Usefulness of Telemedicine for Disabled Children Receiving Feeding Therapy.

We performed a retrospective cohort study using medical records of 374 pediatric patients who visited a university dental clinic specializing in dysphagia rehabilitation in Japan between 2019 and 2020 to clarify the usefulness of telemedicine among disabled children receiving feeding therapy. The primary outcome was the feeding developmental stage confirmed at the final evaluation. Propensity score matching was performed between individuals in two treatment groups (in-person and telemedicine) before the final analysis using patients' age, sex, primary disease, gross motor function, and feeding developmental stage as covariates. A total of 36 patients were enrolled in each of the in-person and telemedicine groups. The initial evaluation for the propensity score matched population using the χ2 test showed no significant difference between the two groups in any parameter. The feeding developmental stage evaluated at the final evaluation using the Wilcoxon signed-rank test significantly improved compared with the stage at the initial evaluation in both groups (in-parson group, p = 0.007; telemedicine group, p = 0.013). The difference in level achieved at the final evaluation revealed that the most common level was "unchanged," followed by "improvement by one level" in both groups, indicating that there was no significant difference in the efficacy of feeding therapy between the two groups (p = 0.314). Our results show that telemedicine can achieve the same therapeutic outcomes as in-person therapy to improve feeding function in children with disabilities when receiving feeding therapy.

Effects of oral ingestion on physical functions before tube feeding in adults with severe motor and intellectual disabilities.

This study aimed to determine the significance of oral ingestion in tube-fed adults. Six males and three females (mean age 48.1 ± 12.4 years) with severe motor and intellectual disabilities were included in this study. The subjects were monitored for cerebral blood flow (CBF) by functional near-infrared spectroscopy imaging, gastric motor function by electrogastrography, and arterial oxygen saturation (SpO2) and pulse rate with a biological data monitoring device. The subjects were divided into two groups, settings A and B. In setting A, after resting for 30 min, the subjects were tube fed a routinely used enteral nutrient solution. In Setting B, the subjects received 10 cc of thickened enteral nutrient solution prior to tube feeding. Cerebral function as measured by CBF significantly increased after tube feeding under setting A (without oral ingestion), as compared to the resting state. Under setting B (with oral ingestion), CBF significantly increased after oral ingestion and after tube feeding. SpO2 significantly decreased under setting B after oral ingestion and after tube feeding. Gastric motor function showed no significant change after tube feeding in either setting. The pulse rate significantly increased before tube feeding as compared to that in the resting state, after feeding as compared to before feeding and after feeding as compared to the resting state. Our data suggest that introducing oral ingestion, at least partially, in tube-fed individuals with severe dysphagia is beneficial in that it can stimulate cerebral function.

Follicular dendritic cell sarcoma with microtubuloreticular structure and virus-like particle production in vitro.

Neoplasm of follicular dendritic cells (FDC), follicular dendritic cell sarcoma (FDCS), is a rare tumor of intermediate to high-grade malignancy in lymph nodes and visceral organs. Reported herein is a case of FDCS arising from cervical lymph nodes in a 16-year-old Japanese boy, who died of the disease 3 years after diagnosis. The tumor cells were pale eosinophilic and elongated with euchromatic nuclei and were positive for CD21, clusterin, and CNA-42 on immunohistochemistry, as well as desmosome-like junctions on electron microscopy. The presence of microtubuloreticular structures (MTRS) in the tumor cells and associated lymphocytes characterized this case, suggesting some viral infection, although qualitative polymerase chain reaction of genomic and complementary DNA obtained from the tumor failed to demonstrate any viral infection at the laboratory level. The stimulation of dispersed tumor cells and peripheral blood mononuclear cells with mAb to CD3 and interleukin-2 was attempted; and the cell line established by the authors (FDCS-Sa) was stimulated with iododeoxyuridine. Virus-like particles (VLP) were successfully induced from each cellular source. The VLP, 100 nm in diameter, showed an electron-dense thorny envelope and granular core. This is the first case of FDCS with MTRS accompanying VLP production in vitro.

[Detection of herpesvirus genome by multiplex polymerase chain reaction (PCR) and real-time PCR in ocular fluids of patients with acute retinal necrosis].

PURPOSE: The human herpesvirus (HHV) family consists of types 1 to 8 (HHV1-8). The purpose of this study was to investigate the detection of HHV DNA, especially HSV1 (herpes simplex virus 1, HHV1), HSV2 (herpes simplex virus 2, HHV2), and VZV (varicella-zoster virus, HHV3) in ocular fluids of patients with acute retinal necrosis(ARN). METHODS: The intraocular genome for HHV1-8 was determined in 19 ocular fluid samples (12 vitreous fluid and 7 aqueous humor samples) taken from ARN patients (n=14). The samples were tested for the presence of virus DNA by two systems of polymerase chain reaction (PCR): the multiplex PCR screening test and real-time quantitative PCR. RESULTS: Multiplex PCR demonstrated VZV (n=16, 84%), HSV1 (n = 1.5%) or HSV2 (n = 2.11%)genomic DNA in all the samples. In real-time PCR, a high copy number of virus DNA was detected. The virus DNA-positive samples contained Epstein-Barr virus (EBV, HHV4) DNA in 9 of 19 samples (47%). No HHV6-8 DNA was detected in the ocular samples, and no virus DNA was detected in the serum samples. CONCLUSIONS: The genome for HHV1-3 was detected in the patients with ARN. All cases contained a high copy number for the virus DNA that indicates viral replication. PCR systems are useful for determing whether virus infections are associated with uveitis.

Distribution of causes and treatments of dysphagia at dysphasia/dysphagia rehabilitation clinic of Showa University Dental Hospital: 1999-2002.

The purpose of this study was to investigate the distribution of causes of dysphagia and the types of treatments being provided at the Dysphasia/Dysphagia Rehabilitation Clinic of Showa University Dental Hospital. The subjects included 173 dysphagic patients. Fifty-three percent of patients ranged 0-12 age, and 24% of them were over 60 years old. The survey results showed that diseases of the central nervous system, such as cerebral palsy (CP), was a major diagnosis in young patients, and cerebrovascular accident (CVA) was a predominant cause in adult and elderly patients. Diagnosis distribution showed that swallowing dysfunction was the most frequent diagnosis for patients on their first visit when compared to other feeding dysfunctions including malfunction of lips, tongue, and mastication. Almost 40 % of patients still continue to have rehabilitation for their dysphagic symptoms at the end of March 2002. This suggests that dysphagia rehabilitation is needed for a long time for many disabled individuals.

Analysis of feeding function and jaw stability in bedridden elderly.

The purpose of this study was to analyze the relationship between jaw stability and the feeding function of 53 bedridden elderly dysphagic patients. Investigations included a questionnaire on daily life activities and meals, oral examinations, functional tests for feeding ability, and assessments of feeding function during the meal. The results of intraoral examination of this patient population for jaw stability revealed that 34.0% of individuals had posterior support for occlusion regardless of whether they had natural teeth or dentures. Thus, the number classified as having mandibular stability (ST) was 18 and that with no mandibular stability (NST) was 35. In a Repetitive Saliva Swallowing Test (RSST), 83.3% of the NST group and 40.0% of the ST group were unable to swallow more than 3 times within 30 seconds. In a water swallowing test, 91.4% of the NST of group was unable to swallow 15 mL of water by a single swallow, while 40.0% of ST group was capable. The results suggest that jaw stabilization by occlusion with the posterior teeth or dental prosthetics is important to feeding function, particularly swallowing.