Jaw-Opening Force as a Useful Index for Dysphagia: A Cross-Sectional and Multi-Institutional Study.

INTRODUCTION: Jaw-opening force (JOF) can be a potential screening tool for dysphagia. However, confounding variables such as comorbidities or physical and oral functions that are associated with the physiology of swallowing have not previously been examined. Adjusting for these variables could reveal the relationship between JOF and dysphagia and indicate whether JOF is an independent factor associated with dysphagia. We therefore aimed to assess the efficacy of using JOF for dysphagia screening in this multi-institutional study. METHODS: Community-dwelling older adults over the age of 65 years (N = 403) who visited the university dental hospitals and participated in health surveys (mean age ± standard deviation, 77.1 ± 7.0 years; range, 65-96 years) between November 2018 and January 2020 were included in this study. The JOFs of all participants were measured. The measured JOF was compared with the presence of dysphagia, which was defined using the Functional Oral Intake Scale and the Eating Assessment Tool-10. RESULTS: Multiple logistic regression analysis revealed that the presence of dysphagia was independently associated with JOF, calf circumference, and dependence after adjusting for age and sex. DISCUSSION/CONCLUSION: Decreased JOF can be a risk factor for dysphagia in older adults.

Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study.

BACKGROUND: In Japan's super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user's quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required. METHODS: A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni's multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable. RESULTS: Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5. CONCLUSIONS: The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users' quality of life as a quality indicator of care, to improve and manage it.

The impact of sarcopenia on low back pain and quality of life in patients with osteoporosis.

PURPOSE: Osteoporosis combined with sarcopenia contributes to a high risk of falling, fracture, and even mortality. However, sarcopenia's impact on low back pain and quality of life (QOL) in patients with osteoporosis is still unknown. The purpose of this study is to investigate low back pain and QOL in osteoporosis patients with sarcopenia. METHODS: We assessed 100 ambulatory patients who came to our hospital for osteoporosis treatment. Low back pain was evaluated using the Visual Analogue Scale (VAS) with 100 being an extreme amount of pain and 0 no pain. The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) score was used to assess QOL after adjustment for age, history of vertebral fracture, and adult spinal deformity. Differences in low back pain intensity assessed by VAS between groups were evaluated by the Willcoxon rank-sum test. Covariance analysis was used to assess QOL. All data are expressed as either median, interquartile range, or average, standard error. RESULTS: Patients were classified into the sarcopenia group (n = 32) and the non-sarcopenia group (n = 68). Low back pain intensity assessed by VAS was significantly higher in the sarcopenia group than in the non-sarcopenia group (33.0 [0-46.6] vs. 8.5 [0-40.0]; p < 0.05). The subscales of the JOABPEQ for low back pain were significantly lower in the sarcopenia group than in the non-sarcopenia group (65.0 ± 4.63 vs. 84.0 ± 3.1; p < 0.05). CONCLUSION: In this cross-sectional study, sarcopenia affected low back pain and QOL in ambulatory patients with osteoporosis. Sarcopenia may exacerbate low back pain and QOL.

The effect of rotator cuff physical exercise combined with electrically stimulated antagonist on shoulder rotator cuff strength.

BACKGROUND: An elastic band (EB) is generally used with a low load for rotator cuff physical exercise, but the resulting increase in muscle strength is insufficient. We assessed the efficacy on external rotator muscle strength of the shoulder joint; of a hybrid training system (HTS) that resists the motion of a volitionally contracting agonist muscle using the force generated by its electrically stimulated antagonist vs. general rotator cuff exercise with EB. METHODS: Twenty healthy men with no shoulder joint disorders were randomized to 6 weeks of triweekly 10-min rotator cuff exercise with HTS or EB in a clinical research laboratory. Isokinetic concentric external rotator muscle strength at angular velocities of 60°/s and 180°/s (CON60, CON180, respectively) and isokinetic eccentric external rotator muscle strength at an angular velocity of 60°/s (ECC60) were measured as rotator cuff function before and after 6 weeks of intervention. RESULTS: There were no significant intergroup differences in baseline characteristics. There were statistically significant differences (p = 0.0358, p = 0.0213, respectively) in the increase in CON180 (mean ± SD) and ECC60 between the HTS group (Δ6.0 ± 6.0Nm, p = 0.015; Δ7.5 ± 4.7Nm p = 0.0007, respectively) and the EB group (Δ0.3 ± 5.2Nm, p = 0.8589; Δ1.8 ± 5.3 Nm p = 0.3133, respectively). There was a trend toward CON60 increasing in the HTS group (Δ4.7 ± 6.5Nm, p = 0.0494) which was greater than in the control group (Δ-0.9 ± 6.3Nm, p = 0.6637) (inter-group, p = 0.0677). CONCLUSIONS: The results of this study support the conclusion that HTS is more effective for increasing external rotator muscle strength more effectively than EB. HTS would be useful for rotator cuff physical exercise.

