Bioaccessibility of Plant Sterols in Wholemeal Rye Bread Using the INFOGEST Protocol: Influence of Oral Phase and Enzymes of Lipid Metabolism.

Bioaccessibility of plant sterols (PS) in an enriched wholemeal rye bread was evaluated, for the first time, using the INFOGEST protocol without gastric lipase (GL) and cholesterol esterase (CE), with GL or GL + CE. Moreover, human chewing and an in vitro oral phase (simulated salivary fluid and α-amylase) were evaluated for this purpose. The addition of GL decreased the bioaccessibility of total PS (from 23.8 to 18.5%), whereas the use of GL + CE does not significantly affect PS bioaccessibility. The in vitro oral phase resulted in an ineffective homogenization of the fresh vs partially dried and milled bread, reducing the bioaccessibility of total (from 20.2 to 12.8%) and individual PS. The INFOGEST digestion including the use of GL and CE, as well as an oral phase with human chewing, is proposed for the assessment of PS bioaccessibility in a solid matrix such as wholemeal rye bread since it more closely approximates the in vivo situation.

Ultrasonographic Measurement of Masseter Muscle Thickness Associates with Oral Phase Dysphagia in Institutionalized Elderly Individuals.

BACKGROUND & AIMS: Oral phase dysphagia is dependent on ability to chew. As people age, general muscle atrophy contributes to decreased masseter strength. The main objective of this study was to assess the relationship between the thickness of the masseter muscle measured by ultrasonography and the presence of dysphagia in a group of institutionalized elderly people. As a secondary objective, we aimed to establish cutoff points of masseters muscle thickness (MMT) to identify elderly individuals at risk of oral dysphagia. METHODS: Cross-sectional study of all residents from 3 nursing homes. All individuals underwent ultrasonographic measurements of left and right MMT and were classified according to the presence of dysphagia assessed by both the EAT-10 screening questionnaire and the volume-viscosity swallow test (V-VST). RESULTS: 469 patients (69% women, mean age 84.7 yrs) were recruited. Dysphagia was present in 41.6% and 26% of individuals according the EAT-10 and V-VST, respectively. Multivariate logistic regression showed that 1 mm increase in MMT reduced the risk of dysphagia by 21% according to the EAT-10 tool and by 30% using the V-VST after adjusting for age, sex, mini-nutritional assessment score, and body mass index. We used receiver operative characteristic (ROC) curves to identify cutoff points of MMT to detect dysphagic individuals according to either EAT-10 or V-VST. CONCLUSIONS: The MMT measured by ultrasonography is reduced in elderly individuals with dysphagia. Based on MMT, clinicians may be better informed about the patients'´ ability to masticate solid foods and identify potential nutrient deficiencies in geriatric settings.

Clinical Factors Associated with Videofluoroscopic Swallowing Study Findings in Stroke Patients / 대한연하장애학회지

OBJECTIVE: To examine the clinical factors and brain lesion locations related to the patterns of dysphagia in stroke patients in a rehabilitation hospital. METHODS: The medical records of 116 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) between January 2010 and January 2015 in a rehabilitation hospital were reviewed retrospectively. The swallowing-related parameters were assessed using a VFSS. The brain lesion locations were classified as the cortex, basal ganglia, thalamus, midbrain, pons, medulla, cerebellum, and others (subarachnoid or intraventricular hemorrhage). The ambulation ability was assessed using functional ambulation categories (FACs). The independence in the activities of daily living and the degree of cognitive impairment were assessed using the Korean versions of the modified Barthel index (K-MBI) and Mini-Mental State Examination (K-MMSE), respectively. After adjusting for the potential confounding factors in multivariate analysis, the odds ratios and confidence intervals of the stroke brain lesions were calculated and the clinical factors for predicting the VFSS findings were determined. RESULTS: Among the 116 patients, 35 (27%) had an impaired oral stage and 58 (50%) had aspiration. The impaired oral stage was associated significantly with the onset time, basal ganglia stroke, dietary and fluid intake methods at the time of the VFSS, symptoms of dysphagia, FACs, K-MBI, and K-MMSE. Aspiration was correlated with a pontine stroke, methods of dietary and fluid intakes at the time of the VFSS, symptoms of dysphagia, FACs, and K-MBI. Multivariate analysis showed that the pontine stroke and methods of dietary and fluid intake at the time of VFSS predicted aspiration after adjusting for the potential confounding factors. In subgroup analysis of the diet type, the liquid and semisolid aspirations were correlated with the dietary and fluid intake methods and pontine stroke, respectively. CONCLUSION: Patients with a pons lesion stroke, who are on a modified diet (fluid thickening and tube feeding), have higher risks of aspiration. This provides evidence for precise clinical reasoning in this specific patient group.

