Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial.

BACKGROUND: Effortful swallowing training (EST) is a remedial method for the training of swallowing-related muscles in the oropharyngeal phase. However, clinical evidence of its effectiveness is insufficient. AIMS: To investigate the effects of EST on tongue strength and swallowing function in patients with stroke. METHODS & PROCEDURES: Stroke patients with dysphagia were randomly assigned to one of two groups: an experimental group (n = 12) and a control group (n = 12). The experimental group underwent EST, while the control group performed saliva swallowing. Training was conducted 5 days per week for 4 weeks. Both groups underwent conventional dysphagia treatment for 30 min/day, 5 days/week for 4 weeks. OUTCOMES & RESULTS: Tongue strength was assessed using the Iowa Oral Performance Instrument. The Videofluoroscopic Dysphagia Scale (VDS), based on a videofluoroscopic swallowing study, was used to analyze oropharyngeal swallowing function. The experimental group showed greater improvements in anterior and posterior tongue strength compared with the control group (p = 0.046 and 0.042, respectively), and greater improvement in the oral phases of the VDS (p = 0.017). CONCLUSIONS & IMPLICATIONS: We recommend EST as a remedial strategy for improving tongue strength and oral swallowing function in patients with stroke.

Comparison of orbicularis oris muscle strength and endurance in young and elderly adults.

[Purpose] The purpose of this study was to compare the strength and endurance of the orbicularis oris muscle in healthy Korean (young vs. elderly adults). [Participants and Methods] A total of 60 participants (30 young adults and 30 elderly adults) were recruited. The Iowa Oral Performance Instrument was used to measure orbicularis oris muscle maximal strength and endurance. [Results] Elderly adults showed significantly lower orbicularis oris muscle strength and endurance than younger adults. [Conclusion] This study confirmed a significant age-related decrease in orbicularis oris muscle strength and endurance. The data collected will be useful as a basis for future on speech and swallowing therapy.

Oropharyngeal swallowing function in patients with presbyphagia.

[Purpose] This study investigated the characteristics of oropharyngeal swallowing function in patients with presbyphagia. [Participants and Methods] Data for 25 patients with presbyphagia were retrospectively analyzed. The oropharyngeal swallowing function was evaluated using VDS based on videofluoroscopic swallowing study. [Results] Lip closure, mastication, laryngeal elevation, and aspiration showed a relative decrease in function. [Conclusion] This study showed a reduction in oropharyngeal swallowing in patients with presbyphagia. Our results may help in the diagnosis and treatment of presbyphagia.

Effect of expiratory muscle strength training on swallowing-related muscle strength in community-dwelling elderly individuals: a randomized controlled trial.

OBJECTIVE: This study aimed to investigate the effect of expiratory muscle strength training (EMST) on swallowing-related muscle strength in community-dwelling elderly individuals. BACKGROUND: Expiratory muscle strength training is an intervention for patients with oropharyngeal dysphagia. This training is associated with respiration, coughing, speech and swallowing, and its effectiveness has been proven in previous studies. However, the effects of EMST on elderly individuals and evidence are still lacking. MATERIALS AND METHODS: This study included 24 community-dwelling senior citizens aged ≥65 years (12 men and 12 women). The experimental group trained at the 70% threshold value of the maximum expiratory pressure using an EMST device 5 days per week for 4 weeks and comprised five sets of five breaths through the device for 25 breaths per day. The placebo group trained with a resistance-free sham device. Post-intervention, muscle strength of the bilateral buccinator and the orbicularis oris muscles (OOM) was measured using the Iowa Oral Performance Instrument. Surface electromyography was used to measure activation of the suprahyoid muscles (SM). RESULTS: After intervention, the strength of the buccinator and the OOM in the experimental group showed statistically significant improvement. There was also statistically significant activation of the SM. In the placebo group, the strength of the orbicularis oris muscle alone improved. No statistically significant differences between groups were found for the strength of the buccinator and the OOM and the activation of the SM. CONCLUSION: EMST had a positive effect on swallowing-related muscle strength in elderly participants.

Differences in maximal strength and endurance of the tongue according to region in healthy adults.

[Purpose] The purpose of this study was to identify differences in maximal strength and endurance of the tongue among healthy adults. [Subjects and Methods] A total of 60 healthy volunteers (30 men; 30 women; age range, 20-26 years) were recruited and evaluated for maximal strength and endurance of the anterior and posterior regions of the tongue using the Iowa Oral Performance Instrument. [Results] Tongue strength in the anterior region was greater than that in the posterior region. In contrast, tongue endurance in the posterior region was greater than that in the anterior region. [Conclusion] In conclusion, these results confirm that the anterior region of the tongue exhibits greater strength, whereas the posterior region exhibits greater endurance.