Jaw-retraction exercise increases anterior hyoid excursion during swallowing in older adults with mild dysphagia.

OBJECTIVES: The present study aimed to evaluate the effectiveness of a newly designed jaw-retraction exercise for strengthening the geniohyoid muscle and thus improving the anterior movement of the hyoid bone during swallowing. BACKGROUND: Although previous studies suggest a relationship between anterior hyoid excursion and upper esophageal sphincter (UES) opening, there are currently no reports of physical exercises without the use of special equipment that can effectively improve this movement of the hyoid bone during swallowing. MATERIALS AND METHODS: This before-after study included patients presenting to the authors' hospital with mild dysphagia (Level 5 on the Dysphagia Outcome and Severity Scale). The participants were instructed to perform a jaw-retraction exercise designed to strengthen the geniohyoid muscle. Each participant was instructed to perform two sets of the exercise daily for four weeks, with each set consisting of five repetitions. Before and after the four-week training period, videofluoroscopic swallowing studies were performed and later analysed. RESULTS: Twenty-five patients with a median age of 77 were included. The median peak anterior hyoid position before and after exercise were 129.82 and 132.74 (%C2-C4 length), respectively, and this increase was found to be significant (P = .007). The median extent of UES opening before and after exercise were 8.6 and 9.3 (mm), respectively, and this increase was also found to be significant (P = .040). CONCLUSION: Our findings demonstrate that the jaw-retraction exercise can effectively improve the anterior movement of the hyoid bone. This exercise may be effective in individuals with oral frailty when signs of swallowing disorders are observed.

Optimal application of stereotactic body radiotherapy and radiofrequency ablation treatment for different multifocal hepatocellular carcinoma lesions in patients with Barcelona Clinic Liver Cancer stage A4-B1: a pilot study.

BACKGROUND: In clinical practice, many hepatocellular carcinoma (HCC) patients in Barcelona Clinical Liver Cancer (BCLC) stage A4-B1 cannot receive the curative treatments of liver transplantation, resection, and radiofrequency ablation (RFA), which are the recommended options according to liver cancer guidelines. Our aim is to study the feasibility of RFA and stereotactic body radiotherapy (SBRT) as a curative treatment for different multifocal HCCs in BCLC stage A4-B1 patients. METHODS: From September 2014 to August 2019, 39 multifocal HCC lesions (median diameter: 16.6 mm) from 15 patients (median age: 73 years) were retrospectively selected. Among them, 23 were treated by RFA and the other 16 by SBRT because of predictable insufficiency and/or risk related to RFA performance. The indicators for evaluating this novel therapy were the tumor response, prognosis (recurrence and survival), and adverse effects (deterioration of laboratory test values and severe complications). RESULTS: The median follow-up duration was 31.3 months (range: 15.1-71.9 months). The total patients with a one-year complete response, stable disease, or disease progression were 11, 1, and 3, respectively. In total, 8 and 2 patients had confronted intrahepatic or local recurrence, respectively. The one-year progression-free survival rate and local control rate were 80% (12/15 patients) and 97.4% (38/39 lesions), respectively. The median time to progression was 20.1 (2.8-45.1) months. The one- and two-year survival rates were 100 and 88.9%, respectively. In up to five months' observation, no patient showed severe complications. Seven, four, and two patients had slight changes in their white blood cells, platelet count, or albumin-bilirubin grade, respectively. CONCLUSIONS: For patients with BCLC stage A4-B1, RFA and SBRT treatment for different multifocal HCCs may be a potential option because of the favorable prognosis and safety. However, before its application in clinical practice, prospective, controlled, large-scale studies are needed to further confirm our conclusions.