Effect of an impaired oral stage on swallowing in patients with Parkinson's disease.

We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because patients with PD frequently exhibit an impaired oral stage of swallowing and the tongue movement affects oral and pharyngeal stage. In total, 201 patients with PD (106 men, 95 women; mean age 70·6 ± 8·0 years; median Hoehn-Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography, and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70·3 ± 7·8 years) with an OTT + 2 standard deviation (0·89 + 2 × 0·46) of 1·81 s, the patients with PD were divided into 167 patients with an OTT < 1·81 s and 34 patients with an OTT ≥ 1·81 s. Swallowing function was compared between the groups and assessed using logistic regression analysis. The following factors were significantly associated with oral stage impairment in both groups: tongue-to-palate contact, tongue root-to-posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration and onset of swallowing reflex. Logistic regression analysis showed that tongue root-to-posterior pharyngeal wall contact, onset of swallowing reflex and aspiration were independent factors. PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD.

Oral Mucosal Lesion Related with Dysphagia / 대한연하장애학회지

Anatomically, the oral cavity is an organ of the digestive system that is anteriorly delimited by the lips, posteriorly by the oropharynx, superiorly by the hard and soft palates, and inferiorly by the tongue (anterior 2/3) and floor of the mouth, and surrounded by a buccal mucosa that lines the cheeks. Oral mucosal diseases represent several conditions that can affect oral function, systemic health, and quality of life for patients. In the swallowing stage, oral mucosa of lip, buccal, gingiva and tongue plays an important role as well as the movement of tongue during oral preparatory and oral stage. Therefore, oral mucosal diseases that cause pain and odynophagia can have serious adverse effects on swallowing. Proper diagnosis and treatment of oral mucosal disease will be helpful in the treatment of dysphagia due to oral mucosal diseases.

The Relation Between the Presence of Aspiration or Penetration and the Clinical Indicators of Dysphagia in Poststroke Survivors

OBJECTIVE: To examine the relation between the presence of penetration or aspiration and the occurrence of the clinical indicators of dysphagia. The presence of penetration or aspiration is closely related to the clinical indicators of dysphagia. It is essential to understand these relationships in order to implement proper diagnosis and treatment of dysphagia. METHODS: Fifty-eight poststroke survivors were divided into two groups: patients with or without penetration or aspiration. Medical records and videofluoroscopic swallowing examinations were reviewed. The occurrence of clinical indicators of dysphagia between two groups was analyzed with Cross Tabulation and the Pearson chi-square test (p<0.05). RESULTS: Poststroke survivors with penetration or aspiration had significantly high occurrences of delayed initiation of the swallow (p=0.04) and reduced hyolaryngeal elevation (p<0.01) than those without penetration or aspiration. CONCLUSION: The results of this study indicate that delayed initiation of the swallow is a strong physiological indicator of penetration or aspiration during the oral stage of swallowing in poststroke survivors. For the pharyngeal stage of swallowing, hyoid and laryngeal elevation is a key event related to occurrence of penetration or aspiration. Clinical indicators should be investigated further to allow appropriate implementation of treatment strategies for stroke survivors.

Karl Abraham's revolution of 1916: from sensual sucking to the oral-aggressive wish of destruction.

The author argues that "The First Pregenital Stage of the Libido" (Abraham 1916-1917) expounds a new conception of orality, i.e., of purposeful oral aggression directed against an object during the first stage of psychic development. This conception is shown to be contrary to Freud's view of orality as elaborated in Three Essays on the Theory of Sexuality (1905), as well as in other writings of late 1914 and 1915. Abraham's conception ignores fundamental dimensions of Freud's thinking during these years, namely, the difference between autoerotism/narcissism and object love, on the one hand, and also between the leading role of sexuality and the secondary role of aggression, on the other. Thus, Abraham's thinking represents a basic theoretical change that had far-reaching consequences for psychoanalytic practice.

