Prevalence of Hoarseness and Its Association with Severity of Dysphagia in Patients with Sarcopenic Dysphagia

OBJECTIVES

To investigate the prevalence of hoarseness and its association with the severity of dysphagia in patients with sarcopenic dysphagia.

DESIGN

Cross-sectional study using the Japanese sarcopenic dysphagia database.

SETTING

19 hospitals including 9 acute care hospitals, 8 rehabilitation hospitals, 2 long-term care hospitals, and 1 home visit rehabilitation team.

PARTICIPANTS

287 patients with sarcopenic dysphagia, aged 20 years and older.

MEASUREMENTS

Sarcopenic dysphagia was diagnosed using a reliable and validated diagnostic algorithm for the condition. The presence and characteristics of hoarseness classified as breathy, rough, asthenic, and strained were assessed. The prevalence of hoarseness and the relationship between hoarseness and Food Intake LEVEL Scale (FILS) were examined. Order logistic regression analysis adjusted for age, sex, naso-gastric tube, and handgrip strength was used to examine the relationship between hoarseness and FILS at baseline and at follow-up.

RESULTS

The mean age was 83 ± 10 years. Seventy-four (26%) patients had hoarseness, while 32 (11%), 20 (7%), 22 (8%), and 0 (0%) patients had breathy, rough, asthenic, and strained hoarseness, respectively. Median FILS at the initial evaluation was 7 (interquartile range, 5-8). Hoarseness (β=0.747, 95% confidence intervals= 0.229, 1.265, p=0.005), age, sex, naso-gastric tube, and handgrip strength were associated independently with baseline FILS, while hoarseness (β=0.213, 95% confidence intervals= -0.324, 0.750, p=0.438) was not associated independently with the FILS at follow-up.

CONCLUSIONS

Hoarseness was associated with the severity of dysphagia at baseline, however not a prognostic factor for sarcopenic dysphagia. Resistance training of swallowing and respiratory muscles and voice training as part of rehabilitation nutrition might be useful for treating sarcopenic dysphagia.

Association between Inflammation and Functional Outcome in Patients with Sarcopenic Dysphagia

OBJECTIVES

This study aimed to investigate whether inflammation affects the outcome of swallowing ability to improve treatment for sarcopenic dysphagia.

DESIGN

A retrospective observational cohort study was performed using data from the Japanese sarcopenic dysphagia database.

SETTING

The database was constructed using data from 19 hospitals and one home visiting rehabilitation team.

PARTICIPANTS

Patients with sarcopenic dysphagia with measurements of C-reactive protein (CRP) and serum albumin (Alb) were included.

MEASUREMENTS

Patients were assigned to two groups using CRP, Alb, and the Japanese modified Glasgow Prognostic Score (mGPS). The Food Intake LEVEL Scale (FILS) was measured at the times of admission and follow-up (FILS follow-up) to assess swallowing function.

RESULTS

A total of 197 patients were included. Mean or median values of each parameter were as follows: age: 83.8±8.7, Alb: 3.2 ± 0.6 g/dL, CRP: 8.0 [3.0, 29.0] mg/L, mGPS: 1 [1-2], FILS: 7 [6-8], FILS follow-up: 8 [7-8], and duration of follow-up: 57.0 [27.0, 85.0] days. The FILS score at follow-up was significantly lower in the high CRP group (≥ 5.0 mg/L) than in the low CRP group (< 5.0 mg/L) (p = 0.01). Further, the FILS score at follow-up was significantly lower in the high mGPS group (class; 2) than in the low mGPS group (class; 0 and 1) (p = 0.03). In the multiple linear regression analyses without FILS at baseline, CRP and mGPS were independent risk factors for FILS follow-up. When FILS at baseline was entered, CRP and mGPS were not an independent risk factors for FILS follow-up.

CONCLUSIONS

Inflammation could modify the outcome of the patients with sarcopenic dysphagia. Inflammation may be an important risk factor in evaluating patients with sarcopenic dysphagia.