Effects of a low-intensity resistance exercise program on serum miR-630, miR-5703, and Fractalkine/CX3CL1 expressions in subjects with No exercise habits: A preliminary study.

AIMS: Exercise is effective for the prevention of liver cancer. Exercise exerts biological effects through the regulation of microRNAs (miRNAs) and cytokines/myokines. We aimed to investigate the effects of low-intensity resistance exercise on serum miRNA and cytokine/myokine expressions in subjects with no exercise habits. METHODS: We enrolled seven male subjects with no exercise habits in this prospective before-after study. All subjects performed a low-intensity resistance exercise program (three metabolic equivalents, approximately 20 min/session). Serum miRNA expressions were evaluated using microarrays. We performed Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of differentially expressed miRNAs before and after exercise. Serum cytokine/myokine expressions were evaluated using a multiplex panel. RESULTS: All subjects completed the exercise program with no adverse events. In the microarray analysis, seven miRNAs showed a significant change between before and after exercise. Of these, microRNA (miR)-630 and miR-5703 showed a >1.5-fold increase (miR-630: 40.7 vs. 69.3 signal intensity, p = 0.0133; miR-5703: 30.7 vs. 55.9 signal intensity, p = 0.0051). KEGG pathway enrichment analysis showed that miR-630- and miR-5703-related genes were enriched in 37 and 5 pathways, including transforming growth factor-beta and Wnt signaling pathways, respectively. In the multiplex analysis, 12 cytokines/myokines showed significant alteration after exercise compared to before exercise. Of these, fractalkine/CX3CL1 showed the most significant up-regulation by exercise (94.5 vs. 109.1 pg/ml, p = 0.0017). CONCLUSIONS: A low-intensity resistance exercise program was associated with upregulation of serum miR-630, miR-5703, and fractalkine/CX3CL1 expressions in subjects with no exercise habits. Thus, even low-intensity exercise may alter miRNA and cytokine/myokine expressions in humans.

Radiotherapy for Hepatocellular Carcinoma Results in Comparable Survival to Radiofrequency Ablation: A Propensity Score Analysis.

Potentially curative treatments for early-stage hepatocellular carcinoma (HCC) have drawbacks and contraindications. Recently, radiotherapy has achieved good outcomes. We compared the outcomes of radiotherapy and radiofrequency ablation (RFA) for early-stage HCC. Consecutive patients with ≤3 early-stage HCC lesions and tumor diameters ≤3 cm treated with RFA or radiotherapy were reviewed. RFA was the first choice for HCC unsuitable for surgery. Otherwise, stereotactic body radiotherapy in five fractions was mainly performed. For HCC adjacent to the gastrointestinal tract, radiotherapy with mild hypofractionation was performed. Propensity score matching was performed to reduce the selection bias between the RFA and radiotherapy groups. Between 2012 and 2016, a total of 231 patients with 474 tumors and 143 patients with 221 tumors were eligible and were treated with RFA and radiotherapy, respectively. In an unmatched comparison, the 3-year local recurrence rate was significantly lower for radiotherapy than for RFA (5.3%; 95% confidence interval [CI], 2.7-9.2; versus 12.9%, 95% CI, 9.9-16.2) (P < 0.01). A propensity score matching analysis of 106 patients in each group successfully matched the two treatment groups with regard to Barcelona Clinic Liver Cancer staging, T stage, and tumor size but not the adjacency of the tumor to risk organs or first or salvage treatment. The 3-year overall survival rates for RFA and radiotherapy patients were comparable (69.1%; 95% CI, 58.2-77.7; and 70.4%; 95% CI, 58.5-79.4, respectively; P = 0.86). Conclusion: Radiotherapy has excellent local control and comparable overall survival in patients with well-compensated liver function, exhibiting advantageous characteristics and compensating for the deficiencies of other treatment modalities; radiotherapy appears to be an acceptable alternative treatment option for patients who are not candidates for RFA.

Relationship between tongue pressure and back muscle strength in healthy elderly individuals.

BACKGROUND: Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear. AIMS: To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals. METHODS: In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed. RESULTS: In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (ß = 0.373, p = 0.001) and the Eichner index (ß = 0.190, p = 0.036). CONCLUSIONS: TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.

Association of aging and tooth loss with masseter muscle characteristics: an ultrasonographic study.

