Impact of the COVID-19 pandemic on the incidence of surgical site infection after orthopaedic surgery: an interrupted time series analysis of the nationwide surveillance database in Japan

BACKGROUND

During the COVID-19 pandemic, hygiene awareness was increased in communities and hospitals. However, there is controversy regarding whether such circumstances affected the incidence of surgical site infections (SSIs) in the orthopaedic surgical field.

AIM

To examine the impact of the COVID-19 pandemic on the incidence of SSIs after orthopaedic surgery.

METHODS

The medical records of patients having undergone orthopaedic surgery were extracted from the nationwide surveillance database in Japan. The primary outcomes were the monthly incidences of total SSIs, deep or organ/space SSIs, and SSIs due to meticillin-resistant Staphylococcus aureus (MRSA). Interrupted time series analysis was conducted between pre-pandemic (January 2017 to March 2020) and pandemic (April 2020 to June 2021) periods.

RESULTS

A total of 309,341 operations were included. Interrupted time series analysis adjusted for seasonality showed no significant changes in the incidence of total SSIs (rate ratio 0.94 and 95% confidence interval 0.98-1.02), deep or organ/space SSIs (0.91, 0.72-1.15), or SSIs due to MRSA (1.07, 0.68-1.68) along with no remarkable slope changes in any parameter (1.00, 0.98-1.02; 1.00, 0.97-1.02; and 0.98, 0.93-1.03, respectively).

CONCLUSIONS

Awareness and measures against the COVID-19 pandemic did not markedly influence the incidence of total SSIs, deep or organ/space SSIs, or SSIs due to MRSA following orthopaedic surgery in Japan.

Clinicopathologic differences of gastric neoplasms between Helicobacter pylori-infected and -naïve patients: a multicenter retrospective analysis

BACKGROUND

The incidence of gastric neoplasms in Helicobacter pylori (Hp)-naïve patients has recently increased due to a remarkable decrease in the Hp-infected population in Japan. We investigated the clinicopathologic differences between Hp-infected gastric neoplasms (HpIGNs) and Hp-naïve gastric neoplasms (HpNGNs) that have not been fully elucidated so far.

METHODS

This retrospective multicenter study investigated 966 consecutive patients with 1131 gastric dysplasia or cancers who underwent endoscopic or surgical treatment for the recent decade. Clinicopathologic features were compared between HpIGN and HpNGN cases.

RESULTS

One thousand and sixty-eight HpIGNs in 916 patients included 877 differentiated types and 191 undifferentiated types. Sixty-three HpNGNs in 50 patients included 57 differentiated types (35 foveolar types, 15 intestinal types, 6 fundic-gland types, and 1 other differentiated type) and 6 undifferentiated types. HpNGNs occurred in younger (59.5 vs. 71.8 years, p < 0.05) and female patients (40.0% vs. 26.5%, p < 0.05), were found more frequently in the proximal compartment (p < 0.05), and had smaller size (median 4.0 vs. 20.0 mm, p < 0.05). Histologically, HpNGNs and HpIGNs both primarily consisted of differentiated type (90.5% vs. 82.1%, p = 0.089) and HpNGNs showed lower prevalence of invasive cancer (11.1% vs. 37.6%, p < 0.05) and lymphovascular invasion (1.6% vs. 31.6%, p < 0.05). Nearly all HpNGNs (62/63, 98.4%) were diagnosed in early pathological stage, while 16.1% (172/1068) of HpIGNs were diagnosed in advanced stage (p < 0.05).

CONCLUSIONS

HpNGNs is recently on the increase but shows lower malignant nature regardless of histologic type than HpIGN. Endoscopic gastric cancer screening will be reviewed via cost effectiveness for Hp-naïve individuals in future.

[A Case of Pathological Complete Response of Advanced Rectal Cancer with Direct Invasion of the Prostate and Extra-Regional Lymph Node Metastasis after Chemotherapy]

A 62-year-old man was diagnosed as having advanced rectal cancer with an invasive carcinoma of the prostate and the right inguinal lymph node metastasis. He received chemotherapy consisting of combination of 5-FU, oxaliplatin, Leucovorin (mFOLFOX6)and bevacizumab. After 5 courses of the chemotherapy, CT and MRI findings revealed the tumor shrinkage. After 6 courses of the chemotherapy, a laparoscopic abdominoperineal resection, bilateral lymph node dissection and a resection of right inguinal lymph node were performed. The pathological findings showed a pCR. NAC with mFOLFOX6 and bevacizumab may contribute to the reduction of the surgical stress for the patients and be an effective treatment for advanced rectal cancer with distant lymph node metastasis.

Preoperative mechanical bowel preparation using conventional versus hyperosmolar polyethylene glycol-electrolyte lavage solution before laparoscopic resection for colorectal cancer (TLUMP test): a phase III, multicenter randomized controlled non-inferiority trial

BACKGROUND

A hyperosmolar ascorbic acid-enriched polyethylene glycol-electrolyte (ASC-PEG) lavage solution ensures excellent bowel preparation before colonoscopy; however, no study has demonstrated the efficacy of this lavage solution before surgery. This study aimed to establish the non-inferiority of ASC-PEG to the standard polyethylene glycol-electrolyte solution (PEG-ELS) in patients undergoing laparoscopic resection for colorectal cancer.

METHODS

This was a prospective, single-blind, multicenter, randomized, controlled, non-inferiority clinical trial. Overall, 188 patients scheduled for laparoscopic colorectal resection for single colorectal adenocarcinomas were randomly assigned to undergo preparation with different PEG solutions between August 2017 and April 2020 at four hospitals in Japan. Participants received ASC-PEG (Group A) or PEG-ELS (Group B) preoperatively. The primary endpoint was the ratio of successful bowel preparations using the modified Aronchick scale, defined as "excellent" or "good."

RESULTS

After exclusion, 86 and 87 patients in Groups A and B, respectively, completed the study, and their data were analyzed. ASC-PEG was not inferior to PEG-ELS in terms of effective bowel preparation prior to laparoscopic colorectal resection (0.93 vs. 0.92; 95% confidence interval, - 0.078 to 0.099, p = 0.007). The total volume of cleansing solution intake was lower in Group A than in Group B (1757.0 vs. 1970.1 mL). Two and three severe postoperative adverse events occurred in Groups A and B, respectively. Patient tolerance of the two solutions was almost equal.

CONCLUSIONS

ASC-PEG is effective for preoperative bowel preparation in patients undergoing laparoscopic resection for colorectal cancer and is non-inferior to PEG-ELS.

Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery: A matched-pair analysis

The indications of minimally invasive surgery (MIS) for T4 colorectal cancer are controversial because the advantages of MIS are unclear. Therefore, we compared overall survival (OS) and recurrence-free survival (RFS) as the primary endpoint, and short-term outcome, alteration in perioperative laboratory data, and the interval of postoperative chemotherapy from operation as secondary endpoints, between MIS and open surgery (OPEN) using a matched-pair analysis. We explored the advantages of MIS for T4 colorectal cancer. In this retrospective single-institution study, we included 125 patients with clinical T4 colorectal cancer who underwent curative-intent surgery of the primary tumor between October 2010 and September 2019. Conversion cases were excluded. MIS patients were matched to OPEN patients (ratio of 1:2) according to tumor location, clinical T stage, and preoperative treatment. We identified 25 and 50 patients who underwent OPEN and MIS, respectively, including 31 with distant metastasis. Both groups had similar background characteristics. The rate of major morbidities (Clavien-Dindo grade > III) was comparable between the 2 groups (P = .597), and there was no mortality in either group. MIS tended to result in shorter postoperative hospitalization than OPEN (P = .073). Perioperative alterations in laboratory data revealed that MIS suppressed surgical invasiveness better compared to OPEN. Postoperative chemotherapy, especially for patients with distant metastasis who underwent primary tumor resection, tended to be started earlier in the MIS group than in the OPEN group (P = .075). OS and RFS were comparable between the 2 groups (P = .996 and .870, respectively). In the multivariate analyses, MIS was not a significant prognostic factor for poor OS and RFS. MIS was surgically safe and showed similar oncological outcomes to OPEN-with the potential of reduced invasiveness and enhanced recovery from surgery. Therefore, patients undergoing MIS might receive subsequent postoperative treatments earlier.

Transabdominal Ultrasonography for Preoperative Diagnosis of Lymph Node Metastasis in Colon Cancer: A Retrospective Cohort Study

Background/Aim

Although computed tomography (CT) is the standard modality for diagnosing lymph node metastasis (LNM), transabdominal ultrasonography (US) can be useful due to its high spatial resolution and use of Doppler signals to precisely analyse lymph nodes. This study aimed to evaluate the accuracy of US for lymph node assessment, establish US-based diagnostic criteria for LNM, and compare the capability of US with that of CT for the diagnosis of LNM.

Patients and Methods

This retrospective, single-institution, cohort study included patients who underwent radical surgery for clinical stage 0-III colon cancer, between March 2012 and February 2019.

Results

Overall, 34.9% (66/189) of patients had pathological LNM. The optimal US diagnostic criteria were 1) short axis ≥7 mm and short/long ratio ≥0.75 and 2) at least two of the following: the absence of hilar echoes, expansive appearance, or peripheral/mixed vascularity by the colour Doppler and/or contrast-enhanced method. Compared to CT, US showed a higher diagnostic sensitivity (54.5% vs. 43.9%; p=0.296), higher concordance with the number of pathological LNM (correlation coefficient: US, 0.42; CT, 0.27) and pathological N diagnosis (weighted ĸ: US, 0.35; CT, 0.18), and higher sensitivity for advanced LNM, including multiple LNMs (47.4% vs. 18.4%; p=0.014) and N2 stage (27.8% vs. 5.6%; p=0.177).

Conclusion

US has higher sensitivity than CT for diagnosing LNM in colon cancer, along with a more accurate preoperative diagnosis of the N stage. Additionally, US may be more helpful than CT alone for preoperatively deciding the appropriateness of neoadjuvant treatment in colon cancer with advanced LNM.

Ursodeoxycholic Acid Triggers Primary Enterolith Growth in a Crohn's Disease Patient with Jejunal Stenosis

Primary enteroliths associated with Crohn's disease have been considered to be rare and are most likely caused by severe ileal stenosis. Herein, we report the case of a primary enterolith possibly caused by mild jejunal stenosis in a Crohn's disease patient who received oral administration of ursodeoxycholic acid (UDCA). A 62-year-old woman with a 6-year history of Crohn's disease, currently in clinical remission, was on UDCA prescription for liver dysfunction. Magnetic resonance imaging and double-balloon endoscopy, which were performed to examine epigastric pain, revealed mild jejunal stenosis and an enterolith on the oral side. Since it was difficult to remove or crush the enterolith endoscopically, we decided to remove it surgically with the stenotic jejunum. Component analysis revealed that more than 98% of the enterolith was composed of UDCA; subsequently, oral administration of UDCA was discontinued. This case demonstrated that primary enterolith might develop in Crohn's disease patients with mild intestinal stenosis, and oral administration of UDCA can trigger an enterolith in such patients. Therefore, routine follow-up imaging is necessary for early detection. Oral UDCA should be administered with caution for Crohn's disease patients with stenosis of the proximal small intestine.

Design of microfluidic channels to prevent negative filtration in implantable hemofiltration devices

In order to improve the quality of life of dialysis patients, our group have been developing an implantable hemofiltration device (IHFD) composed of multiple layers of dialysis membranes and microfluidic channels. To improve the hemodialysis performance of IHFD, preventing the negative filtration, which is caused by the oncotic pressure of blood, is mandatory. In this study, we fabricated IHFDs with five different microchannel designs and experimentally investigated the performance of each device in in vitro experiment. In addition, the successful IHFD was further evaluated by ex vivo experiments with a beagle dog. The experiments verified the effectiveness of the microchannel design, which will be used for the IHFD for in vivo experiments with pigs in the future.

Combined Laparoscopic and Transperineal Endoscopic Pelvic Tumor Resection with Sacrectomy for Locally Recurrent Rectal Cancer

Pelvic tumor resection with sacrectomy for locally recurrent rectal cancer is a challenging operation with a high complication rate and poor prognosis. We report a case of pelvic tumor resection with sacrectomy by transperineal endoscopy following laparoscopic dissection for locally recurrent rectal cancer. A 70-year-old man underwent laparoscopic abdominoperineal resection for rectal cancer and was diagnosed with local pelvic recurrence on follow-up computed tomography (CT) three years postoperatively. As the recurrence was in contact with the front of the sacrum, we concluded that distal sacrectomy was necessary to ensure a surgical margin. We safely performed combined laparoscopic and transperineal endoscopic pelvic tumor resection with sacrectomy by exposing the surface of the sacrum from both abdominal and transperineal approach. The operative time was 200 minutes, with minimal blood loss. There was no tumor exposure on the surgically dissected surface, and the patient was discharged without complications 14 days postoperatively. Transperineal endoscopy may be useful for pelvic tumor resection with sacrectomy for locally recurrent rectal cancer.