Evaluation of hyoid bone movements in subjects with open bite: a study with real-time balanced turbo field echo cine-magnetic resonance imaging / 대한치과교정학회지

OBJECTIVE: To assess the position and movements of the hyoid bone during deglutition in patients with open bite. METHODS: Thirty-six subjects were divided into 2 groups according to the presence of anterior open bite. The open bite group (OBG) and control group each comprised 18 patients with a mean overbite of -4.9 +/- 1.9 mm and 1.9 +/- 0.7 mm. The position of the hyoid bone during the 4 stages of deglutition was evaluated by measuring vertical and horizontal movement of the bone. RESULTS: Interactions of group and stage showed no significant effect on the measurements (p > 0.05). However, when group and stage were evaluated individually, they showed significant effects on the measurements (p < 0.001). In OBG, the hyoid bone was more inferiorly and posteriorly positioned, and this position continued during the deglutition stages. CONCLUSIONS: The hyoid bone reaches the maximum anterior position at the oral stage and maximum superior position at the pharyngeal stage during deglutition. Open bite does not change the displacement pattern of the bone during deglutition. The hyoid bone is positioned more inferiorly and posteriorly in patients with open bite because of released tension on the suprahyoid muscles.

[Who is afraid of Ulrike May? On Wolfgang Hegener's paper "From passionate sucking to oral-aggressive destruction wishes: really a revolution"?]. / Wer hat Angst vor Ulrike May? Zu Wolfgang Hegeners Artikel "Vom Wonnesaugen zum oral-aggressiven Vernichtungswunsch: wirklich eine Revolution"?

The author wonders why Hegener perceived May's historical elucidation of Abraham's concept of oral sadism as a threat to his identity as part of the Freudian tradition. Referring to his use of the concept of death drive and to his view of depression, she questions his overall tendency to minimize any differences between Freud and Abraham, while ignoring the temporal sequence of their theory formation.

[From passionate sucking to oral-aggressive destruction wishes: really a revolution? A rejoinder to Ulrike May]. / Vom Wonnesaugen zum oral-aggressiven Vernichtungswunsch: wirklich eine Revolution? Eine Entgegnung auf Ulrike May.

The author discusses May's paper on the history and relevance of oral sadism, published in the last issue of LUZIFER-AMOR. He doubts that the oral-sadistic organisation was an exclusive feature of Abraham's theory and that for Freud sadism never predated the anal stage. He misses a distinction between internal and external objects and criticizes that May did not really consider other readings of the texts she explored. By characterizing Abraham's ideas as a "revolution" the author feels that May has disputed their being rooted in Freud's thought, thereby divesting Abraham and his followers of the connection to Freud which is essential for every psychoanalyst.

Obturator Prosthesis for Velopharyngeal Insufficiency after Treatment of Soft Palate Cancer: A Case Report

Velopharyngeal insufficiency after surgical resection of soft palate cancer can be troublesome. This report concerns a male suffered from severe dysphagia following combined treatment for soft palate cancer. Sequential videofluoroscopic swallowing studies (VFSS) were used to assess his swallowing function and plan the interventional strategies. Initial VFSS showed huge nasal regurgitation, increased oral transit time, residues in oral cavity, delayed swallowing reflex, pharyngeal residue, impaired laryngeal elevation, and aspiration in semisolid and liquid trials. Obturator prosthesis was fabricated to minimize velopahryngeal insufficiency. After application of obturator prosthesis, swallowing dysfunction in oral and pharyngeal stages was markedly improved. Nasal regurgitation was not shown. Oral residue, oral transit time in oral stage also improved. Residue on vallaculae and pyriform sinuses decreased in pharyngeal stage. Aspiration also decreased. We reported successful obturator prosthesis application with sequential changes of clinical and VFSS findings in our case.

Diagnosis of ovarian cancer and object relationships in early memories: a pilot study.

Women newly diagnosed with ovarian cancer (N = 16) and women from the community (N = 17) each described 3 early memories. We assessed the developmental maturity level of the memories with Mayman's Libidinal Level of Relationships scale, which assesses the maturity of memories form oral to latency levels. The early memories of the cancer patients were at a significantly lower libidinal level and more often involved oral relationship themes than the memories of the community women. The results suggest that a diagnosis of a life-threatening illness can invoke comforting memories of being cared for and fed, associated with a greater sense of dependence on others.