OBJECTIVES: This study aimed to investigate the relationship between aging and tooth loss on masseter muscle quantity and quality. MATERIALS AND METHODS: This cross-sectional study was conducted among 112 participants (in their 20s to 90s) who were independent in activities of daily living and were able to follow verbal commands. Exclusion criteria comprised participants with a lack of molar occlusal support, diseases that could affect muscle function, or temporomandibular disorder. Age, tooth loss, and weight were documented, and masseter muscle thickness (MMT) and masseter muscle echo intensity (MMEI) were measured using an ultrasonic diagnostic apparatus. A multiple regression analysis was used to determine the relationship between MMT, MMEI, aging, and tooth loss, among each sex. The significance level in the statistical analysis was p < 0.05. RESULTS: In males, aging was a significant explanatory variable for MMT (adjusted R2 = 0.27), while both aging and weight were significantly associated with MMEI (adjusted R2 = 0.54). In females, tooth loss and aging were significant explanatory variables for MMT (adjusted R2 = 0.36) and MMEI (adjusted R2 = 0.5), respectively. In both men and women, MMT and MMEI were highly correlated. CONCLUSIONS: Masseter muscles in males were more likely to be attenuated by aging than in females. The main attenuation factors were observed to differ between MMT and MMEI in women. CLINICAL RELEVANCE: In females, preservation of the natural dentition or prosthetic treatment may be effective for maintaining masseter muscle characteristics. In males, additional approaches, such as resistance exercise training, may be necessary.

Tongue thickness is associated with masticatory performance of perioral muscles: Ultrasonographic study of perioral muscle characteristics in healthy young subjects.

BACKGROUND: Mastication is a complicated task that involves the teeth and perioral muscles, such as the tongue and lip. Previous studies have shown correlations between masticatory performance and perioral muscle strength (eg tongue pressure) and between masticatory performance and occlusal forces. OBJECTIVE: To investigate the relationships between masticatory performance and perioral muscle characteristics. METHODS: Forty-nine healthy young subjects (men: 24 and women: 25) with Eichner classification group A were included in this cross-sectional study. Age, body weight, masticatory performance, masseter muscle thickness, masseter muscle echo intensity, cross-sectional area of geniohyoid muscle, geniohyoid muscle echo intensity, tongue thickness (TT) and tongue echo intensity were assessed. Masticatory performance was evaluated using a colour-changeable chewing gum. The thickness and echo intensity of the masseter muscle, geniohyoid muscle and tongue were observed using an ultrasonic diagnostic apparatus. Stepwise multiple regression analysis was conducted to examine relationships between perioral muscle characteristics and masticatory performance. RESULTS: Tongue thickness (P < .01) was the sole significant explanatory variable for masticatory performance. The standard partial regression coefficient was 0.47. The multiple correlation coefficient (R) was .47, and the adjusted R2 was .20; the variance inflation factor was 1.0. This study showed that TT was related to masticatory performance, whereas perioral muscle quality was not. Moreover, perioral muscle quantity was highly correlated with perioral muscle quality. CONCLUSIONS: Tongue thickness is a predictor of masticatory performance in healthy young subjects. An ultrasonic diagnostic apparatus is useful in the evaluation of perioral muscle characteristics.

Association between myotonometric measurement of masseter muscle stiffness and maximum bite force in healthy elders.

BACKGROUND: Maximum bite force (MBF) is a common and useful index of masticatory function; it correlates with physical strength in elderly people. Palpation of stiffness in the masseter muscle during forceful biting has been considered to be associated with MBF. However, this assessment method relies on subjective judgments; no study has verified the relationship between MBF and quantitative measurements of masseter muscle stiffness (MMS). OBJECTIVE: We aimed to verify the association between masseter muscle myotonometric assessment results and MBF. METHODS: In total, 117 community-dwelling >65-year-old individuals from the Tokyo metropolitan area were assessed. MMS on the dominant side during forceful biting was measured with a MyotonPRO device. Masseter muscle thickness (MMT) during rest and forceful biting was measured with an ultrasonic diagnostic apparatus, and the difference in MMT (DMMT) between the rest and forceful biting conditions was determined. MBF data were obtained with a pressure-sensitive sheet and an associated device. To determine the independent variables affecting MBF and MMS, multivariate linear regression analyses with adjustments for age, sex and number of teeth were performed. RESULTS: The multivariate analysis revealed that MBF correlated with the number of teeth (ß = .489, P < .001) and MMS (ß = .259, P = .003) (R2  = .433). MMS correlated with MBF (ß = .308, P = .003) and DMMT (ß = .430, P < .001) (R2  = .326). CONCLUSION: Masseter muscle stiffness possibly reflects a force generated by the masseter muscle during forceful biting. Therefore, MMS is effective to assess tooth loss as well as an index of masseter muscle strength when evaluating MBF.