Novel Prognostic Stratification Factor Based on the Pathological Profile of the Invasive Front in Colorectal Cancer

BACKGROUND/AIM

This study aimed to develop a new pathological finding, namely, invasion front grade and verify its clinical usefulness.

MATERIALS AND METHODS

We re-examined haematoxylin-eosin-stained specimens in 162 stage II-III colorectal cancer patients who underwent radical resection. We assessed the desmoplastic reaction, Klintrup grade, and poorly differentiated cluster. These three findings were combined to form the invasion front grade (good prognosis group; Grade A, poor prognosis group; Grade B), and its reproducibility and prognostic stratification ability were statistically analysed.

RESULTS

Invasion front grade was Grade A in 116 cases and Grade B in 46 cases, and its kappa coefficient was 0.81 for interobserver and 0.74 for intraobserver variability. The 3-year recurrence-free survival rates of Grade A and Grade B were 90.4% and 55.9%. Multivariate analysis showed that invasion front grade was an independent prognostic factor.

CONCLUSION

Invasion front grade is useful as a prognostic stratification factor for stage II-III colorectal cancer.

Transperineal total mesorectal excision for rectal cancer on the residual rectum after multiple abdominal surgeries in a patient with Crohn's disease: a case report

BACKGROUND

The improved prognosis of Crohn's disease may increase the opportunities of surgical treatment for patients with Crohn's disease and the risk of development of colorectal cancer. We herein describe a patient with Crohn's disease and a history of multiple surgeries who developed rectal stump carcinoma that was treated laparoscopically and transperineally.

CASE PRESENTATION

A 51-year-old man had been diagnosed with Crohn's disease 35 years earlier and had undergone several operations for treatment of Crohn's colitis. Colonoscopic examination was performed and revealed rectal cancer at the residual rectum. The patient was then referred to our department. The tumor was diagnosed as clinical T2N0M0, Stage I. We treated the tumor by combination of laparoscopic surgery and concomitant transperineal resection of the rectum. While the intra-abdominal adhesion was dissected laparoscopically, rectal dissection in the correct plane progressed by the transperineal approach. The rectal cancer was resected without involvement of the resection margin. The duration of the operation was 3 h 48 min, the blood loss volume was 50 mL, and no intraoperative complications occurred. The pathological diagnosis of the tumor was type 5 well- and moderately differentiated adenocarcinoma, pT2N0, Stage I. No recurrence was evident 3 months after the operation, and no adjuvant chemotherapy was performed.

CONCLUSION

The transperineal approach might be useful in patients with Crohn's disease who develop rectal cancer after multiple abdominal surgeries.

Ischemic proctitis 6 months after laparoscopic sigmoidectomy: a case report

Background

Ischemic colitis is a common disease; however, its pathophysiology remains unclear, especially in ischemic proctitis after sigmoidectomy. We present a rare case of ischemic proctitis 6 months after laparoscopic sigmoidectomy.

Case presentation

The patient was a 60-year-old man with hypertension, type 2 diabetes, and hyperlipidemia. He was a smoker. He underwent laparoscopic sigmoidectomy for pathological stage I sigmoid colon cancer and was followed up without any adjuvant therapy. Six months after his surgery, he complained of lower abdominal discomfort, bloody stools, and tenesmus. Colonoscopy showed extensive rectal ulcers between the anastomotic site and the anal canal, which was particularly severe on the anal side several centimeters beyond the anastomosis. We provided non-surgical management, including hyperbaric oxygen therapy. The rectal ulcers had healed 48 days after the therapeutic intervention. He has not experienced any recurrence for 3.5 years.

Conclusions

While performing sigmoidectomy, it is important to consider the blood backflow from the anal side of the bowel carefully, especially for patients with risk factors of ischemic proctitis.

Intestinal anisakiasis with severe intestinal ischemia caused by extraluminal live larvae: a case report

Background

Anisakiasis is a parasitic infection caused by Anisakis worms found in raw fish. Most cases of anisakiasis occur in the stomach and rarely occur in the intestine. It is extremely rare for live larvae to break through the intestine into the mesentery and cause severe intestinal ischemia. Anisakiasis can be treated conservatively, because the larvae will die in approximately 1 week, but, sometimes, a serious condition can arise, as in this case. We report the first case of extraluminal anisakiasis in which a live Anisakis worm caused severe intestinal ischemia.

Case presentation

The patient was a 26-year-old woman who ate squid a week prior. She had abdominal pain and was admitted to our emergency department. On physical examination, abdominal guarding and rebound tenderness were present in her lower abdomen. Contrast-enhanced computed tomography showed ascites, the whirl sign, localized submucosal edema of the intestinal wall, and a dilated small bowel segment with edema. We suspected the strangulated small bowel obstruction based on the CT-scan findings. To rule out the strangulated small bowel obstruction, laparoscopic exploration was performed. Bloody ascites in the pouch of Douglas and severe inflammation in 20 cm of the ileum were observed. An Anisakis larva had perforated the intestinal wall and was found alive in the mesentery. The ileum had developed a high degree of ischemia, so the affected section was resected. Histopathological examination revealed that the Anisakis worm body was in the inflamed mesentery and caused a high degree of ischemia in the intestinal tract. The patient was discharged 9 days after surgery.

Conclusions

A living Anisakis larva punctured the mesentery of the small intestine, resulting in severe intestinal ischemia. As seen in this case, intestinal anisakiasis may cause serious symptoms, and a low threshold for performing diagnostic laparoscopy for the early diagnosis of bowel ischemia secondary to anisakiasis can be useful in determining the definite diagnosis and indications for resection.

Evaluating Health Impact at High Altitude in Antarctica and Effectiveness of Monitoring Oxygen Saturation

Background

The Japanese Antarctic Research Expedition (JARE) has been conducting research activities in inland Antarctica, which is extremely cold dryland covered with a thick ice sheet. This environment may cause a health disorder called acute mountain sickness (AMS). To improve the safety of expedition members, we evaluated the impact of extreme environmental conditions on human health and the effectiveness of monitoring of hypoxia for the early detection of AMS.

Methods

In total, 9 members from JARE 59 were studied. Dome Fuji Station (Dome F), located 3,810 m above sea level (ASL), was the destination of the research party. We analyzed daily AMS scores (higher values correspond to more severe AMS-related symptoms), physiological findings, and percutaneous arterial blood oxygen saturation (SpO₂) during the inland activity. We also determined the factors related to AMS scores.

