Work of breathing and lung volume during forward leaning supported by the upper limbs.

This study compared work of breathing (WOB) and the pressure time product (PTP) to verify whether WOB and PTP decrease in the forward-leaning posture compared with erect sitting. Seven healthy adults (two females and five males) adopted three sitting postures: upright, and two forward-leaning postures of 15° and 30°. The WOB was obtained using the modified Campbell diagram, and PTP was calculated as the time integral of the area between esophageal and chest wall pressure. End-expiratory lung volume and transpulmonary pressure were significantly increased in the 15° and 30° forward-leaning postures compared with erect sitting (p â‰¦ 0.05). End-inspiratory lung volume was significantly increased in the 30° forward-leaning posture compared to erect sitting (p â‰¦ 0.05). PTP and inspiratory resistive WOB were significantly lower in the 15° and 30° forward-leaning postures compared to erect sitting (p â‰¦ 0.05). Forward leaning increases lung volume, which may dilate the airways, decrease resistant WOB, and reduce respiratory muscle activity.

The impact of postoperative blood glucose levels on complications and prognosis after esophagectomy in patients with esophageal cancer.

PURPOSE: This study aimed to characterize postoperative blood glucose fluctuation in patients who underwent esophagectomy for esophageal cancer, and to define its impact on complications and prognosis. METHODS: The subjects of this retrospective study were 284 patients who underwent esophagectomy at Osaka University Hospital between 2015 and 2017. Data analyzed included clinicopathological background, the immediate postoperative blood glucose level (IPBG), postoperative blood glucose variability (PBGV), insulin dosage, postoperative complications, and prognosis. RESULTS: The median IPBG and PBGV were 170 (64-260) mg/dl and 64.5 (11-217) mg/dl, respectively. Postoperative pneumonia was more common in patients with PBGV > 100 mg/dl (P = 0.015). Patients with IPBG < 170 mg/dl had significantly worse 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) than those with IPBG > 170 mg/dl (54.5% vs. 80.4%, respectively, [P < 0.001] and 44.3% vs. 69.3%, respectively, [P = 0.001]). The 5-year OS rates were 43.5%, 68.3%, 80.6%, and 79.0% for patients with IPBG < 154, 154-170, 170-190, and ≥ 190 mg/dl, respectively. The corresponding 5-year RFS rates were 38.1%, 52.4%, 77.0%, and 61.3%, respectively. Multivariate analysis revealed that IPBG < 154 mg/dl and pathological stage were independent poor prognostic factors for OS. CONCLUSION: PBGV was associated with postoperative pneumonia, and low IPBG was an independent poor prognostic factor for patients with esophageal cancer.

The detection of Candida species in patients with halitosis.

To examine the effects of Candida on halitosis, the carrier state of Candida was examined in patients who made a visit with a chief complaint of halitosis. Methods. Subjects were 123 patients (42 males and 81 females) who visited our clinic, with a chief complaint of halitosis. Their average age was 45.8 years. To examine halitosis, an organoleptic test was conducted, and volatile sulfur compounds (VSCs) were measured by gas chromatography. Tongue-coating samples collected at the initial visit were cultured in CHROMagar Candida medium. The results of a Candida culture test, an organoleptic test, and VSC measurements were examined. Results. The male-to-female ratio of the patients was about 1 : 2. Patients with severe halitosis accounted for less than 20%. In the Candida culture test, the positive rate was about 25.2%, and C. albicans was the most frequently detected. Two kinds of Candida species were detected in 75% (6/8) of the strongly Candida-positive group. The VSC measurements were correlated with the Candida culture test results. Methyl mercaptan concentration was higher in the strongly C. albicans-positive group or the subjects having two kinds of Candida species. Conclusion. We suggest that imbalance of oral microbial community exists in the strongly Candida-positive group.

Determination of Candida species nestled in denture fissures.

With the growing number of elderly individuals, Candida is occasionally recognised as a fungal cause of aspiration pneumonia. In addition, there are numerous investigational reports on oral candidiasis. However, there are currently no reports on Candida contamination of denture base materials. This study was conducted to investigate Candida species in the oral cavity, denture parts and oral lesions of older/elderly subjects with oral candidiasis. The Candida strains were isolated and the species identified. Candida was also cultured in a medium with sample of denture resin and observed under an electron microscope. The results demonstrated the presence of several Candida species in the lesions of the oral mucosa and the surface and inner portions of the dentures. The following species of Candida were detected: Candida albicans, Candida glabrata, Candida tropicalis and Candida parapsilosis. Using electron microscopy, the invasion of Candida was observed in the incomplete polymerized resin base material and/or through microcracks (fissures) that have a tendency to form in used dentures. It was concluded that Candida may be present on the surface as well as the deeper portions of dentures. In addition, it appeared necessary to consider denture and oral cavity cleaning and the risks of remaking old dentures.

