Hironobu Hata

An open-label, noncomparative, dose escalation pilot study of the effect of paroxetine in treatment of burning mouth syndrome

OBJECTIVE The objective of this study was to evaluate the effectiveness and tolerability of paroxetine in patients with burning mouth syndrome (BMS). DESIGN In a 12-week open-label, noncomparative, prospective study, 71 subjects with primary BMS were assigned to receive an initial dosage of paroxetine (10 or 20 mg/day). The dosage was increased to a maximum of 30 mg/day. Of these patients, 52 were available to examine the efficacy of treatment in this study. RESULTS The cumulative proportion of responders was 80.8% (42/52). Of those responding, complete remission of pain was observed in 70.4% (19/27) of patients by week 12. The effects of paroxetine were dose-dependent. The incidence of adverse reactions for the initial daily dosage of 10 mg (41%) was significantly lower than that for 20 mg (76%) (chi(2) test). No serious safety issues were observed. CONCLUSION About 80% of BMS patients experienced pain reduction with 12 weeks of paroxetine treatment with only minor transient side effects. These results suggest that paroxetine may be useful in the treatment of patients with BMS.

18F-Fluoromisonidazole PET Uptake Is Correlated with Hypoxia-Inducible Factor-1α Expression in Oral Squamous Cell Carcinoma

Hypoxia is a common feature of cancer and a prognostic factor for many types of cancer. 18F-fluoromisonidazole (18F-FMISO) PET can detect tumor hypoxia noninvasively. Hypoxia-inducible factor-1 (HIF-1) is a key player in the transcriptional response to low oxygen tension in many types of cancer. Its activity is mainly dependent on the stability and modification of HIF-1α, which is a composition of HIF-1. However, it is unclear whether 18F-FMISO PET can identify HIF-1α expression in oral squamous cell carcinoma (OSCC). The present study was performed to elucidate the correlation between 18F-FMISO PET findings and HIF-1α expression in OSCC. Methods: Twenty-three patients (age range, 42–84 y; 15 men, 8 women) with OSCC were enrolled in this study. The T-stages of cancer were T1 in 1 patient, T2 in 9, T3 in 2, and T4a in 11. The N-stages were N0 in 13 patients, N1 in 5, and N2 in 5. Each patient underwent 18F-FMISO and 18F-FDG PET before surgery, and the maximum standardized uptake value (SUVmax) of both PET studies was measured. HIF-1α expression in the operation materials was evaluated by immunohistochemical staining. The SUVmax of both PET studies and HIF-1α findings were compared statistically. Results: 18F-FMISO PET detected uptake in the primary site in 14 of the 23 patients (61%). The median SUVmax of 18F-FMISO and 18F-FDG PET in the primary site was 1.83 (range, 0.8–2.7) and 16.5 (range, 1.0–32.3), respectively. There was a weak significant correlation between 18F-FMISO and 18F-FDG PET SUVmax (P = 0.02, r = 0.48). HIF-1α expression was clearly detected in 11 of the 23 patients (48%). The 18F-FMISO PET SUVmax was significantly higher in the HIF-1α–positive cases than in the HIF-1α–negative cases (median, 2.1; range, 1.5–2.4, vs. median, 1.6; range, 0.8–2.0, respectively) (P = 0.002). However, there were no significant correlations between 18F-FDG PET SUVmax and HIF-1α expression (median, 21.8; range, 7.7–29.1 vs. 1.0–32.2) (P = 0.06). Conclusion: 18F-FMISO uptake in the primary site of OSCC indicates a hypoxic environment with HIF-1α expression.

Relationships between perceived chewing ability and muscle strength of the body among the elderly

The aim of the present study was to elucidate whether self-assessed masticatory ability (masticatory ability) is significantly related to muscle strength of the body evaluated as handgrip strength and skeletal muscle mass of the whole body (kg) (SMM) after adjusting for confounding variables, including, age, gender, height, weight, employment status, type of household, educational background, social interaction, chronic medical conditions, smoking habit, drinking habits and dentition status among the elderly. A total of 381 persons aged 67-74 years were enrolled. Masticatory ability was classified into one of three categories: ability to chew all kinds of food, ability to chew only slightly hard food or ability to chew only soft or pureed food. Handgrip strength was measured, and bioimpedance analysis was used to estimate SMM. One-way analysis of variance and Bonferroni methods were used to examine differences in handgrip strength and SMM among the three groups of masticatory ability. An ordinal regression model was conducted with masticatory ability as the dependent variable and handgrip strength as the principal independent variable. Handgrip strength was significantly lower in those individuals who could chew only soft or pureed food than in those individuals who could chew all kinds of food. No significant difference in SMM was found among the three groups of masticatory ability. Masticatory ability was significantly related to handgrip strength after adjusting for SMM, dentition status and background factors. Chewing ability may be related to muscle strength of the body evaluated as handgrip strength, but not evaluated as SMM.