Sarcopenic Dysphagia with Low Tongue Pressure Is Associated with Worsening of Swallowing, Nutritional Status, and Activities of Daily Living

OBJECTIVES

According to the recently proposed diagnostic criteria for sarcopenic dysphagia, sarcopenic dysphagia can be classified as probable or possible based on tongue pressure. However, it is unclear whether patients with probable and possible sarcopenic dysphagia have different characteristics. Therefore, this study aimed to investigate whether patients with possible and probable sarcopenic dysphagia have different clinical characteristics.

DESIGN

A cross-sectional study.

SETTING

A rehabilitation hospital.

PARTICIPANTS

In total, 129 patients aged ≥65 years with sarcopenic dysphagia were included.

METHODS

A tongue pressure of <20 kPa was indicative of probable sarcopenic dysphagia, and a tongue pressure of ≥20 kPa was indicative of possible sarcopenic dysphagia. Kuchi-Kara Taberu (KT) index scores were compared between the probable or possible sarcopenic dysphagia groups.

RESULTS

According to the tongue pressure, 76 and 53 patients were classified into the probable and possible sarcopenic dysphagia groups, respectively. In multiple linear regression analysis, the presence of probable sarcopenic dysphagia was independently associated with the total KT index score (standardized coefficient: -0.313, regression coefficient: -4.500, 95% confidence interval [CI], -6.920 to -2.080, P < 0.001). The presence of probable sarcopenic dysphagia was independently associated with some subitems of the KT index (willingness to eat, cognitive function while eating, oral preparatory and propulsive phase, severity of pharyngeal dysphagia, eating behavior, and daily living activities).

CONCLUSIONS

Patients with probable sarcopenic dysphagia were characterized by poor overall eating-related conditions, especially poor swallowing ability, ability to perform activities of daily living, and nutritional status.

Correction to: G:U‑Independent RNA Minihelix Aminoacylation by Nanoarchaeum equitans Alanyl‑tRNA Synthetase: An Insight into the Evolution of Aminoacyl‑tRNA Synthetases

In the original version of this article, "A73" in Fig 6b was inadvertently labeled as "G73". The corrected Fig. 6 is given here.

Moiré Potential, Lattice Corrugation, and Band Gap Spatial Variation in a Twist-Free MoTe2/MoS2 Heterobilayer

To have a fully first-principles description of the moiré pattern in transition-metal dichalcogenide heterobilayers, we have carried out density functional theory calculations on a MoTe₂(9 × 9)/MoS₂(10 × 10) stacking, which has a superlattice larger than an exciton yet not large enough to justify a continuum model treatment. Lattice corrugation is found to be significant in both monolayers, yet its effect on the electronic properties is marginal. We reveal that the variation of the average local potential near Mo atoms in both MoTe₂ and MoS₂ layers displays a conspicuous moiré pattern. They are the intralayer moiré potentials correlating closely with the spatial variation of the valence band maximum and conduction band minimum. The interlayer moiré potential, defined as the difference between the two intralayer moiré potentials, changes roughly in proportion to the band gap variation in the moiré cell. This finding might be instructive in chemical engineering of van der Waals bilayers.

Tongue surface model can predict radiation tongue mucositis due to intensity-modulated radiation therapy for head and neck cancer

Acute radiation tongue mucositis has a profound effect on talking and eating. We examined whether the dose-volume histogram obtained from the tongue surface model correlates with mucositis severity, and whether it is useful for predicting acute radiation tongue mucositis in patients with head and neck cancer treated with intensity-modulated radiation therapy. Thirty-six patients who received intensity-modulated radiation therapy for head and neck cancer were analysed for acute radiation tongue mucositis according to the Common Terminology Criteria for Adverse Events, version 4.0, as well as the Radiation Therapy Oncology Group scoring systems. The corresponding high-dose locations in anatomical sub-regions in the tongue surface model and the development of high-grade acute radiation tongue mucositis were compared. The mucositis sites coincided with the high-dose anatomical sub-regions in the tongue surface model. There was a clear dose-response relationship between the mean dose to the tongue and the acute radiation tongue mucositis Radiation Therapy Oncology Group grade. According to the dose-volume histogram, patients receiving 16.0-73.0 Gy to the tongue were susceptible to grade 2-3 toxicity. The tongue surface model can predict the site and severity of acute radiation tongue mucositis. In future, radiation treatment plans ccould be optimized using this model.