Results

The average AMS score on arrival at Dome F was significantly higher than that at the departure point (560 m ASL). The average SpO₂ level was significantly lower than that at other points. The SpO₂ level correlated negatively with the AMS score in Spearman's rank correlation. Generalized estimating equations analysis showed that the AMS score was negatively associated with SpO₂ level and positively associated with age.

Conclusion

Hypoxia is a contributory factor to AMS which we can easily assess by measuring the SpO₂ level with a pulse oximeter. SpO₂ monitoring is a potentially useful health management tool for members in inland Antarctic expeditions. In addition, our results are helpful for understanding physiological responses and health issues in extreme environments.

Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study

BACKGROUND AND AIMS

Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis.

METHODS

This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up.

RESULTS

The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1-60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs.

CONCLUSIONS

ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.

Prospective multicenter study of the esophageal triamcinolone acetonide-filling method in patients with subcircumferential esophageal endoscopic submucosal dissection

BACKGROUND AND AIM

The esophageal triamcinolone acetonide (TA)-filling method is a novel local approach for stenosis prevention after extensive esophageal endoscopic submucosal dissection (ESD). We evaluated this method after subcircumferential ESD.

METHODS

We enrolled 20 patients with esophageal cancer requiring subcircumferential ESD in a prospective multicenter study. Esophageal TA filling was carried out 1 day and 1 week after ESD, with follow-up endoscopy every 2 weeks. We treated severe stenosis preventing endoscope passage with endoscopic balloon dilatation (EBD) and additional TA filling, and mild stenosis allowing endoscope passage with additional TA filling only. Primary endpoint was incidence of severe stenosis; secondary endpoints were total number of EBD, rate of additional TA filling, time to stenosis and complete re-epithelialization, dysphagia score, and adverse events. Horizontal resection grade was divided into grades 1 (≥ 9/12 and <10/12 of the circumference), 2 (≥ 10/12 and <11/12), and 3 (≥ 11/12 but not circumferential) and analyzed statistically for correlation with endpoints.

RESULTS

Incidence of severe stenosis was 5.0% (1/20; 0.1-24.8%) and was treated with three EBD. Six patients showed mild stenosis. Additional TA filling was carried out in these seven patients: 0% (0/9) for grade 1 resection, 40% (2/5) for grade 2, and 83% (5/6) for grade 3 (P < 0.05). Median time to stenosis and re-epithelialization was 3 and 7 weeks, respectively. Dysphagia score deteriorated in one patient. No adverse events occurred.

CONCLUSIONS

The esophageal TA-filling method prevented stenosis after subcircumferential ESD. Grade ≥2 resection showed a high risk for stenosis, but additional TA filling for mild stenosis inhibited stenosis progression (UMIN000024384).

Analysis of the pattern of suprahyoid muscle activity during pharyngeal swallowing of foods by healthy young subjects

We previously developed the T_P technique to discriminate between the activity patterns of skeletal muscles. In this study we aim to identify the T_P value(s) that can be used to sensitively evaluate the activity patterns of the suprahyoid (SH) muscles during swallowing. We also analyse the effect of food textural properties on the activity patterns of the SH muscle during oral and pharyngeal swallowing. Three test foods consisting of 3%, 6% and 9% of a thickening agent, Mousse-up (MU) were prepared. Their textural properties differed significantly. Swallowing of 9% MU involved a significantly longer average duration than 3% MU. The average T₅₀ value for 6% MU was significantly larger than that for 3% MU. However, the average T₂0 and T₈₀ values of the test foods did not differ. Thus, the T₅₀ value is particularly suitable for evaluating SH muscle swallowing patterns. Moreover, test foods that vary in their textural properties elicit different durations and patterns of SH muscle activity.

Activity patterns of the suprahyoid muscles during swallowing of different fluid volumes

Influences of bolus volumes on activity patterns of the suprahyoid muscles during swallowing were examined using the T(P) technique (which quantitatively evaluates muscle activity patterns and indicates a negatively skewed pattern at lower T(P) values) in healthy young adults (eight men and four women). One of six volumes of tea ranging from 10 to 32 mL was delivered randomly to each subject while recording an electromyogram of the suprahyoid muscles and a laryngeal mechanogram with a piezoelectric sensor. Each subject was asked to swallow the full volume of liquid in a gulp if possible. T(P) values were calculated as deciles from T(0) to T(100) during intervals that were defined by the trajectory of the laryngeal mechanogram recorded during swallowing. Seven significant differences were detected in the average T(P) values from T(30) to T(60): between 16 mL (e.g., 0.448 in T(30)) and 25 mL (0.408 in T(30)) and between 20 mL (0.453 in T(30)) and 25 mL. There were significant differences among the 12 subjects for all of the nine average T(P) values (Ps < 0.001), suggesting a notable intersubject variation in the suprahyoid (SH) activity patterns. The average peak amplitudes of the integrated suprahyoid activity differed significantly among the six volumes (P < 0.001), while the average durations measured by the laryngeal mechanogram did not. The present results suggest that the swallowing volume mainly affects SH activity patterns, which were evaluated by the T(P) technique, during the early period of each swallow.

Influence of food properties and body position on swallowing-related muscle activity amplitude

This study was designed to examine the effect of different food properties and body positions on electromyographic amplitudes of the anterior tongue (AT) and suprahyoid (SH) muscles during swallowing in normal subjects (six men and three women; 21-30 years old). Each subject was asked to swallow three foods (consisting of 2.0%, 5.7% or 9.1% of a thickening agent dissolved in water) with different textural properties in one of four body positions: upright, inclined at 60 degrees or 30 degrees , or supine. Surface electromyograms (EMG) were recorded from the anterior tongue and SH muscles, and the integrated and cumulated EMG were used to evaluate the amplitude changes. The increases in food hardness and adhesiveness elevated the integrated and cumulated EMGs of both the AT and SH muscles during swallowing in a stepwise manner (P < 0.0001, one-way anova) that was independent of the body position. There was a linear relationship between the concentrations of the thickening agent and the logarithmic values of the food hardness. There was also a parallel relationship between the logarithmic hardness values and the final logarithmic values of the cumulated muscle activity during swallowing. Unlike these simple amplitude responses of the AT and SH muscles to the different food properties, our previous studies have shown that the durational responses of these muscle activities to different food properties are more complicated. Possible neural mechanisms responsible for the amplitude responses observed are discussed.