Associations between self-assessed masticatory ability and higher brain function among the elderly.

Among the elderly, the quality of higher brain function is a contributing factor in performing activities of daily living. The aim of the study is to elucidate, epidemiologically, associations between mastication and higher brain function. A total of 208 community-dwelling elderly persons, aged 70-74 years, were enrolled. Self-assessed masticatory ability (masticatory ability) was classified into one of three categories: ability to chew all kinds of food, ability to chew only slightly hard food, or ability to chew only soft or pureed food. Brain function was assessed by four neuropsychological tests: Ravens Colored Progressive Matrices (RCPM) test, the Verbal Paired Associates 1 (VerPA) task and the Visual Paired Associates 1 task (from the Wechsler Memory Scale Revised Edition), and the Block Design subtest (from the Wechsler Adult Intelligence Scales-Third Edition). Correlations between masticatory ability and each test were examined using Spearman rank correlation coefficients. Multinominal logistic regression models were conducted with the neuropsychological tests as the dependent variables and masticatory ability as the principal independent variable to adjust for age, gender, educational background, social activity, drinking/smoking habits, chronic medical conditions and dental status. Significant correlations were found between the RCPM test, the VerPA task, the Block Design test and masticatory ability. In multinominal logistic regression models, poor masticatory ability was significantly and independently related to the categories under the mean-s.d. points compared with those of the mean ± s.d. ranges for RCPM test and the VerPA task. Significant associations may exist between mastication and higher brain function among the elderly.

Single-photon emission computed tomography of spontaneous liver metastasis from orthotopically implanted human colon cancer cell line stably expressing human sodium/iodide symporter reporter gene

BackgroundWe aimed to develop a mouse spontaneous liver metastasis model from an orthotopically implanted human colon cancer cell line stably expressing a human sodium/iodide symporter (NIS) reporter gene, which can be imaged with single-photon emission computed tomography (SPECT) using 99mTcO4−.MethodsA recombinant plasmid containing a constitutively driven NIS gene (pcDNA3-NIS) was transfected into the human colon cancer cell line HCT116, and stable cell lines were established. The stable cells were subcutaneously injected into the nude mice. When the diameter reached 10 mm, the xenografts were excised, cut into small fragments, and orthotopically implanted into the cecal walls of another nude mice. 99mTcO4− SPECT/CT imaging was initiated 8 weeks later and repeated every 1 to 2 weeks.ResultsThe production and function of NIS protein was confirmed in vitro by Western blotting and 99mTcO4− uptake assay. On SPECT/CT imaging, focal 99mTcO4− uptake was detected in the liver. Necropsy revealed local growth of the orthotopic colon xenografts with extensive invasion, microscopic serosal metastasis, and metastatic foci in the corresponding hepatic regions showing focal 99mTcO4− uptake. Immunohistochemistry revealed high levels of NIS expression in cells forming liver tumor, indicating that the liver tumor cells originated from the orthotopic colon xenografts.ConclusionsThe present proof-of-concept study provided a rationale for employing a radionuclide reporter gene for the specific visualization of spontaneous liver metastasis in living mice. This unique animal model of clinically relevant and externally detectable liver metastasis will be a powerful tool for investigating tumor biology and developing novel therapies for cancer metastasis.

Cervical toxoplasmic lymphadenitis can mimic malignant lymphoma on FDG PET.

A 63-year-old woman presented with indolent swelling in her right submandibular region. CT and MRI demonstrated enlarge- ment of multiple right neck lymph nodes with homogeneous en- hancement. Because malignant lymphoma was suspected, whole body FDG PET was performed, which revealed accumulation of FDG in the submandibular region and additional increased accumu- lation with delayed imaging. After excisional biopsy of the enlarged right submandibular lymph node, histopathology showed evidence of probable toxoplasmic lymphadenitis. The patient had a history of exposure to cats and her serum toxoplasmic antibody titer was high. These findings led to a final diagnosis of toxoplasmosis. Increased uptake on FDG PET may occur in patients with cervical toxoplasmic lymphadenitis.