Factors associated with the number of microorganisms on the tongue surface in patients following acute stroke.

BACKGROUND: Oral hygiene management of patients with acute stroke is important for preventing aspiration pneumonia and ensuring oral intake. The tongue coating score can be useful for evaluating the oral hygiene level since it reflects the microorganism number on the tongue surface in elderly patients. However, the relationship between the number of oral microorganisms and the tongue coating score in patients with acute stroke remains unclear. OBJECTIVES: We aimed to investigate the relationships between the microorganism number on the tongue surface and oral factors, including tongue coating score, tongue surface moisture level and tongue function. METHODS: This cross-sectional study enrolled 73 patients with acute stroke who were hospitalised at an acute care hospital and underwent dental intervention. Potential explanatory factors, including sex, age, Glasgow Coma Scale score, tongue coating score, tongue surface moisture level, nutrition intake method, number of functional teeth and tongue function, were evaluated. Logistic regression analysis determined their association with the microorganism number on the tongue surface. RESULTS: The tongue coating score (odds ratio: 1.31) and tongue surface moisture level (odds ratio: 1.10) were significantly associated with increased microorganism numbers on the tongue surface. CONCLUSION: The tongue coating score, which reflects the actual number of microorganisms on the tongue surface, could be an effective tool for evaluating oral hygiene level in patients with stroke. Moreover, reducing oral microorganisms in saliva through oral hygiene management, including removing the tongue coating, could contribute towards the prevention of aspiration pneumonia.

Relationship between displacement of the masseter muscle during biting and masseter muscle quality and bite force in healthy elderly persons.

BACKGROUND: Although age-related changes in muscle quality influence muscle strength, the relationship between masseter muscle (MM) quality and maximum biting force (MBF) has never been studied. OBJECTIVE: The aims of the study were to verify the relationship among MM quality, MBF, and the displacement of the MM while biting forcefully (MMD) and to clarify the age-related decline in MBF in healthy elderly persons. METHODS: Seventy-four healthy community-dwelling individuals (mean age, >65 years) from Tokyo metropolis were recruited. The thickness (index of muscle quantity), echo intensity (index of muscle quality) and displacement of the MM while biting forcefully (MMT, MMEI and MMD, respectively) were measured by ultrasonography. MBF was measured using a pressure-sensitive sheet. Independent predictors of MBF and MMD were determined using multivariate linear regression analyses adjusted for age, sex and the number of present teeth. RESULTS: MBF was significantly correlated with the number of teeth (ß = 0.577, P < .001) and MMD (ß = 0.302, P = .015), but not with MMT (ß = 0.019, P = .868) or MMEI (ß = 0.054 P = .703). MMD was significantly correlated with MMEI (ß = -0.606, P < .001), but not with MMT (ß = 0.048, P = .681) or the number of teeth (ß = 0.065, P = .613). CONCLUSIONS: MMEI was associated with MMD, an index of MBF, regardless of tooth number. The age-related quality change in the MM might cause a decrease in its contraction, resulting in age-related decline in MBF.

[A Case of Metachronous Testicular Tumor Developing Twenty Years after Treatment of Retroperitoneal Extragonadal Germ Cell Tumor].