Influences of body posture on duration of oral swallowing in normal young adults

The primary purpose of this study was to determine whether body posture altered the duration of oral swallowing. To answer this question, we recorded electromyograms (EMGs) from the anterior tongue and suprahyoid (SH) muscles as well as laryngeal movement associated with swallowing in nine normal young subjects. The subjects swallowed a test food after receiving a signal while in four randomly set postures: upright, two inclined (60 degrees and 30 degrees to the horizontal), and supine positions. We measured the durations from the start to the peak and from the peak to the end of the integrated tongue and SH EMGs. We assumed that the duration from the start to the peak of the integrated SH EMG would correspond to the duration of oral swallowing. The average duration from the start to the peak of the integrated SH EMG decreased after moving from the upright to the inclined and supine positions. The decrease in the duration was statistically significant and consistent for three experimental sessions. The duration from the start to the peak of the integrated tongue EMG during swallowing tended to decrease after lying down, but not significantly. The postural changes did not affect the remaining four durations. The decrease in the duration of oral swallowing induced by lying down suggests that the gravitational force placed on the test food facilitates the swallowing reflex. Large variation in the tongue activity during swallowing among the subjects can probably be attributed to the lack of a significant decrease in the duration of the tongue activity.

Analysis of head movements coupled with trunk drift in healthy subjects

Accelerometers were used to measure sequential head tilt and trunk drift in 14 healthy young subjects while they performed three kinds of head task. First, maximum inclination angles in anterior, posterior, right and left directions were measured to estimate cervical ranges of motion for flexion-extension and lateral bending. The inclination angles measured (61.2 degrees on average for flexion, 51.7 degrees for extension, 42.7 degrees for right bending and 43.9 degrees for left bending) were consistent with previous findings. Secondly, cross-correlation analysis was applied to evaluate the degree of functional coupling between the head and trunk during flexion-extension and lateral bending. Significantly higher correlation coefficients were found between head tilt and trunk drift when these movements were in the same (iso-) directional condition than in a different (allo-) directional condition. The coupled trunk drift in flexion-extension for the iso-directional condition (10.3 degrees on average) was much larger than for the allodirectional condition (2.3 degrees). Finally, head turning was recorded as oval traces in a biaxial plane. In both clockwise and counter-clockwise head turning conditions, the maximum inclination angles of the traces were larger in the anterior-posterior direction (59.8 degrees anterior and 58.2 degrees posterior, in the clockwise condition, and 47.4 degrees and 47.4 degrees in the counter-clockwise condition) than in the right-left direction (36.3 degrees right and 39.0 degrees left, in the clockwise condition, and 40.5 degrees and 36.7 degrees in the counter-clockwise condition), and the angles in the four directions were almost equal to flexion-extension and lateral bending. The characteristics of the traces recorded and a possible application of the present recording system are discussed.

Head movement associated with performance of mandibular tasks

The present study was designed to examine the hypothesis that the motor system controlling phonation is functionally coupled with the motor system controlling posture of the head and neck, as previously suggested (U. Haddar, T.J. Steiner, E.C. Grant and F.C. Rose Human Movement Science 2: 35 and Language and Speech 26: 117). Head tilt and trunk drift in the antero-posterior and right-left directions were measured simultaneously for 20 s before and during three types of speech sounds (/pa/, /ta/ and /ka/) as well during a maximum jaw open-close task in 14 healthy young subjects. The major findings obtained in all of the four tasks were: (i) the trunk drift measured in both directions was negligible in comparison with the head tilt; (ii) the head tilt in the antero-posterior direction was much larger than in the right-left direction and (iii) the head tilt during performance of the four tasks consisted of 'initial' and 'sustained' phases. In the initial phase, the head tilted posteriorly in association with the start of individual tasks. In the sustained phase, the head tilted either anteriorly or posteriorly when the task progressed. The magnitude of the net head tilt in the sustained phase negatively correlated with that of the initial head tilt. These findings indicate that phonation, in the form of jaw open-close, accompanies head movement in two consecutive phases.

Barrett's oesophagus with predominant intestinal metaplasia correlates with superficial cyclo-oxygenase-2 expression, increased proliferation and reduced apoptosis: changes that are partially reversed by non-steroidal anti-inflammatory drugs usage

BACKGROUND

Cyclo-oxygenase-2 expression has been reported to play an important role in the metaplasia-dysplasia-carcinoma sequence in Barrett's oesophagus. However, the existence of cyclo-oxygenase-2 expressing cells in Barrett's epithelium is still uncertain.

AIM

To identify the cells that express cyclo-oxygenase-2 protein and to investigate the relationship between cyclo-oxygenase-2 expression and mucin-phenotype of Barrett's epithelium.

METHODS

Sections from 466 biopsy samples of Barrett's epithelium from 358 non-medicated patients were immunohistochemically examined for the cyclo-oxygenase-2 expression, mucin-phenotype, cell proliferation and apoptosis.

RESULTS

Cyclo-oxygenase-2 expression was detected in 71.0% of Barrett's epithelium biopsy samples. In Barrett's epithelium with the gastric predominant mucin-phenotype, cyclo-oxygenase-2 expression was mainly found in stromal and deep epithelial cells, whereas in intestinal predominant mucin-phenotype, it was mostly in superficial epithelial cell. A significant elevation of proliferating cell nuclear antigen index and suppression of apoptotic index was observed in Barrett's epithelium with superficial epithelial cyclo-oxygenase-2 expression. Neither such elevation of proliferating cell nuclear antigen index nor the suppression of apoptotic index could be found in chronic non-steroidal anti-inflammatory drugs users.

CONCLUSIONS

Barrett's epithelium with intestinal mucin and superficial epithelial cyclo-oxygenase-2 expression possess a higher proliferation potential, but this risk may be thwarted by non-steroidal anti-inflammatory drugs administration.

Expression of midkine and receptor-like protein tyrosine phosphatase (RPTP)-beta genes in the rat stomach and the influence of rebamipide

BACKGROUND

Midkine has been reported to bind to receptor-like protein tyrosine phosphatase (RPTP)-beta and to play important roles in growth and differentiation of various cells. Midkine is expressed in rat stomach during experimental ulcer healing, suggesting that the midkine-RPTP-beta system has some physiological functions in the stomach. Rebamipide is a mucoprotective drug used for the treatment of gastric ulcers. We have tested the hypothesis that the ulcer healing mechanism stimulated by rebamipide is linked physiologically to the gastric midkine-RPTP-beta system.

MATERIALS AND METHODS

Seven-week-old-male Wistar rats were used. Midkine and RPTP-beta gene expression in rat stomach was investigated by laser capture microdissection coupled with the reverse transcription-polymerase chain reaction (RT-PCR). The effects of rebamipide on midkine and RPTP-beta expression in rat stomach and the gastric epithelial cell line RGM1 were evaluated by RT-PCR and Northern blot analyses.