Effect of neuromuscular electrical stimulation on lip strength and closure function in patients with dysphagia after stroke.

[Purpose] This study aimed to investigate the effect of neuromuscular electrical stimulation (NMES) on lip strength and closure function of patients with dysphagia after stroke. [Subjects and Methods] Eight patients with dysphagia were recruited. NMES was applied to the orbicularis oris muscle. All the participants received NMES for 30 min/d, 5 d/wk, for 4 weeks. Lip strength was measured using the Iowa Oral Performance Instrument. To assess lip closure, the lip closure subitem of the videofluoroscopic dysphagia scale was used. [Results] Lip strength showed significant improvement and lip closure function showed a significant decrease. [Conclusion] This study demonstrates that NMES is useful for improving lip strength and closure function.

Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study.

[Purpose] The purpose of this study was to investigate the effect of jaw opening exercise (JOE) on aspiration in patients with dysphagia after stroke. [Subjects and Methods] Three subjects were recruited. Isometric and isotonic JOE were performed using a rubber ball, 5 days a week for 4 weeks. Aspiration was evaluated using the penetration-a spiration scale (PAS) based on a videofluoroscopic swallowing study. [Results] All subjects showed a score reduction of at least 1 point and a maximum reduction of 2 points in the PAS in the liquid type. [Conclusion] This study confirmed that JOE can be used to reduce aspiration in patients with dysphagia after stroke.

Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study.

[Purpose] The purpose of this study was to investigate the effect of self-exercise on oropharyngeal swallowing function in patients with dysphagia. [Subjects and Methods] Nine patients with dysphagia after stroke were recruited. Self-exercise including effortful swallowing, tongue strengthening, and shaker exercise was performed 5 times a week for 4 weeks. Swallowing function was evaluated using the videofluoroscopic dysphagia scale (VDS) based on a videofluoroscopic swallowing study. [Results] There were significant differences in both the oral and pharyngeal phases of the VDS before and after the intervention. [Conclusion] This study demonstrated that bedside self-exercise is a positive method to improve oropharyngeal swallowing function in patients with dysphagia after stroke.

Effect of mirror therapy and electrical stimulation on upper extremity function in stroke with hemiplegic patient: a pilot study.

[Purpose] This study investigated the effects of mirror therapy and neuromuscular electrical stimulation on upper extremity function in stroke patients. [Subjects and Methods] This study recruited 8 stroke patients. All patients were treated with mirror therapy and neuromuscular electrical stimulation five times per week for 4 weeks. Upper limb function evaluation was performed using upper extremity part of fugl meyer assessment. [Results] Before and after intervention, fugl meyer assessment showed significant improvement. [Conclusion] In this study, mirror therapy and neuromuscular electrical stimulation are effective methods for upper extremity function recovery in stroke patients.

Comparison of maximal tongue strength and tongue strength used during swallowing in relation to age in healthy adults.

[Purpose] The aim of this study was to measure and compare the maximal tongue strength and tongue strength used during swallowing in young and older adults. [Subjects and Methods] The study recruited 80 healthy young (aged 20 to 39 years) and older adults (aged ≥65 years) in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and tongue strength used during swallowing. For each subject, the peak value of three measurements was recorded and analyzed. [Results] Maximal tongue strength was statistically significantly higher for the young adults group than the older adults group. Conversely, tongue strength used during swallowing was statistically significantly higher for the older adults group than the young adults group. The percentages of tongue strength used during swallowing for the young adults and older adults groups were approximately 38.8% and 53.8%, respectively. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength than young adults, but a higher tongue strength used during swallowing.

Differences in maximal isometric tongue strength and endurance of healthy young vs. older adults.

[Purpose] The aim of this study was to measure and compare the maximal tongue strength and endurance of young and older adults. [Subjects and Methods] This study recruited 60 healthy young (aged 20 to 39 years) and older adults (aged 67 to 75 years) at a university and in public places. The Iowa Oral Performance Instrument was used to measure maximal tongue strength and endurance. [Results] Maximal tongue strength was significantly higher in the young adult group than the older adult group. Maximal tongue endurance was longer in the young adult group than in the older adult group, but the difference between the groups was not significant. [Conclusion] This study confirmed that older adults have a lower maximal tongue strength and endurance than young adults.

Effect of tongue strength training using the Iowa Oral Performance Instrument in stroke patients with dysphagia.

