Predictors of early postoperative pneumonia after oncologic surgery with the patients receiving professional oral health care: A prospective, multicentre, cohort study.

This study was a prospective, multicentre, cohort study on 685 patients who had undergone oncologic surgery. The patients were divided into two groups according to the presence or absence of postoperative pneumonia. The two groups were compared with respect to their background, index operation, food eaten, oral condition, contents of oral care and dental treatment, laboratory data, and bacterial flora. All postoperative pneumonias occurred in six cases within four days postoperatively. The multivariable logistic regression analysis showed that preoperative serum C-reactive protein was the strongest predictor of postoperative pneumonia. In addition, decreased postoperative Candida albicans colonies was an effective predictor of postoperative pneumonia. For patients with predictors of postoperative pneumonia, perioperative strategies for its prevention should be considered in addition to professional oral health care. This study was approved by the National Hospital Organization's Central Ethics Review Board and was also approved by the directors of the participating institutions.

Influence of cervical, thoracic and lumbar spines, and shoulder girdle range of motion on swallowing function of dependent older adults.

AIM: The present study examined the cervical, thoracic and lumbar spines, and shoulder girdle range of motion (ROM) of dependent older adults to clarify the influence of these variables on swallowing function, in order to evaluate the efficiency of ROM training to maintain older adults' swallowing function. METHODS: A total of 37 (mean age 86.8 ± 6.2 years; 11 men; 26 women) dependent older adults were included in the study. The level of swallowing function was assessed using the Functional Oral Intake Scale. The following ROM were measured three times to calculate the mean: the cervical spine (flexion, extension, rotation and lateral bending); thoracic and lumbar spines (flexion, extension, rotation and lateral bending); and shoulder girdle (flexion, extension, elevation and depression). In order to compare ROM, the participants showing Functional Oral Intake Scale scores of 7 were classified as dysphagia (-), and those showing scores <7 were included in the dysphagia (+) subgroups. RESULTS: The dysphagia (+) group showed significantly limited cervical spine (flexion, extension and lateral bending), thoracic and lumbar spines (flexion, extension, rotation and lateral bending), and shoulder girdle (flexion, elevation, and depression) ROM. CONCLUSIONS: Although strict relationships were not clarified, the results of the present study suggested the influence of some joint ROM on swallowing function. This suggests the feasibility of preventing dysphagia among dependent older adults by maintaining and enhancing the elasticity and extensibility of their muscles through cervical, thoracic and lumbar spines, and shoulder girdle ROM training. Geriatr Gerontol Int 2017; 17: 2565-2572.

Effect of swallowing exercises in independent elderly.

The aim of this study was to investigate the effects of swallowing exercises on oral function in independent elderly patients visiting the Department of Prosthodontics at Tokyo Dental College Chiba Hospital. Twenty-nine patients aged over 65 years (15 men and 14 women; mean age, 75.0 years) in whom treatment was completed at this college were enrolled in the study. The patients were instructed on how to perform swallowing exercises monthly (including at baseline) for the first 2 months from the start of the study and asked to perform those exercises at least once daily. At the beginning and end of the study (a 3-month study period), the Repetitive Saliva Swallowing Test was conducted and occlusal force, oral diadochokinesis, unstimulated whole saliva flow rate, stimulated whole saliva flow rate, salivary pH at rest, and salivary buffering capacity measured to determine the effects of the exercises on oral function. Analyses demonstrated significant increases in diadochokinesis rate (/ta/ and /ka/) and unstimulated whole saliva flow rate (p<0.05), suggesting that the swallowing exercises promote the maintenance and improvement of oral function in the independent elderly.

Appropriate spoon form for feeding of liquids in infant feeding development.

Feeding development in infants is important not only for of the purpose of acquiring nutrition but also for developing the ability to intake liquids. Our previous study showed that the introduction of a straw was appropriate after an infant has acquired the ability to sip liquid from a spoon and/or cup. In this study, we investigated the effect of a bowlshaped spoon on liquid intake. The aim of this study was to determine the appropriate form of spoon for infant feeding development. Eleven healthy infants (3 girls and 8 boys, 10-18 months old, mean age: 13.3 months) were recruited with their guardians' consent. We made 3 types of prototype spoon: A, oval (a standard renge soup spoon); B, flared-out (with the margin of the bowl flared out); and C, hemispherical (with a hemispherical bottom, and smaller than type A or B). We observed infants taking liquid supported by their mothers and evaluated the following responses: 1) confusion with regard to lip position, 2) spillage and 3) choking. Type C showed statistically less confusion with regard to lip position than type A or B (p<0.01), and B showed less than type A (p<0.05). No statistically significant differences were observed in spillage or choking among the three types of spoon. The renge soup spoon is often used to smooth the transition from breast/bottle to cup feeding. In this study, we demonstrated the appropriate spoon form for infant feeding development.

