompression. All patients became ambulatory postoperatively without special fixation of the cervical spine. In the younger group, the level mostly loaded during cervical movement was C5/6, however, the levels in the older group were C2/3 and C3/4. In elderly patients, less mobilization of the middle and/or lower cervical spine due to spondylotic change causes overloading at higher levels resulting in high cervical disc lesions. Retro-odontoid disc lesions can be caused by a herniated disc at C2/C3, which migrates upward. Regarding surgical strategy, the posterolateral intradural approach is less invasive and more advantageous for these lesions.

Minimizing displacement of the proximal segment after bilateral sagittal split ramus osteotomy in asymmetric cases.

PURPOSE: This study evaluated a modified sagittal split ramus osteotomy designed to minimize displacement of the proximal segmentation asymmetric cases. PATIENTS AND METHODS: Nine patients with facial asymmetry were corrected with modified bilateral sagittal split ramus osteotomy from November 1992 to February 1999. Preoperative and 3-month postoperative anteroposterior (AP) radiographs were traced and compared. The angle of mandibular rotation of the proximal segments was obtained by measuring the intersection of lines passing through the upper rim of the orbit and the lateral border of the proximal segment. The condition of the temporomandibular joint (TMJ) was evaluated clinically by measuring the interincisal distance and looking for any untoward symptoms. RESULTS: The data showed an average 1.94 degrees +/- 1.18 degrees difference between the preoperative and postoperative condition and no clinical signs of TMJ symptoms. These findings support the use of this procedure for treating asymmetric mandibles.

[Estimating organ doses of dental students in dental radiographic exercises].

To estimate doses absorbed in organs of dental students in the exercises of dental radiography, we measured the average organ doses of the dental radiographic examinations and sent out questionnaires about the radiographic exposure of the dental students. We selected five organs in the head and neck regions: lens of the eye, parotid gland, submaxillary gland, thyroid and pituitary fossa. The dose determinations were made for the full mouth intra-oral radiography with 10 films, and panoramic radiography and cephalometric radiography. Doses for all organs, except for the parotid gland, were widely distributed with one peak. The highest average dose per dental student was about 5000 microGy for the parotid gland, about 2900 microGy for the submaxillary gland, about 900 microGy for the lens of the eye, about 480 microGy for the thyroid and about 140 microGy for the pituitary fossa. Dose limits for dental students in such exercises have not been yet established. But the organ doses, especially for the parotid gland, appear very high. To reduce exposure in the exercises and to protect the dental students from excess exposure, we need to reconsider the study of dental radiographic techniques.