[Purpose] The aim of this study was to evaluate the effectiveness of a structured program of resistance training for the tongue in order to improve swallowing function in stroke patients with dysphagia. [Subjects and Methods] Twenty-seven stroke patients with dysphagia were randomly divided into two groups. The experimental group participated in a resistance-training program involving a 1-repetition maximum, with an intensity of 80%, along with 50 repetitions per day each for the anterior and posterior regions of the tongue. Both groups received conventional therapy for dysphagia for 30 min per day, 5 times per week, for 6 weeks. [Results] The experimental group showed statistically significant improvements in both, the anterior and posterior regions of the tongue. In contrast, the control group showed significant improvements only in the anterior region of the tongue. In the videofluoroscopic dysphagia scale evaluation, improvement was noted at both, the oral and pharyngeal stages in the experimental group, whereas significant improvements were only noted in the oral stage and total score in the control group. [Conclusion] Our study confirmed that tongue resistance training is an effective intervention for stroke patients with dysphagia, offering improved tongue muscle strength and overall improvement in swallowing.

Biocatalytic nitric oxide generating hydrogels with enhanced anti-inflammatory, cell migration, and angiogenic capabilities for wound healing applications.

Although wound healing is a normal physiological process in the human body, it is often impaired by bacterial infections, ischemia, hypoxia, and excess inflammation, which can lead to chronic and non-healing wounds. Recently, injectable hydrogels with controlled nitric oxide (NO) release behaviour have become potential wound healing therapeutic agents due to their excellent biochemical, mechanical, and biological properties. Here, we proposed novel multifunctional NO-releasing hydrogels that could regulate various wound healing processes, including hemostasis, inflammation, cell proliferation and angiogenesis. By incorporating the copper nanoparticles (NPs) in the network of dual enzymatically crosslinked gelatin hydrogels (GH/Cu), NO was in situ produced via the Cu-catalyzed decomposition of endogenous RSNOs available in the blood, thus resolving the intrinsic shortcomings of NO therapies, such as the short storage and release time, as well as the burst and uncontrollable release modes. We demonstrated that the NO-releasing gelatin hydrogels enhanced the proliferation and migration of endothelial cells, while promoting the M2 (anti-inflammatory) polarization of the macrophage. Furthermore, the effects of NO release on angiogenesis were evaluated using an in vitro tube formation assay and in ovo chicken chorioallantoic membrane (CAM) assay, which revealed that GH/Cu hydrogels could significantly facilitate neovascularization, consistent with the in vivo results. Therefore, we suggested that these hydrogel systems would significantly enhance the wound healing process through the synergistic effects of the hydrogels and NO, and hence could be used as advanced wound dressing materials.

Gelatin microgel-coated balloon catheter with enhanced delivery of everolimus for long-term vascular patency.

In-stent restenosis (ISR) after percutaneous coronary intervention is a major reason for limited long-term patency due to complex neointimal proliferation caused by vascular injury. Drug-coated balloon (DCB) has been developed to treat various cardiovascular diseases including ISR by providing anti-proliferative drugs into blood vessel tissues. However, a significant proportion of the drug is lost during balloon tracking, resulting in ineffective drug delivery to the target region. In this study, we report an everolimus-coated balloon (ECB) using everolimus-loaded gelatin-hydroxyphenyl propionic acid microgel (GM) with enhanced everolimus delivery to vascular walls for long-term patency. GM with high drug loading (> 97%) was simply prepared by homogenizing enzyme-mediated crosslinked hydrogels. The optimal condition to prepare GM-coated ECB (GM-ECB) was established by changing homogenization time and ethanol solvent concentration (30 ∼ 80%). In vitro sustained everolimus release for 30 d, and cellular efficacy using smooth muscle cells and vascular endothelial cells were evaluated. Additionally, an in vivo drug transfer levels of GM-ECB using rabbit femoral arteries were assessed with reduced drug loss and efficient drug delivery capability. Finally, using ISR-induced porcine models, effective in vivo vascular patency 4 weeks after treatment of ECBs was also confirmed. Thus, this study strongly demonstrates that GM can be used as a potential drug delivery platform for DCB application. STATEMENT OF SIGNIFICANCE: We report an ECB using everolimus-loaded GM prepared by homogenization of enzymatic cross-linked hydrogel. GM showed efficient drug loading (> 97 %) and controllable size. GM-ECB exhibited potential to deliver everolimus in a sustained manner to target area with drug efficacy and viability against SMC and EC. Although GM-ECB had much lower drug content compared to controls, animal study demonstrated enhanced drug transfer and reduced drug loss of GM-ECB due to the protection of encapsulated drugs by GM, and the possible interaction between GM and endothelium. Finally, vascular patency and safety were assessed using ISR-induced porcine models. We suggest an advanced DCB strategy to alleviate rapid drug clearance by bloodstream while improving drug delivery for a long-term vascular patency.