A step towards international prospective trials in carbon ion radiotherapy: investigation of factors influencing dose distribution in the facilities in operation based on a case of skull base chordoma

Background

Carbon ion radiotherapy (CIRT) has been delivered to more than 20,000 patients worldwide. International trials have been recommended in order to emphasize the actual benefits. The ULICE program (Union of Light Ion Centers in Europe) addressed the need for harmonization of CIRT practices. A comparative knowledge of the sources and magnitudes of uncertainties altering dose distribution and clinical effects during the whole CIRT procedure is required in that aim.

Methods

As part of ULICE WP2 task group, we sent a centrally reviewed questionnaire exploring candidate sources of uncertainties in dose deposition to the ten CIRT facilities in operation by February 2017. We aimed to explore native beam characterization, immobilization, anatomic data acquisition, target volumes and organs at risks delineation, treatment planning, dose delivery, quality assurance prior and during treatment. The responders had to consider the clinical case of a clival chordoma eligible for postoperative CIRT according to their clinical practice. With the results, our task group discussed ways to harmonize CIRT practices.

Results

We received 5 surveys from facilities that have treated 77% of the patients worldwide per November 2017. We pointed out the singularity of the facilities and beam delivery systems, a divergent definition of target volumes, the multiplicity of TPS and equieffective dose calculation approximations.

Conclusion

Multiple uncertainties affect equieffective dose definition, deposition and calculation in CIRT. Although it is not possible to harmonize all the steps of the CIRT planning between the centers, our working group proposed counter-measures addressing the improvable limitations.

Unique B7-H1 expression on masticatory mucosae in the oral cavity and trans-coinhibition by B7-H1-expressing keratinocytes regulating CD4+ T cell-mediated mucosal tissue inflammation

The PD-1/B7-H1 pathway regulates immune responses and maintains homeostasis. Here, we identified a unique expression of B7 homolog 1 (B7-H1) on masticatory mucosae in the oral cavity. B7-H1 was physiologically expressed on the dorsal surface of the tongue, gingiva, and hard palate. Other squamous epithelia and other structures of the epithelia did not express B7-H1 in the steady state. Physiological B7-H1 expression on masticatory mucosae was limited on prickle cells, and its expression on basal keratinocytes (KCs) was strictly regulated. B7-H1 on prickle cells was upregulated by external topical stimuli, but B7-H1 on basal KCs was induced only by internal stimuli via infiltrating cells. The blocking of KC-associated B7-H1 or the lack of programmed cell death-1 (PD-1) on tissue effector CD4⁺ T cells in mice lacking B7-H1 on immune cells drastically exacerbated the tissue inflammation induced by topical OVA painting as an exogenous antigen, indicating direct interaction with KCs and CD4⁺ T cells. Trans-coinhibitory signals by KCs may modulate local T-cell/dendritic cell activation, resulting in inhibition of T-cell responses in both peripheral and secondary lymphoid tissues. Careful control of B7-H1 induction in KCs may play a crucial role in the protection from CD4⁺ T cell-mediated tissue inflammation by exogenous antigens delivered from the mucosal surface.