Dynamic imaging of swallowing in a seated position using open-configuration MRI.

PURPOSE: To assess the feasibility of dynamic MRI of swallowing in a seated position using an open-configuration MRI scanner, and to compare its capacity for motion analysis around the pharyngeal wall with that of videofluorography. MATERIALS AND METHODS: Six healthy individuals (four women and two men, mean age = 31.4 +/- 7.5 years) were examined with an open-configuration MRI system using a fast spoiled gradient-recalled echo (SPGR) sequence. Dynamic imaging was performed while the subjects were in a seated position after they swallowed oral contrast medium from a cup. An oral and maxillofacial radiologist measured the motion of six structures: the hyoid bone (HB), larynx (LX), upper oropharynx (UOP), lower oropharynx (LOP), pharyngoesophageal segment (PES) behind the vocal folds, and upper esophagus (ESO). The measured motions were compared with reported values from videofluorography-based observations. RESULTS: Open-configuration MRI depicted the anatomic structures related to swallowing (lip, tongue, soft palate, mandible, pharynx, HB, LX, and PES), and the course of the mylohyoid muscle (MM). The vertical and anteroposterior displacements of these structures did not differ significantly from those measured by videofluorography. CONCLUSION: Dynamic imaging of swallowing using open-configuration MRI provides image information comparable to that obtained from videofluorography.

Diagnostic value of dynamic contrast-enhanced MRI in the salivary gland tumors.

To evaluate the diagnostic value of dynamic contrast-enhanced MRI (DCE-MRI) in salivary gland tumors, thirty-five patients (47 lesions) who underwent MR examinations and were histopathologically diagnosed with salivary gland tumors in Okayama University Hospital, between April 1998 and March 2005, were entered in the present study. The parameters included CI(max300) or CI(max600), which was the contrast index (CI) at maximal contrast enhancement upon 300 s or 600 s, and Tmax, which was the time that corresponded to the CI(max300). Washout ratio (WR(300) or WR(600)) was defined as follows: CI(max300)-CI(300s)/CI(max300) or CI(max600)-CI(600s)/CI(max600)x100 (%), where CI(300) or CI(600) was the CI at 300s or 600s after contrast medium administration. We obtained the following results from the analysis of DCE-MRI parameters; (a) The salivary gland tumors were categorized into three CI curve types according to Tmax and WR300; Pleomorphic adenoma; Tmax > 210 s and WR300 < 10%, Warthin tumor; Tmax < 60 s and WR300 > 40%, and malignant tumor; 60s < Tmax < 210 s and 10% < WR300 < 30%; (b) On the basis of the relationship between Tmax and CImax or WR, all pleomorphic adenomas were successfully differentiated from Warthin tumor lesions. Of the 20 pleomorphic adenomas, 18 (90.0%) were successfully differentiated from malignant tumors. All Warthin tumor lesions were successfully differentiated from pleomorphic adenomas and malignant tumors. Of 12 the malignant tumors, 11 (91.7%) were successfully differentiated from pleomorphic adenomas. All malignant tumors were successfully differentiated from Warthin tumors. Thus, DCE-MRI parameters are useful in diagnosing salivary gland tumors on the basis of the combined assessment of Tmax and CImax or WR.

Assessment of pleomorphic adenomas using MRI and dynamic contrast enhanced MRI.

We evaluated magnetic resonance images (MRI) and the value of dynamic contrast enhanced MRI (DCE-MRI) of pleomorphic adenomas retrospectively. MRI was performed for 18 pleomorphic adenomas, including 11 cases with DCE-MRI. We obtained the following results on the MRI and DCE-MRI. (a). Pleomorphic adenomas showed a predilection for homogeneous intermediate signal intensity on T1-weighted images (T1WI), heterogeneous high signal intensity on T2-weighted images, and heterogeneous enhancement on Gd-T1WI. (b). Of 11 contrast index (CI) curves of pleomorphic adenomas, nine CI curves (81.8%) increased gradually to 600 s or increased gradually, reached a plateau, and sustained the plateau to 600 s. The remaining two (18.2%) increased gradually and decreased gradually thereafter. (c). CI curves reached the maximum CI index at 135-300 s.

Thermoradiotherapy combined with adenoviral p53 gene therapy in head and neck squamous cell carcinoma cell lines.