Synthesis and characterizations of in situ cross-linkable gelatin and 4-arm-PPO-PEO hybrid hydrogels via enzymatic reaction for tissue regenerative medicine.

In situ cross-linkable hybrid hydrogels composed of gelatin and 4-arm-polypropylene oxide-polyethylene oxide (Tetronic) was developed as an injectable scaffold for tissue regeneration. The gelatin was modified by hydroxyphenyl propionic acid (HPA) and the Tetronic was conjugated with tyramines (Tet-TA). The hydrogels were rapidly formed by mixing the polymer solutions containing horseradish peroxidase (HRP) and hydrogen peroxide (H(2)O(2)). The gelation time and mechanical properties of the hydrogels could be controlled by varying the HRP and H(2)O(2) concentrations. In vitro degradation study of the hybrid hydrogels was carried out using collagenase and the prolonged proteolytic degradation was obtained due to the presence of the Tetronic. Human dermal fibroblast (hDFB) was cultured in the hydrogel matrices to evaluate the cyto-compatibility. The encapsulated cells were shown to be highly viable and spread over the gel matrices, suggesting that the hybrid hydrogels have an excellent cyto-compatibility. The hydrogels were also subcutaneously injected in the back of mice and the results demonstrated that the hydrogels were rapidly formed at the injected site. From these results, we demonstrate that the in situ cross-linkable hydrogels formed by hybridization of gelatin and Tetronic via enzyme-mediated reactions hold great promise for use as injectable matrices for tissue regenerative medicine due to their tunable physico-chemical properties and excellent bioactivity.

Echinacea purpurea Extract Enhances Natural Killer Cell Activity In Vivo by Upregulating MHC II and Th1-type CD4+ T Cell Responses.

There are a number of factors that cause immune system disruption, including infection caused by foreign antigens and decreased immunity due to excessive exercise, and public interest in improving immunity is growing. In this study, we investigate the immunomodulatory effects of Echinacea purpurea (E) extract in C57BL/6N mice that were exposed to a forced swimming exercise. There were six experimental groups as follows: wild-type, forced swimming exercise control, positive control (red ginseng, 300 mg/kg), and E (50, 100, and 200 mg/kg b.w.) groups. The mice were administered the E extract for 2 weeks. We detected chicoric acid, the active substance of E, through high-performance liquid chromatography and evaluated changes in the following laboratory values in response to forced swimming exercise using flow cytometry and ELISA: the major histocompatibility complex (MHC), CD4+ and CD8+ T cells, Th1 and Th2 cytokines, natural killer (NK) cell activity, and number of leukocytes. Oral E intake increased levels of MHC II, CD4+ T cells, Th1 cytokines, and NK cell activity. In addition, E treatment increased B cell proliferation, leukocyte counts, and immunoglobulin levels. Taken together, these results suggest that the chicoric acid of E can improve immune response by controlling NK cell activity, which may be a useful function for immunomodulation systems.

Deer Velvet and Eleutherococcus senticosus Mixture Regulated Immune Function in C57BL/6N Mice with Immunosuppression Induced by Forced Swimming.

Immunosuppression occurs in response to a variety of external antigens. However, various immune cells and cytokines can activate the immune system. In this study, it was found that fermented deer velvet (FD) and fermented Eleutherococcus senticosus (FE) extract (FDE) mixtures regulated the immunity of animals that underwent induced immunosuppression through forced swimming exercise (FSE). Seven mouse treatment groups were included in the experiment: normal controls, FSE controls, positive controls (FSE+red ginseng 300 mg/kg body weight), FD200 (FSE+FD 200 mg/kg body weight), FE200 (FSE+FE 200 mg/kg body weight), FDE50 (FSE+FDE 50 mg/kg body weight), and FDE200 (FSE+FDE 200 mg/kg body weight). Oral intake of experimental and control substances lasted for 2 weeks. Oral FDE intake increased cell counts for major histocompatibility complex (MHC) I, MHC II, CD4(+) T cells, and CD8(+) T cells compared with controls. Moreover, FDE increased Th1 (interleukin [IL]-2 and interferon gamma) cytokine proliferation, T cell proliferation, IL-12 and IL-15 production, and natural killer cell activity compared with controls. In addition, FDE inhibited Th2 cytokines (IL-4, IL-6, IL-10, and tumor necrosis factor alpha) and nitric oxide production, increased B cell proliferation and leukocyte count, and promoted immunoglobulin A and G serum levels compared with controls. Thus, the finding that FDE increased immune function in an immunosuppression model suggests that FDE has immunomodulatory capacity.