Abstract P4-20-06: Results of an educational program delivered through e-learning, focused on nursing for primary breast cancer patients

Aim: An educational program delivered through e-learning was conducted, focusing on nursing for primary breast cancer patients. This paper investigates the results of the program, clarifying changes in levels of understanding before and after the program, and evaluations of the program by nurses who participated. Methods: The content of the education program, which consisted of 24 lessons, each lasting 15-20 minutes, including case studies, covered concerns raised in questions by patients and families about diagnosis, multimodal treatment and nursing for primary breast cancer. Instructors were Certified Nurses in Breast Cancer Nursing and Certified Nurse Specialists in Cancer Nursing, and PowerPoint presentations with video and audio material were created. A dedicated website was created, and 1417 participants took the on-demand program, which was provided from September 2015 to March 2016. Survey participants were the first 500 nurses registered for the course to respond. A questionnaire created by the researchers was sent by post to respondents. Responses were anonymous with identifying information code, and questionnaires were sent with a return envelope before the program (within 2 weeks of registration) and after the program (within 1 month of the end of the program), with return of the questionnaire signifying consent to participate. The questionnaire comprised 24 items on level of understanding of breast cancer nursing, aligned to program content, plus 11 items on evaluation of the program. Responses were selected from a 5-point scale, where 1 meant “strongly disagree” and 5 meant “strongly agree”. Analysis: Responses were quantified, and mean scores for each item were calculated. In addition, respondents were divided into two groups, namely, those with less than 3 years of breast cancer nursing experience (Group A) and those with 3 or more years' experience (Group B), and were compared using the Mann-Whitney U test. SPSS Statistics V22.0 was used. Ethical considerations: The study went through Research Ethics approval at the researchers' institute of affiliation. Results: A total of 126 people replied to both the pre-program and post-program questionnaire, and of these, the responses of 106 nurses (Group A: 34 nurses, Group B: 72 nurses) who were not qualified as Certified Nurses or Certified Nurse Specialists were used for analysis. Median age was 41.0 years (Group A: 38.5 years, Group B: 42 years), and median number of years of breast cancer nursing was 4.6 years. In terms of program evaluation, “I could study when it was convenient for me” scored 4.63, while “It will be useful for breast cancer nursing from now on” scored 4.57. In terms of comparison of level of understanding before and after the program, understanding improved on all 24 items, and was significant on 19 items. Comparison of the 2 groups showed significant difference on 2 items, “support for changes in body image” and “communication with the patient”, with changes in level of understanding in Group A being greater. Discussion: The study suggests that participants' understanding of breast cancer nursing increased and improvements in clinical practice can be expected through e-learning materials that facilitate effective learning.

Citation Format: Abe K, Iseki C, Suzuki M, Kokufu H, Arahori Y, Ohno T, Kanazawa M, Takeishi Y. Results of an educational program delivered through e-learning, focused on nursing for primary breast cancer patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-06.

Bone Degeneration and Its Recovery in SMP30/GNL-Knockout Mice

Senescence marker protein-30 (SMP30) decreases androgen-independently with aging and is a lactone-hydrolyzing enzyme gluconolactonase (GNL) that is involved in vitamin C biosynthesis. In the present study, bone properties of SMP30/GNL knockout (KO) mice with deficiency in vitamin C synthesis were investigated to reveal the effects of SMP30/GNL and exogenous vitamin C supplementation on bone formation. Mineral content (BMC) and mineral density (BMD) of the mandible and femur of SMP30/GNL KO and wild-type mice at 2 and 3 months of age with or without vitamin C supplementation were measured by dual-energy X-ray absorptiometry. Body and bone weight of both age groups decreased and became significantly lower than those of wild-type mice. The bones of SMP30/GNL KO mice were rough and porous, with BMC and BMD significantly below wild-type. Oral supplementation with vitamin C eliminated differences in body weight, bone weight, BMC, and BMD between SMP30/GNL KO and wild-type mice at each age. These results indicate that bone degeneration in SMP30/GNL KO mice was caused by lack of vitamin C, and that this mouse strain is an appropriate model for bone metabolism in humans, which have no ability to synthesize vitamin C.