New implantable therapeutic device for the control of an atrial fibrillation attack using the Peltier element.

For the development of the new therapeutic device for the atrial fibrillation, implantable cooling device using Peltier element was developed in this study. An implantable cooling device had been consisted from Peltier element with transcutaneous energy transmission system (TETS). 1st coil can be contacted from outside of the body, when the patients will feel palpitation. Electrical current will be induced to the implanted 2nd coil. Peltier element will able to cool the surface of the atrium. For the confirmation of the effect of the cooling device, trial manufacture model was developed. Animal experiments using six healthy adult goats after animal ethical committee allowance was carried out. Fourth intercostals space had been opened after anesthesia inhalation, and various sensors had been inserted. AF was induced by the electrical current with battery. As the results, AF had been recovered to the normal sinus rhythm after cooling in all six goats. So, this cooling system for the control of AF showed evident effect in these experiments. Smaller size cooling device has been under development aiming at totally implantable type. Catheter type cooling device for the insertion by the use of fiber-scope type is now under planning for the clinical application. This new type device may be able to become good news for the patients with uncontrollable AF.

[Clinical analyses of oral squamous cell carcinoma patients showing a complete response to chemotherapy with S-1 alone].

The purpose of this study was to investigate the effectiveness and safety of palliative chemotherapy using S-1 alone. We clinically analyzed 8 oral squamous cell carcinoma patients showing a complete response(CR)to chemotherapy with S-1 alone. These patients received chemotherapy consisting of 2 weeks' administration, including 5-days' administration and 2- days' termination, following a 1-week rest. Adverse effects were observed in 4 patients. However, all of them were grade 1 toxicities. The average length of S-1 administration before achieving CR was 9. 8 ± 3. 1 weeks(3. 3 ± 1. 0 courses). Seven patients had a recurrence. The prognosis of this group was 5 deaths by local recurrence, and 1 death by lymph node metastasis. The average length of disease progression was 447. 4 ± 479. 5 days. Two patients, one who received surgery and the other who received irradiation after chemotherapy by S-1, are alive without tumors. The 1-year and 3-year disease-free survival rates were 100% and 37. 5%, respectively.

[A case of breast cancer with extensive osteonecrosis of maxilla induced by a bisphosphonate].

Here, we report a case of extensive osteonecrosis of the maxilla associated with a history of bisphosphonate (BP) therapy for management of bone metastases from breast cancer. A 66-year-old woman was referred to our hospital because of a fistulation on the right side of the maxilla in May 2005 by her dentist. The patient had a medical history of breast cancer with bone metastasis that was treated by chemotherapy with 45 mg pamidronate in 2 weekly courses for 16 months. We suspected that this rare case of osteonecrosis was caused by chemotherapy with BPs. Palliative treatments, including antibiotic therapy and local irrigation, were administered. Finally, extensive osteonecrosis of the maxilla occurred.

Clinical relevance of thymidylate synthase (TS) activity for S-1-based chemotherapy in squamous cell carcinoma of the oral cavity.

S-1 is a newly developed oral fluoropyrimidine derivative that is now widely used as a chemotherapeutic agent in the treatment of oral squamous cell carcinoma (SCC). Thymidylate synthase (TS) is the rate-limiting enzyme in the de novo DNA biosynthetic pathway, and improves clinical response to chemotherapy with fluoropyrimidines. We have retrospectively evaluated the predictive value of thymidylate synthase activity in 75 patients with oral SCC with an enzyme-linked immunosorbent assay (ELISA). Mean (SD) activity (pmol/mg) in the specimens was 0.078 (0.080) (median 0.059). The median value was taken as the cut-off value based on which the patients were divided into high and low activity groups. Both the clinical and histopathological responses to chemotherapy and radiochemotherapy were higher in the group with low TS activity. The group with low TS activity also differed significantly in their clinical response to S-1-based chemotherapy (p<0.05). However, there was no significant difference in cause-specific survival. Measurement of TS activity may aid in predicting the clinical response to chemotherapy including S-1 for oral SCC.