Sobrepeso, obesidade e compulsão bucal entre mulheres de baixa renda na cidade de Carapicuiba-SP / Overwight, obesity and mouth compulsion among low income women in the city of Carapicuíba-SP

O crescente aumento de incidência da obesidade nas últimas décadas, tanto nos países desenvolvidos como nos em desenvolvimento, tornou esse desvio nutricional como o principal problema de saúde pública para o século XXI. O aumento de prevalência da obesidade no Brasil tem sido relevante e mais observado em famílias de baixo poder aquisitivo, especialmente entre as mulheres. O Brasil, país que ainda apresenta grupos populacionais que vivem em risco de carência nutricional, enfrenta um momento epidemiológico de transição nutricional com um maior crescimento dos desvios nutricionais que acarretam excesso de peso. Dessa forma, o Brasil vive atualmente uma situação nutricional paradoxal e as razões desse fenômeno precisam ser melhores explicadas, especialmente o maior crescimento da obesidade em mulheres de baixa renda. Portanto, o intuito deste estudo foi pesquisar as causas que contribuem para obesidade. Como principais causas, observamos queixas de ansiedade, “nervosismo”, frustrações e depressão. Foi observado no grupo de mulheres de baixa renda da cidade de Carapicuíba-SP que, a conscientização do corpo obeso foi adquirida através do profissional de saúde. Evidenciou-se uma complexidade na história de vida destas mulheres perseguidas pela dor, doenças, privações financeiras, abusos sexuais, fome, miséria, falta de informações e sobrecarga de trabalho. Diante dessa realidade, a obesidade tornou-se secundária, advindo como forma de alívio através da alimentação. Concluímos que o trabalho de conscientização psicoterápico no tratamento da obesidade, possibilitando a interação das pessoas com seu próprio corpo, a família e sua vida afetiva e sexual possa levar a compreensão do problema da obesidade como um sintoma e assim contribuir para uma maior eficácia do tratamento higiênico-dietético da obesidade. É importante que tratamentos específicos voltados para o problema da obesidade integrem-se à rede de saúde pública no Brasil, ressaltando-se a importância de adota...

Sobrepeso, obesidade e compulsão bucal entre mulheres de baixa renda na cidade de Carapicuiba-SP

O crescente aumento de incidência da obesidade nas últimas décadas, tanto nos países desenvolvidos como nos em desenvolvimento, tornou esse desvio nutricional como o principal problema de saúde pública para o século XXI. O aumento de prevalência da obesidade no Brasil tem sido relevante e mais observado em famílias de baixo poder aquisitivo, especialmente entre as mulheres. O Brasil, país que ainda apresenta grupos populacionais que vivem em risco de carência nutricional, enfrenta um momento epidemiológico de transição nutricional com um maior crescimento dos desvios nutricionais que acarretam excesso de peso. Dessa forma, o Brasil vive atualmente uma situação nutricional paradoxal e as razões desse fenômeno precisam ser melhores explicadas, especialmente o maior crescimento da obesidade em mulheres de baixa renda. Portanto, o intuito deste estudo foi pesquisar as causas que contribuem para obesidade. Como principais causas, observamos queixas de ansiedade, “nervosismo”, frustrações e depressão. Foi observado no grupo de mulheres de baixa renda da cidade de Carapicuíba-SP que, a conscientização do corpo obeso foi adquirida através do profissional de saúde. Evidenciou-se uma complexidade na história de vida destas mulheres perseguidas pela dor, doenças, privações financeiras, abusos sexuais, fome, miséria, falta de informações e sobrecarga de trabalho. Diante dessa realidade, a obesidade tornou-se secundária, advindo como forma de alívio através da alimentação. Concluímos que o trabalho de conscientização psicoterápico no tratamento da obesidade, possibilitando a interação das pessoas com seu próprio corpo, a família e sua vida afetiva e sexual possa levar a compreensão do problema da obesidade como um sintoma e assim contribuir para uma maior eficácia do tratamento higiênico-dietético da obesidade. É importante que tratamentos específicos voltados para o problema da ...

Progression from oral to oedipal themes: a defense against experiences of object loss.

This paper will focus on a patient whose associations appeared to involve triangular, oedipally organized themes, but who also had a severely compromised ego. This apparent discrepancy in development can be understood as a defensive maneuver. The defense protected him from experiencing object loss as he reflected on a deprived childhood, sought assistance in managing current romances, and developed a transference and relationship in the therapeutic situation. Discussion of case material, in light of traditional psychoanalytic perspectives, including those put forth by A. Freud, Winnicott, Zetzel, and Brenner, will address whether an apparent "progression" from a cluster of features associated with one phase to those associated with another can serve as a defense. Although "progression" is perhaps not the best term for this phenomenon, it will serve as a concise description for the sake of this article.