We examined effects of recombinant p53-expressing adenovirus combined with thermoradiotherapy in 8 head and neck squamous cell carcinoma (SCC) cell lines to improve the outcomes of the treatment of advanced head and neck cancer. The p53 gene therapy did not improve the discrepancy between thermoradiosensitivities among the 8 SCC cell lines. However, p53 gene therapy improved the effects of thermoradiotherapy in all 8 cell lines, and there were significant differences in four situations of the HSC4 44 degrees C (p=0.032), SAS at 44 degrees C (p=0.029), the KB at 43 degrees C (p=0.025), and the Ca9-22 43 degrees C (p=0.020). In comparing the survival rates of thermoradiotherapy with those of thermotherapy and radiotherapy, thermoradiotherapy demonstrated actual survival rates less than theoretical survival rates based on the survival rates of thermotherapy multiplied by the survival rates of radiotherapy in almost all treatments of thermoradio-gene therapy of the 8 SCC cell lines. These results demonstrate that thermoradiotherapy combined with p53 gene therapy may be a useful tool in treating SCC cells.

MR features of aneurysmal bone cyst of the mandible and characteristics distinguishing it from other lesions.

Aneurysmal bone cyst (ABC) is a relatively rare, non-neoplastic expansile lesion of bone. Bleeding may occur during an operation or biopsy for ABC, as this cyst is an aneurys with numerous pools of blood. Therefore, it is necessary to diagnose ABC before treatment or biopsy. In the present report, we describe the characteristic computed tomography (CT) and magnetic resonance imaging (MRI) features of ABC in the mandible. Based on the literature and on our own experiences, we compare with the features of ABC with the corresponding features of other lesions showing similar conventional radiographic appearances. In the present case, bone-targeting CT showed the characteristic feature, which reflected the histopathological appearance of a partially cystic meshwork divided by coarse septa. MRI showed almost homogeneous intermediate signal intensity, including a partial slight low-signal-intensity area on the T1-weighted image, and homogeneous high signal intensity, which showed a 'bubbly' appearance, on T2-weighted image. On the enhanced T1-weighted image, the intermediate signal intensity areas apart from the areas that showed slight low-signal intensity on the non-enhanced T1-weighted image, were well enhanced. This creates a 'honeycomb' appearance. The 'meshwork' appearance on bone-targeting CT, the 'bubbly' appearance on the T2WI and the 'honeycomb' appearance on Gd-T1WI may be the characteristic features of ABC.

Application of dynamic CT for various diseases in the oral and maxillofacial region.

OBJECTIVE: To investigate whether dynamic CT enables quantitative differentiation between inflammation, benign tumors, and malignant tumors in oral and maxillofacial regions. METHODS: Sixteen malignant tumors (14 squamous cell Ca, one adenoid cystic Ca, one mucoepidermoid Ca), six benign tumors (one Warthin tumor, two pleomorphic adenomas, one lipoma, one Schwanoma, one hemangioma), and seven inflammation cases (three submandibular adenitis, two osteomyelitis, two perimandibular inflammations) were examined. Contrast agent (0.8 ml/kg) was injected intravenously at 5 ml/s. CT (Toshiba TCT 900S) scanning was performed at the time of the beginning of contrast medium injection. Parameters from the time-density curve were investigated: peak height (PH), relative CT value from the base CT value when the curve reached peak point; peak time (PT), the time when the curve reaches the peak point from contrast medium infusion; transit time (TT), time between two transit points on the time-density curve; and peak time ratio (PR), the ratio of peak time from the lesion to the artery and peak time from the vein to the artery. RESULTS: PH was highest in inflammation, followed by malignant tumors and benign tumors. TT was significantly longer in benign tumor cases compared with malignant tumor and inflammation cases. PR for malignant tumor and inflammation were between the artery and vein phase, and that for benign tumor was beyond the vein phase. CONCLUSION: Parametrical analysis of a contrast enhanced dynamic CT study may serve to differentiate the lesions in the oral and maxillofacial region.

Clinical applications of 3-D CT and 3-D plastic models in the maxillo-facial region / Aplicação clínica dos modelos CT 3-D e 3-D plastico na região maxilofacial

We compared the usefulness of 3-D plastic models with that of 3-D CT images with regard to their applications in the field of maxillo-facial medicine. We also considered possibilities for wider clinical applications for both these methods. Five patients with the following conditions were involved in this study: hyperplasia of the mandibular condyle, 1; fracture of the maxilla and mandible, 1; coronoid hyperplasia, 2; and unilateral temporomandibular joint ankylosis with microgenia, 1) Stereolithographic models and 3-D CT images were made for each patient. Ct and 3-D CT images were superior to plastic models with respect to their clinical diagnostic value. Furthermore they provided more precise information about the surface and inner structures of the jaws. 3-D plastic models made it possible to do close observation of the complex anatomical relationship of the region which were easily overlooked on axial CT images and even on 3-D CT images. The 3-D plastic models were useful for simulated surgery in all these cases. In the cases with bilateral coronold process hyperplasia, the plastic model well clarified the direct functional cause of the patients trismus. The analysis on plastic models suggested that the abnormal contact of the coronold process with the deformed surrounding anatomical structures might cause trismus and elongation of the process. We believe that plastic models can be applied to other dental fields such as dental implantology, prosthodontics and measuring for 3-D cephalometry