RESULTS

Midkine and RPTP-beta expression was detected in the gastric mucosal, submucosal and muscle layers. Rebamipide stimulated both midkine and RPTP-beta expression in rat stomach and RGM1 cells.

CONCLUSION

Rebamipide may protect the gastric mucosa by regulating midkine and RPTP-beta expression.

Activation of prostaglandin E2-receptor EP2 and EP4 pathways induces growth inhibition in human gastric carcinoma cell lines

The effect of prostaglandin E2 (PGE2) on the proliferation of gastric cancer cells is still unclear. PGE2 receptors are divided into four subtypes - EP1, EP2, EP3, and EP4 - which are coupled to three different intracellular signal-transduction systems. Stimulation of EP2 and EP4 is linked with cyclic adenosine 3', 5'-monophosphate (cAMP)-dependent protein kinase A (PKA). In some human gastric cancer cells, PGE2 has been suggested to have an antiproliferative effect by way of increased cAMP production. Expression of EP2 and EP4 in human gastric carcinoma cells, however, has not been examined. We examined the expression of EP2 and EP4 and the antiproliferative effects of specific EP2 and EP4 agonists on four different human gastric cancer cell lines. Our data clarified that all the cell lines investigated in this study expressed EP2 and EP4 and that the specific agonists of these receptors induced growth inhibition with an accompanying increase in cAMP production. In summary, gastric cancer cells have EP2 and EP4 receptors, and their selective activation is linked with the decreased cell proliferation.

Graphic analysis of the relationship between skin colour change and variations in the amounts of melanin and haemoglobin

BACKGROUND/AIMS

The L*a*b* coordinate is the most commonly used colour system to measure skin colour in dermatology and cosmetology. In this system, a* and L* are often used for quantification of the degrees of erythema and pigmentation. The aim of this study was to examine whether a* and L* can be used as specific scales to indicate the amount of haemoglobin and melanin, respectively, in the skin.

METHODS

The a* and L* values were examined with a reflectance spectrometer in various skin conditions or lesions caused by a change in the amount of either melanin or haemoglobin, i.e. vitiligo, ultraviolet-induced pigmentation (PG), erythema resulting from slapping (ER), corticosteroid-induced blanching, erythema due to stasis by arm lowering, and a combination of PG and ER. The differences in values between the test sites and the adjacent normal skin, deltaa* and deltaL*, were plotted on the deltaa*-deltaL* plane and analysed statistically and geometrically.

RESULTS

L* depended substantially not only on melanin but also on haemoglobin, especially if the oxygen saturation level was expected to be low. a* was also influenced by melanin. The results of graphic analysis indicated that a linear transformation of (deltaa*, deltaL*) into (deltaHb = 1.68 deltaa* + 0.60 deltaL*, deltaMel =-1.06 deltaa*-1.44 deltaL*) was suitable for separately estimating the change in the amount of haemoglobin (deltaHb) and in that of melanin (deltaMel).

CONCLUSION

The results of this study may be of value for understanding the relationship between colour coordinates of the skin and the quantities of haemoglobin and melanin, and may be of use when pigmented lesions of the face are monitored by tristimulus colourimetry, as facial skin colour is affected considerably by the rich and easily variable cutaneous blood flow.

Skin reflectance-spectra and colour-value dependency on measuring-head aperture area in ordinary reflectance spectrophotometry and tristimulus colourimetry

BACKGROUND/AIMS

Measurement of skin colour has become increasingly popular in the study of dermatology with the increased availability of portable instruments. However, different instruments have been reported as giving different results from measurement of the same skin region. The aim of this study was to examine the effects of differences in measuring-head aperture area on skin reflectance spectra and colour values.

METHODS

We measured both reflectance spectra and CIE-L*a*b* values of the skin in five different anatomical regions on 10 subjects using two MINOLTA reflectance spectrometers that were identical apart from the aperture area of the measuring heads (diameters: 5 and 11 mm). For comparison, data were also obtained from a skin-coloured tile.

RESULTS

Skin reflectance values measured with the wider-aperture instrument were higher than those measured with the other, irrespective of anatomical location. The differences between the two were near zero at an incident light wavelength of 400 nm, but increased to around 10% of the reflectance value at 700 nm, increasing exponentially with incident light of increasing wavelength. Skin colour was observed to be brighter, redder and yellower, in CIE-L*a*b* expression, when measured with the wider-aperture instrument. The differences between measurements obtained from the skin-coloured tile were much smaller.

CONCLUSION

Skin reflectance and colour values measured with reflectance instruments are not absolute data but depend on the aperture area of the measuring head. This is probably due to variations in the proportion of longer-wavelength light reflected from the skin and collected by the instrument.

Changes in jaw reflexes by stimulation of the hypothalamus in anesthetized rabbits

Changes in the masseteric monosynaptic reflex (MMR) and jaw-opening reflex (JOR) responses resulting from conditioning stimulation in the hypothalamus were studied in anesthetized rabbits. Stimulation of the lateral hypothalamus evoked a facilitation of the MMR and an inhibitory or facilitatory effect on the JOR. The facilitatory effect on JOR was stronger than that on the MMR. The facilitatory effective site for the JOR was in the dorsal and lateral directions as compared to the inhibitory field. The results suggest two functionally distinct regions in the lateral hypothalamus that separately project to the jaw-opening muscles.

Localized heat urticaria: a clinical study using laser Doppler flowmetry

We studied the pathophysiology of localized heat urticaria using laser Doppler flowmetry (LDF) in two patients with this rare disease. In heat challenge tests, performed with different challenge times and temperatures, a heat stimulator with a thermoregulated metal disc was utilized. Immediately after removal of the heat source, cutaneous blood flow (CBF) changes in the tested sites were monitored with LDF. In both patients the increase in (CBF) took place at some intervals after a heat challenge, synchronous with the start of the urticarial response. This interval, or the latency time (LT), showed distinct inverse proportion to the intensity of heat stimuli and was prolonged by effective treatments, such as application of antihistamines and repeated heat exposure by LDF. Therefore, the time of latency might be regarded as a good indicator of the severity of illness and therapeutic effectiveness, and thus might reflect the relationship between the degree of heat stimuli and the releasing process of chemical mediator(s) in patients with localized heat urticaria (LHU).

Sweet's syndrome associated with chronic myelogenous leukemia: demonstration of leukemic cells within a skin lesion

We report a case of acute febrile neutrophilic dermatosis, Sweet's syndrome, associated with chronic myelogenous leukemia (CML) in which we found rearrangement of the bcr gene in DNA obtained from a skin lesion as well as in blood DNA by Southern blot analysis. This indicated the presence of CML cells within the skin lesion. To our knowledge, this is the first report in which the presence of CML cells is shown within skin lesions of Sweet's syndrome. In our patient, leukocyte alkaline phosphatase activities returned to normal levels when he was suffering from Sweet's syndrome and decreased again to below normal levels after it subsided. Whether the normalization of leukocyte alkaline phosphatase activity is common among CML patients with Sweet's syndrome remains to be determined.