A 49-year-old male visited our department of gastroenterology with chief complaints of blackish feces and ill complexion in February 1997. Computed tomography (CT) revealed a right retroperitoneal tumor, which was removed the same month. Histopathological examination showed teratoma and yolk sac tumor. He was diagnosed with primary retroperitoneal extragonadal germ cell tumor, and received three cycles of chemotherapy (bleomycin/etoposide/cisplatin ; BEP) starting in March 1997. Periodic imaging and determination of tumor markers (α fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) showed no recurrence or metastasis for five years after treatment. After his visit in April 2002 he stopped visiting our outpatient ward. In November 2017, the patient visited our department with chief complaints of indolent right scrotum enlargement and a right inguinal mass. Past history showed that he had undergone hydrocele of the right testicle in August 1999. Contrast enhanced CT showed a 35-mm contrast effect with uneven contents in the right testis, and enlarged nodes that were suspicious of metastases in the right inguinal and right external iliac lymph nodes. All tumor markers were within the normal ranges. He underwent right high orchiectomy and resection of the right inguinal lymph nodes in the same month. Histopathological findings revealed seminoma (pT1, pN2, M0, S0, and clinical Stage IIA). He received postoperative chemotherapy starting in January 2018 ; one cycle of BEP therapy and three cycles of etoposide and cisplatin (EP) therapy. Post-chemotherapeutic CT confirmed clinical complete response at the right external iliac lymph nodes, and this response was confirmed 12 months later. Neither recurrence nor metastasis has occurred so far.

Circulating microRNA-1246 as a possible biomarker for early tumor recurrence of hepatocellular carcinoma.

AIMS: Early tumor recurrence (ETR) after hepatic resection is a crucial predictor of poor prognosis in patients with hepatocellular carcinoma (HCC). The aim of this study was to identify clinically significant serum microRNAs (miRNAs) involved in the ETR of HCC. METHODS: We compared expression profiles of circulating miRNAs from serum samples between five HCC patients with ETR (recurrence within 12 months after hepatectomy) and five HCC patients without recurrence using microarray analysis of miRNA. The identified miRNA associated with ETR was further verified in 121 HCC patients, 73 liver disease patients, and 15 health controls by real-time quantitative reverse transcription-polymerase chain reaction (PCR). RESULTS: Of the approximately 2000 miRNAs analyzed, we identified 15 miRNAs for which expression levels correlated significantly with ETR. Of these miRNAs, we further investigated expression of miRNA-1246 (miR-1246). Quantitative PCR confirmed that miR-1246 was upregulated in HCC with ETR, compared to the level in HCC without ETR (P < 0.001). Serum miR-1246 showed a receiver operating characteristic curve area of 0.762, with 77.4% specificity and 54.1% sensitivity in discriminating HCC patients with ETR from HCC patients without ETR. Altered expression of miR-1246 was associated with aggressive tumor characteristics, including tumor-node-metastasis classification (P = 0.0413), tumor differentiation (P = 0.0419), and portal vein invasion (P = 0.0394). Moreover, multivariate Cox regression analysis identified serum miR-1246 level as an independent risk factor for overall survival (hazard ratio, 2.784; 95% confidence interval, 1.528-5.071; P = 0.0008). CONCLUSION: Circulating miR-1246 in serum has strong potential as a novel ETR and prognostic biomarker for HCC.

Calf Circumference Is a Useful Index for Assessing Dysphagia among Community Dwelling Elderly Recipients of Long-Term Care.

Dysphagia is a common problem among older adults, causing aspiration pneumonia and malnutrition. It has been reported that calf circumference (CC), an index of nutritional status and physical activity, correlated with dysphagia in acute care hospitals, suggesting that CC can be a useful index for assessing dysphagia. We therefore aimed to explore the association between dysphagia and CC among community elderly people who require long-term care and determined the optimal CC cut-off value for patients with dysphagia. Our cross-sectional study, conducted at Tokyo Metropolis, included 154 participants (65 men) aged > 65 years (mean age: 80.1 ± 7.1) who required long-term care and were examined for dental disease and dysphagia during home visiting treatment. Age, body mass index (BMI), mini-nutritional assessment short-form (MNA-SF) score, Barthel index (BI), CC, functional oral intake scale (FOIS), and dysphagia severity scale (DSS) were evaluated. A DSS score < 5 was defined as dysphagia. To determine the association between CC and dysphagia, we performed logistic regression analysis and calculated the CC cut-off value for dysphagia. Thirty-seven participants (24.0%) were diagnosed with dysphagia. The logistic regression analysis showed that the presence of dysphagia was independently associated with CC after adjusting for age and sex. The CC cut-off value for the presence of dysphagia was 31.0 cm in men (sensitivity, 0.818; specificity, 0.868) and 29.3 cm in women (sensitivity, 0.760; specificity, 0.859). CC is a useful index for assessing dysphagia among community dwelling individuals who require long-term care.

Association between echo intensity of the tongue and its thickness and function in elderly subjects.