Detection of differences in genomic profiles between herpes simplex virus type 1 isolates sequentially separated from the saliva of the same individual.

BACKGROUND: Herpes simplex virus (HSV) is assumed to cause recrudescent lesions, usually through endogenous recurrence and rarely through exogenous re-infection. The occurrence of exogenous re-infection in genital and corneal HSV infections has been previously demonstrated using genomic analysis, while exogenous re-infection in oral-facial HSV infections has not been shown. OBJECTIVES: To confirm the occurrence of exogenous HSV re-infection in oral-facial HSV infections. STUDY DESIGN: Seven isolates (isolates 1-7) of herpes simplex virus type 1 (HSV-1) were sequentially separated from the same individual. Genomic profiles of HSV-1 isolates were studied: (i) by analysis of 20 RFLPs (restriction fragment length polymorphisms) and (ii) by the determination of nucleotide sequences of a PCR-amplified DNA fragment encompassing reiteration VII (hypervariable region) that belongs to sequences containing short tandem repeats. RESULTS: Isolates 1-5 were the same (F83 genotype) and isolates 6 and 7 were the same (F84 genotype), although isolates 1-5 were markedly different from isolates 6 and 7 in genomic profiles. CONCLUSIONS: The infection associated with isolates 6 and 7 was due to exogenous re-infection with F84 genotype virus, thus indicating the occurrence of exogenous HSV re-infection in oral-facial HSV infections.

[Clinical evaluation of palliative chemotherapy with S-1 for oral cancer patients].

The purpose of this study was to investigate the effectiveness and safety of palliative chemotherapy using S-1. We treated 19 advanced oral SCC patients including 8 men and 11 women with S-1. Of the 19 patients studied, two patients were classified as UICC Stage II, two patients as Stage III, 14 patients as Stage IV A, and one patient was classified as StageIV C. The ages varied from 54 to 9 1 years (mean ages; 78.3 years-old). The patients received this chemotherapy (80-120 mg/day) consisting of 2 weeks' administration including 5-days' administration and 2-days' termination (named 'Weekday-on/Weekend-off administration schedule' ) following 1 week rest. After this treatment, 7 CR and 4 PR were achieved, but the toxicities were only anorexia, leukopenia, thrombocytopenia, and uritication of NCI-CTC grade 1. The prognosis of 19 cases was 7 terminal by primary disease, 3 terminal by other disease, 7 lives with tumor bearing, and 2 lives without tumor bearing. We concluded that our novel S-1 administration method was extremely effective for oral SCC, including lymph node metastasis, providing high potential without any severe adverse effects for palliative therapy.

Discriminant analysis of DNA polymorphisms in herpes simplex virus type 1 strains involved in primary compared to recurrent infections.

The restriction fragment length polymorphism (RFLP) was analyzed using a set of herpes simplex virus type 1 (HSV-1) strains isolated from oro-facial lesions (oro-facial site collection), which was composed of two subsets: one subset consisted of 57 strains from primary oro-facial lesions, and the other of 47 strains from recurrent oro-facial lesions of patients complicated by factors possibly triggering the recurrence (e.g. malignancy, operation, and treatment of dental caries). RFLP analysis was carried out previously on two other sets of HSV-1 strains: one set was from genital lesions (genital site collection), and the other was from non-genital lesions (non-genital site collection). Discriminant analysis was carried out on the three sets of HSV-1 strains: the criterion variable had two values of primary infection or recurrence, and the predictor variables were 20 RFLPs. The degrees of separation between primary infection and recurrence increased in the order oro-facial site collection, genital site collection, and non-genital site collection. The results of discriminant analysis in this study confirmed that reactivation of HSV-1 infection is influenced by triggering factors and the site of infection, thereby suggesting the capabilities of multivariate analysis (including discriminant analysis) with DNA polymorphisms for molecular epidemiological studies.

Ramsay-Hunt syndrome with vesicular stomatitis in a 4-year-old infant.

Ramsay-Hunt syndrome (RHS) usually affects adults, but rare cases of preschool children with RHS have been reported. We report a case of RHS in a healthy 4-year-old girl. At the age of 4 years and 5 months, she complained of pain in her mouth and herpes zoster vesicles were noted on the left soft palate and tongue without left pinna, and complete left facial paralysis subsequently developed. She was treated with acyclovir and steroids. Six months later, her facial paralysis had almost fully resolved.