Reflexogenic areas for velopharyngeal closure in rabbits

Responsive areas for velopharyngeal closure were examined by recording diaphragmatic and superior pharyngeal constrictor activities of anesthetized rabbits. Pressure stimulation was applied with a cotton applicator to the mucosae of three pharyngeal areas: the anterior (palatal) and posterior walls of the nasopharynx and the posterior wall of the oropharynx. The intensity and duration of the stimulation were around 9.0 gf and 0.43 sec, respectively. Velopharyngeal closure was elicited more frequently from the posterior wall of the nasopharynx than the other two areas tested. The higher responsiveness of the posterior wall of the nasopharynx for velopharyngeal closure is suggested to be attributed to higher density and/or lower threshold of pressure receptors in this area than those in the other two areas tested. Possible physiological implications of the present results are discussed.

Responses of neurons in the parabrachial region of the rat to electrical stimulation of the superior laryngeal nerve and chemical stimulation of the larynx

The responsiveness of the parabrachial region to electrical stimulation of the superior laryngeal nerve was first examined in anesthetized rats. Action potentials were recorded in 30 parabrachial sites by single and train electrical pulses to the superior laryngeal nerve. The average latency, from the onset of stimulation to the first action potentials, was 9.9 ms (range, 6.5-18.8 ms). The responsiveness of parabrachial neurons to chemical stimulation of the laryngeal region was next examined using anesthetized, immobilized, and artificially ventilated rats in which the chorda tympani and glossopharyngeal nerves were bilaterally sectioned. Taste stimuli were applied to the laryngeal region through a tracheal tube and rinsed with 0.15 NaCl. A total of 66 responses were recorded from 26 neurons. The most effective stimulus for these neurons was 0.03 M hydrochloric acid, followed by 0.01 M quinine hydrochloride, 0.5 M sodium chloride, 0.5 M sucrose, and distilled water. Seven responses were derived from 0.15 NaCl. These neurons were mainly located in a posterodorsolateral part of the parabrachial nucleus. These results suggest that chemical signals from the laryngeal region are transmitted to the parabrachial nucleus through the superior laryngeal nerve.

Impact of sociodemographic and diabetes-related characteristics on depressive state among non-insulin-dependent diabetic patients

One hundred and fifty-one non-insulin-dependent diabetic patients were assessed to detect sociodemographic, psychological and disease-related characteristics that were related to depressive state among diabetic patients. Depressive state in the patients was correlated with poor social support and low economic status, premorbid neurotic personality and the presence of complications, retinopathy in particular. However, depressive state did not correlate with age, gender, education, serum level of HbA1C or duration of diabetes. The severity of the depressive state in diabetic patients may vary with the cultural background of the patient and/or the country in which he or she is living. In treating diabetic patients, doctors need to pay special attention to these factors.

Responses of parabrachial nucleus neurons to chemical stimulation of posterior tongue in chorda tympani-sectioned rats

Responses of parabrachial nucleus (PBN) neurons (n = 43) to chemical stimulation of the posterior tongue were recorded in chorda tympani (CT)-sectioned rats and compared with those (n = 45) in CT-intact. The chemical stimuli used were 0.5 M sucrose, 0.5 M sodium chloride (NaCl), 0.03 M hydrochloric acid (HCl), 0.01 M quinine hydrochloride, and distilled water. These stimuli were applied to an area posterior to the intermolar eminence of the tongue. Neurons of CT-sectioned rats responsive to the chemical stimuli were located in more caudal areas of the PBN compared with those of CT-intact. Numbers of responses to the five stimuli and breadth of responsiveness to the four basics were not different between both groups of rats. However, average response magnitudes of the neurons in CT-sectioned rats were lower than those in CT-intact. In both groups of rats, the response magnitudes to NaCl and HCl were larger than those to the other three stimuli, and responses to NaCl and those to HCl were highly correlated. It is suggested that glossopharyngeal fibers responding strongly to acids and salts are likely to be the main source of PBN responses from the posterior tongue.

Vagal control of pharyngeal constrictor activity in rabbits

The neural control mechanism of pharyngeal constrictor (PC) activity of rabbits was examined in relation to vagal afferents. The average firing rate of single PC units of unilaterally vagotomized animals increased from 0.52 to 8.83 spikes/sec by cooling of the intact vagus nerve at 5 degrees C. Time courses of increases in PC and diaphragmatic (Dia) activities were examined during the period from the start of vagal cooling to the time when the PC reached the maximum firing rate. Although Dia activity linearly increased along with the respiratory cycles, PC activity slowly increased during the first three-quarters of the period and rapidly increased during the last quarter. The result suggests that more impulses in the vagus nerve are required to be blocked by cooling at a lower temperature for eliciting an increase in PC activity compared with that in Dia activity. The increase in PC activity evoked by bilateral vagotomy (from 0.30 to 10.07 spikes/sec) was not different from that by vagal cooling. The presumable afferent nerve fibers responsible for the increase in PC activity were discussed.

A case of dermatomyositis complicated by thrombotic thrombocytopenic purpura

A 60-year-old man with dermatomyositis was admitted to our hospital because of dyspnea and hypertension. He had high fever and convulsive seizures after admission. Laboratory examinations showed hemolytic anemia, thrombocytopenia, and renal failure. A clinical diagnosis of thrombotic thrombocytopenic purpura (TTP) was made. He failed to respond to plasma exchange therapy, pulse therapy with methylprednisolone, high-dose gamma-globulin therapy, and antiplatelet therapies with ticlopidine, dipyridamole and a prostacyclin analog of beraprost sodium. He died on his 17th day in hospital. Autopsy examination revealed widespread microthrombi in his kidneys, lungs, spleen, and intestine. Only seven cases of dermatomyositis or polymyositis complicated by TTP have been cited in the literature. TTP was fatal in 6 of these 7 cases. Early diagnosis and prompt treatment may improve the outcome of TTP patients with dermatomyositis. Dermatologists should keep in mind that TTP occasionally arises as a serious complication of dermatomyositis.