BACKGROUND: The tongue plays an important role during the oropharyngeal phase of swallowing. Each part of the tongue has a different function during swallowing. Ageing causes changes in muscle quantity and quality. Qualitative changes, such as an increase in intramuscular adipose tissue, can be determined by the echo intensity (EI) of the tongue on ultrasonography (US). OBJECTIVE: To clarify the relationship between EI and thickness and function of the tongue. METHODS: Ninety-four healthy elderly individuals (30 male, 64 female) aged >65 years (mean 71.10 ± 4.13 years) were enrolled. Tongue thickness (TT) and EI were determined by US. Tongue function was evaluated by measurement of tongue pressure and oral diadochokinesis (OD). Multiple regression analysis was used to identify the factor with the strongest influence on EI of the tongue. RESULTS: The mean thickness of the middle of the tongue was 40.42 ± 4.24 mm and that of the base was 23.35 ± 3.32 mm; the respective EI values were 46.54 ± 9.33 and 49.33 ± 9.83. The average OD rates for /ta/ and /ka/ were 5.73 ± 1.09 and 5.40 ± 1.00 times/s, respectively. Multiple regression analysis for EI showed that /ta/ (ß = -2.518, P = 0.042) and thickness of the middle of the tongue (ß = -1.278, P < 0.001) were significant independent variables. Similarly, the EI at the base of the tongue showed that /ka/ (ß = -4.038, P = 0.021) and base of TT (ß = -0.913, P = 0.004) were significant independent variables. CONCLUSION: EI may be an indicator of TT and OD in both the middle and base of the tongue. Ultrasound is beneficial for evaluating TT and function.

Association between tongue muscle strength and masticatory muscle strength.

BACKGROUND: The tongue is responsible for compressing food against the palate and squeezing it into the pharynx during the oral preparatory phase of swallowing. Tongue pressure (TP), an indicator of tongue muscle strength, has been observed to decline with age; maximum occlusal force (MOF), an indicator of chewing ability, is correlated with TP. However, no study has investigated the relationship between TP and MOF. OBJECTIVE: To investigate the correlation between TP and MOF according to age in healthy individuals. METHODS: We retrospectively collected handgrip strength (HGS), body mass index (BMI), TP, MOF and tooth loss data for 785 healthy participants (305 men, 480 women). All subjects had either unilateral or bilateral occlusal support, regardless of the presence of dentures or natural teeth. The participants were divided into two groups: an adult (20s-50s, n = 497) group and an elderly (60s-80s, n = 288) group. Multivariate linear regression analysis was performed to determine significant independent variables associated with TP in both groups. RESULTS: Multivariate analysis revealed that TP was significantly associated with age (ß = -0.153), BMI (ß = 0.205), HGS (ß = 0.298) and MOF (ß = 0.239) in the adult group (all P < 0.001) and with age (ß = -0.266, P < 0.001), BMI (ß = 0.160, P = 0.005), MOF (ß = 0.217, P = 0.001) and tooth loss (ß = 0.156, P = 0.011) in the elderly group. CONCLUSIONS: As age and MOF are each associated with TP in both elderly and adult patients, age-related TP decline can be prevented with routine lingual exercises, even before the onset of old age. Additionally, MOF deterioration may indicate a decline in TP for elderly.

[A Case of Dedifferentiated Liposarcoma of the Spermatic Cord].

Liposarcomas are most commonly found in the extremities, in the retroperitoneum and, less often, in the head and neck area. The spermatic cord is a rare site of origin, accounting for about 4-7% of all liposarcomas. We report a case of dedifferentiated liposarcoma of the spermatic cord. A 51-year-old man was referred to our hospital for a painless hard mass in the left inguinal region. Abdominal computed tomography showed a left spermatic cord mass measuring 70 mm in diameter. We performed left high orchiectomy with resection of the mass. Immunohistochemical analysis revealed positive for murine double minute 2 (MDM 2) and cyclin dependent kinase 4 (CDK 4). Therefore, this sarcoma was diagnosed to be dedifferentiated liposarcoma. Since the surgical margin was positive, an additional wide resection including the surrounding normal tissue was performed. Complete excision was achieved after re-resection. He was alive 12 months postoperatively without any signs of recurrence. Dedifferentiated liposarcoma of the spermatic cord is a rare neoplasm. To the best of our knowledge, the present case is the 14th reported case in Japan.