Large ameloblastoma of the mandible with hypoproteinemia

A case of large ameloblastoma of the mandible with severe hypoproteinemia is reported. The patient, a 53-year-old man, had a large swelling (14 x 11 x 10 cm) from the right cheek to the submandible causing severe hypoproteinemia. The tumor was removed when the serum protein level had recovered to 5.3g/dl following administration of 50 ml of 20% albumin for 4 days. After the operation, his hypoproteinemia, which was thought to be caused by leakage of plasma through the oral fistula of the ameloblastoma, rapidly improved. This article describes preoperative and postoperative findings and the clinical course of the patient.

Use of FDG PET to evaluate hyperbaric oxygen therapy for bisphosphonate-related osteonecrosis of the jaw.

An 80-year-old man presented with painful swelling in the mandibular region and a fistula with pus discharge that developed after tooth extractions. He had taken oral alendronate sodium hydrate and prednisolone for osteoporosis for 5 years. The lesion was diagnosed as bisphosphonate-related osteonecrosis of the jaw. Fluorodeoxyglucose positron emission tomography (FDG PET) revealed a high accumulation of FDG in the right mandibular region. The patient underwent hyperbaric oxygen therapy (HBO) 20 times. FDG PET maximum standard uptake value drastically decreased from 5.6 to 1.8 after HBO, paralleling the change in clinical symptoms, whereas other modalities did not show remarkable changes. This study demonstrates the utility of FDG PET in monitoring HBO for bisphosphonate-related osteonecrosis of the jaw.

Differences in sequential posttreatment salivary IL-6 levels between patients with and patients without locoregional recurrences of oral squamous cell carcinoma: Part III of a cohort study.

OBJECTIVE Sequential postoperative salivary interleukin-6 (IL-6) concentrations were examined in patients with oral squamous cell carcinoma (OSCC) who had early or late locoregional recurrences or those who did not. STUDY DESIGN Twenty-seven consecutive patients with OSCC were originally included in the study. All patients underwent radical surgery. Four saliva samples were collected before (periods I and II) and after (periods III and IV) surgery, and IL-6 concentrations were measured. RESULTS Although postoperative (period III: at the time of discharge) salivary IL-6 level was significantly higher in patients with early locoregional recurrence (P = .02) than in those without, no such relationships were observed for preoperative IL-6 concentrations (periods I and II). Postoperative (period IV: 24 months after surgery) IL-6 level was significantly higher in patients with late locoregional recurrence (P = .03) than in those without, but no such relationships were observed for IL-6 concentrations in periods I, II, and III. CONCLUSIONS Sequential postoperative salivary IL-6 concentration may be a useful marker for diagnosis of early and late locoregional recurrence in OSCC.

Elimination of oral candidiasis may increase stimulated whole salivary flow rate

OBJECTIVES Candida infections are frequently encountered fungal infections in the oral mucosa. This study aimed to evaluate the effect of eliminating Candida spp. on stimulated whole salivary flow rate (SWS) in patients with oral candidiasis. SUBJECTS AND METHODS This study involved 66 patients with oral candidiasis. Fifty-two consecutive patients, successfully treated by antifungal therapy, were available to examine the effect of elimination of oral Candida spp. on SWS (success group); the 14 patients who tested positive for Candida after therapy were retrospectively included (control group). SWS were used to measure saliva production. Moreover, tongue pain and xerostomia were evaluated using visual analog score (VAS). RESULTS By eliminating oral Candida spp., SWS significantly increased in the success group after antifungal therapy [SWS: mean value 0.89±0.51ml/min (median 0.82ml/min: 0.15-2.14) to mean value 1.16±0.58ml/min (median 1.05ml/min: 0.2-2.93), P<0.001]. Furthermore, VAS scores for subjective tongue pain and xerostomia were significantly decreased compared with those before therapy in the success group [xerostomia: mean value 52.5±28.8 (median 53: 9-100) to 24.2±1.6 (median 17: 0-70), tongue pain: mean value 52.6±27.2 (median 56: 1-93) to 15.3±18.0 (median 9: 0-62). P<0.001]. There was no significant difference in SWS, subjective tongue pain, or xerostomia in the control group after antifungal therapy. [SWS: mean value 1.08±0.83ml/min (median 0.69ml/min: 0.2-2.7) to 0.98±0.59ml/min (median 0.8ml/min: 0.45-2.5), P=0.65], [xerostomia: mean value 62.8±5.3 (median 62: 28-70) to 64.0±8.8 (median 64: 56-73), P=0.58, tongue pain: mean value 64.3±18.6 (median 67: 31-87) to 58.4±20.0 (median 8: 20-78), respectively; P=0.24] CONCLUSION: Our study demonstrated that SWS may increase by eliminating oral Candida spp. in patients with oral candidiasis.