Responses of primate cortical neurons to unitary and binary taste stimuli

1. The responses of 126 neurons in primary gustatory cortices of two rhesus monkeys were recorded during sapid stimulation of the tongue with 18 taste stimuli. Ten of these stimuli were dissolved in distilled water (DW): 1.0 M sucrose (Suc), 0.1 M and 0.03 M sodium chloride (NaCl), 0.003 M hydrochloric acid (HCl), 0.001 M quinine hydrochloride (QHCl), 0.03 M monosodium glutamate (MSG), 0.03 M polycose, 0.3 M glycine, 0.1 M proline, and 0.1 M malic acid. Seven other stimuli were dissolved in 0.03 M MSG; the last stimulus was a mixture of 1.0 M Suc and 0.03 M NaCl. 2. The average spontaneous rate (2.2 +/- 0.2 spikes/s, mean +/- SE) and response to DW (2.5 +/- 0.2) of these 126 neurons was low but within the range previously reported for neurons in primate taste cortex. Suc was the most effective stimulus for 24.1% of the neurons tested followed by NaCl (15.7%), QHCl (14.8%), HCl (11.1%), MSG (10.2%), and other miscellaneous unitary gustatory stimuli (8.3%). Binary taste mixtures were the most effective stimuli for 15.7% of the sample. The net responses (corrected for DW, in spikes/s) for Suc-best (3.3), NaCl-best (4.3), HCl-best (3.4), QHCl-best (2.3), and MSG-best (4.1) were sluggish, but comparable with that reported previously. 3. The response breadth of the 82 neurons that responded best to either Suc, NaCl, HCl, or QHCl measured with the entropy coefficient indicated a moderate response breadth for these neurons (mean = 0.79; range = 0.30-0.98). According to the response criteria adopted in this experiment (water response +/- 1.96 SD), however, 81 of these 82 neurons (98.1%) responded to only one or two of the four basic taste stimuli. The disparity between the entropy- and criterion-based measures of response derive from the nature of the two statistics. Adjustments that would make the entropy statistic less inclusive and the definition of a response according to statistical criteria less exclusive would increase their concordance. 4. Three multivariate statistics (cluster, principal axis factor, and multidimensional analysis) were used to analyze the data. Cluster analysis enabled us to divide the 82 taste neurons into groups on the basis of response similarity. Each of the four largest groups was dominated by neurons that responded best to one of the four basic taste stimuli: Suc, NaCl, QHCl, and HCl (ranked in descending order); the fifth largest cluster contained neurons that responded best to MSG. Principal axis factor analysis demonstrated that 80.8% of the total variance could be accounted for by three factors. Neurons responding best to Suc, NaCl, and QHCl each were closely associated with one of those three factors, but the loadings of the HCl-best neurons were evenly distributed across all three factors. The communality coefficient of these three factors was > 80% for the Suc-, NaCl-, HCl-, and QHCl-best neurons; the MSG-best neurons, by comparison, had very few high loadings on any of these three factors and a correspondingly low communality coefficient of 40.4%, a difference that was statistically significant from the other four groups. Thus the three factors related to Suc-, NaCl-, HCl-, and QHCl-best neurons are not relevant to MSG-best neurons. We used multidimensional analysis to arrange the neurons that responded best to Suc, NaCl, HCl, QHCl, and MSG into five loosely arranged and partially overlapping clusters. A multidimensional space based on stimulus similarity showed that MSG was as different from the four basic taste stimuli as they were from one another. 5. Mixture suppression, a common observation in human psychophysical experiments, was examined at the neurophysiological level by including binary tastants in the stimulus battery. The average response of 19 Suc-best neurons to 1.0 M Suc (4.1 spikes/s) decreased to near 0 when the solvent was changed from DW to either 0.03 M MSG or 0.03 M NaCl. Similar decrements were observed in NaCl- and MSG-best neurons tested with Suc/NaCl mixtures.

Hypotonic diuresis following oropharyngeal stimulation with water in humans

The role of oropharyngeal mechanisms in body water regulation was studied in 12 human males by measuring urine output and osmolality before and after drinking a very small volume of distilled water (0.15 ml/kg b.w.t.). Hypotonic diuresis was resulted only in the subjects (n = 6) who drank only sufficient water to keep their oropharynx moist continually over a 20 min period but not in those who (n = 6) drank the same volume of water within several seconds. Sham verbal instructions on drinking induced no changes in subjects examined. These results suggest that oropharyngeal afferents alone, and neither gastric afferents nor psychosomatic effects, may account for hypotonic diuresis following water intake in man.

Swallowing reflex elicited by water and taste solutions in humans

We investigated whether water and taste solutions are adequate stimuli for elicitation of the swallowing reflex from the pharyngolaryngeal region in humans. Subjects were five healthy males. Small amounts of water and taste solutions were applied to the posterior tongue of the subject as he reclined on a dental chair. The latency between the onset of application of the stimuli and the occurrence of swallowing was measured. Water was a most effective stimulus for elicitation of the swallowing reflex. The stimulatory effect was altered by anions, particularly Cl-, added to the water. Gustatory factors affected the latency of swallowing. The results suggest that humans have water-sensitive receptors in the pharyngolaryngeal region and that these receptors are responsible for initiation of the swallowing reflex by water.

Autonomic nervous reflexes in respiration elicited by mechanical stimulation of the velopharyngeal region in rabbits

Reflex increases in peak activity of the diaphragm and expiratory pharyngeal muscles were recorded in lightly anesthetized and vagotomized rabbits by gentle mechanical stimulation of the nasal surface of the soft palate and of the posterior wall of the nasopharynx. No noticeable change in diaphragmatic activity was evoked by gentle mechanical stimulation of the oral surface of the soft palate and of the posterior wall of the oropharynx. The present results suggest that afferent signals from mechanoreceptors of the velopharyngeal region may contribute to reflex augmentation of respiration.

Diuresis mediated by the superior laryngeal nerve in rats

Diuresis mediated by the superior laryngeal nerve (SLN) was investigated using pentobarbital-anesthetized rats. A marked increase in urine flow was induced by application of water to the larynx. The diuretic effect of water was conspicuous during the first 30 min after the application and lasted for more than 1 hr. In contrast, a 160 mM solution of NaCl produced only slight diuresis. After bilateral sectioning of the SLNs, water-induced diuresis was considerably reduced. The results suggest that water fibers contained in the SLN may make a major contribution to the diuresis.

Differences in drinking behavior between normal and laryngectomized man

The properties of drinking in normal and laryngectomized groups were examined. Drinking associated with meals was more frequent in the 76 young and 37 older normal subjects than the 25 laryngectomized persons. The laryngectomized group preferred tea and coffee to water to alleviate thirst sensation, while such a preference was hardly seen in either normal group. Results suggest that the larynx may contribute not only to thirst sensation but may be associated with preference in drinking.