Effects of a Mixture of Humulus japonicus on Longitudinal Bone Growth in Hypophysectomized Rats.

Previously, we reported that the administration of a mixture of Humulus japonicus (MH) increased the longitudinal bone growth rate in Sprague Dawley rats. In this study, we investigated the effects of the dietary administration of MH on longitudinal bone growth in growth hormone (GH)-deficient hypophysectomized male and female rats to determine whether the effect of MH was similar to that of GH. We measured the nose-to-anus and nose-to-tail length gain, femur and tibia lengths, growth plate zones, and expression of insulin-like growth factor-1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) after the dietary administration of MH or the injection of GH into hypophysectomized rats for 4 weeks. Results demonstrated that the dietary administration of MH had no effect on longitudinal bone growth, whereas the injection of GH increased the nose-to-tail length gain and femur and tibia lengths in hypophysectomized rats. In addition, MH did not affect the growth plate, bone mineralization, and expression of IGF-1 and IGFBP-3. These findings indicate that MH does not exert a GH-like effect and that the effects of MH and GH on longitudinal bone growth involve different pathways.

Emblica officinalis and Hordeum vulgare L. Mixture Regulates Lipolytic Activity in Differentiated 3T3-L1 Cells.

In this study, we investigated the lipolytic effects of an Emblica officinalis (Indian gooseberry [IG]) and Hordeum vulgare L. (barley sprout [BP]) mixture on differentiated 3T3-L1 cells. On the ninth day of differentiation, Oil red O staining and Western blotting were performed; additionally, glycerol release and triglyceride (TG), fatty acid (FA), and cyclic adenosine monophosphate (cAMP) levels were measured. Compared to the differentiation-induced control (C) group, the IG and BP mixture inhibited intracellular TG and FA levels by 61.7% and 48.9%, respectively, at a concentration of 200 µg/mL. Moreover, the mixture increased glycerol release and cAMP levels by more than twofold more than those in the C group. Western blotting was performed to confirm the protein expression involved in lipolysis, and the IG and BP mixture was found to significantly increase the protein activities of AMP-activated protein kinase, protein kinase A, and hormone-sensitive lipase compared to those of the C group. Furthermore, the mixture significantly inhibited the protein activities of phosphodiesterase 3B, adipose TG lipase, and perilipin compared to those of the C group at a concentration of 200 µg/mL. We found that the IG and BP mixture activates the cAMP pathway and regulates lipolytic enzymes, which are necessary for lipolysis. In conclusion, our findings suggest that the IG and BP mixture can be potentially developed as a new material for targeting mechanisms underlying lipolysis.

Antarctic Krill Oil Ameliorates Monosodium Iodoacetate-Induced Irregularities in Articular Cartilage and Inflammatory Response in the Rat Models of Osteoarthritis.

The aim of this study was to examine the effects of Antarctic krill oil (FJH-KO) in a rat model of monosodium iodoacetate (MIA) induced osteoarthritis. The effect of FJH-KO on the development and severity of MIA-induced osteoarthritis was assessed using hematoxylin and eosin (H&E) staining and micro-CT. The expression of PGE2, pro-inflammatory cytokines (IL-1ß, TNF-α), and arthritics related genes in osteoarthritic rats in response to FJH-KO supplementation was investigated using real time PCR. FJH-KO supplementation in the arthritic rat model reduced tissue damage, cartilage degeneration, and reduced the MIA-induced irregularities in articular cartilage surface. Serum PGE2, IL-1ß, IL-6, and TNF-α levels were higher in MIA treated animals, but these levels decreased upon FJH-KO supplementation. When FJH-KO was provided at a dose of 150 mg/kg b.w to MIA-treated animals, it significantly increased the mRNA expression of anabolic factors. The mRNA expression of catabolic factors was significantly decreased MIA-treated animals that were provided FJH-KO at a dose of 100 and 150 mg/kg b.w. Moreover, the mRNA expression of inflammatory mediators was significantly decreased MIA-treated animals supplemented with FJH-KO. These results suggest supplementation with FJH-KO ameliorates the irregularities in articular cartilage surface and improves the inflammatory response in the osteoarthritis. Thus, FJH-KO could serve as a potential therapeutic agent for osteoarthritis treatment.