記述言語：日本語   出版者・発行元：(一社)日本摂食嚥下リハビリテーション学会  

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記述言語：日本語   出版者・発行元：新潟歯学会  

皮膚筋炎は自己免疫疾患のひとつであり、合併症としてしばしば嚥下障害を呈する。多くの場合は、原疾患の治癒とともに嚥下障害も改善することが報告されているが、治療が長期化し嚥下障害が遷延する報告も見受けられる。我々は、皮膚筋炎の活動性が安定後も関連する合併症等の影響により治療が難渋した症例を経験したため報告する。患者は73歳、男性。X-10年に皮膚筋炎の診断を受け、外来通院にてフォローを行っていたが再燃し、当院入院となった。四肢筋力低下、嚥下困難感を主訴に当科紹介となった。入院当初の嚥下造影検査では液体誤嚥や固形物の咽頭残留を伴う咽頭期障害が顕著であった。原疾患に対してステロイドパルス療法、低栄養改善のために経鼻経管栄養を開始した後に、少量のゼリーを用いた直接訓練を進めた。皮膚筋炎の活動性が安定した後も嚥下障害は残存し、さらに原疾患の合併症として蠕動運動障害や腸管気腫を発症したことで経管栄養の調整及び嚥下訓練は難渋した。その後、代償的嚥下法を獲得し、自宅退院後もごく少量の楽しみ程度の経口摂取が継続可能となった。皮膚筋炎では、関連する消化器や呼吸器等の合併症、低栄養が嚥下障害の予後に関連すると思われる。リハビリテーションの実施にあたっては、全身状態の変化に留意し、難治例には残存機能を生かした訓練を行う必要があることが考えられた。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Examining the coordination of respiration and swallowing is important for elucidating the mechanisms underlying these functions and assessing how respiration is linked to swallowing impairment in dysphagic patients. In this study, we assessed the coordination of respiration and swallowing to clarify how voluntary swallowing is coordinated with respiration and how mastication modulates the coordination of respiration and swallowing in healthy humans. Twenty-one healthy volunteers participated in three experiments. The participants were asked to swallow 3 ml of water with or without a cue, to drink 100 ml of water using a cup without breathing between swallows, and to eat a 4-g portion of corned beef. The major coordination pattern of respiration and swallowing was expiration-swallow-expiration (EE type) while swallowing 3 ml of water either with or without a cue, swallowing 100 ml of water, and chewing. Although cueing did not affect swallowing movements, the expiratory time was lengthened with the cue. During 100-ml water swallowing, the respiratory cycle time and expiratory time immediately before swallowing were significantly shorter compared with during and after swallowing, whereas the inspiratory time did not differ throughout the recording period. During chewing, the respiratory cycle time was decreased in a time-dependent manner, probably because of metabolic demand. The coordination of the two functions is maintained not only in voluntary swallowing but also in involuntary swallowing during chewing. Understanding the mechanisms underlying respiration and swallowing is important for evaluating how coordination affects physiological swallowing in dysphagic patients.

DOI： 10.3389/fphys.2021.696071

PubMed

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記述言語：日本語   出版者・発行元：日本口腔リハビリテーション学会  

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記述言語：日本語   出版者・発行元：新潟歯学会  

三叉神経鞘腫とは、三叉神経根や末梢神経のシュワン細胞に発症する比較的稀な良性腫瘍の1つである。今回、三叉神経鞘腫摘出手術後に摂食嚥下障害を認めた症例を経験したのでここに報告する。症例は44歳女性。右巨大三叉神経鞘腫に対する腫瘍摘出術が施行され、術後2日目に摂食嚥下機能評価目的に当科初診となった。初診時、球麻痺症状としての顔面神経麻痺、舌の運動時の偏位や抵抗力の減弱、開鼻声を伴う左カーテン徴候、軟口蓋右側で感覚の低下や軟口蓋反射・咽頭絞扼反射の消失を認めた。反復唾液嚥下テストは1回、改訂水飲みテストは4点(嚥下後の呼吸良好、ムセなし)であり、嚥下内視鏡検査時には発声時の不完全な声門閉鎖が観察された。また、右側からの食塊口唇漏出、液体摂取時の嚥下反射惹起遅延、緩慢な咀嚼を認めた。食事再開は可能と判断し、半固形食、液体とろみ付与の食事形態で経口摂取再開とした。その後、嚥下訓練、咀嚼訓練を継続し、術後18日目の自宅退院時には食形態が軟飯・軟菜食までに回復した。退院後の術後34日目の再評価時、一部の球麻痺症状は残存したものの、反復唾液嚥下テスト5回、改訂水飲みテストは5点と改善を認めた。急性期病院においては在院日数の短縮が求められるため、本症例のように術後間もなくからの介入により退院まで円滑に摂食嚥下リハビリテーションを実施できたことが、自宅でも十分に生活できる程度の摂食嚥下機能の回復を促進し、生活の質の回復に寄与したものと考えられた。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟歯学会  

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記述言語：日本語   出版者・発行元：日本口腔リハビリテーション学会  

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記述言語：日本語   出版者・発行元：新潟歯学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Capsaicin powerfully evokes the swallowing reflex and is a known therapeutic agent for improving dysphagia and preventing aspiration pneumonia. However, the role of capsaicin-sensitive nerves in the initiation of swallowing evoked by various natural stimuli remains unclear. To explore this question, we blocked laryngeal capsaicin-sensitive nerves following the co-application of QX-314 and capsaicin (QX/Cap), and investigated the effects on swallowing evoked by mechanical and chemical stimulation in anesthetized rats. Swallows were evoked by capsaicin, carbonated water (CW), distilled water (DW), and punctate mechanical stimulation using von Frey filaments applied topically to the larynx. Swallows were documented by recording electromyographic activation of the suprahyoid and thyrohyoid muscles. The initiation of swallowing by capsaicin was strongly suppressed at 5 minutes following QX/Cap treatment and facilitated in a time-dependent manner. CW-evoked swallows at 5 min following QX/Cap treatment were significantly diminished compared with before and 30 min after treatment. In contrast, DW-evoked and mechanically evoked swallows were unchanged by QX/Cap treatment. Furthermore, CW-evoked swallows were virtually abolished by transection of the superior laryngeal nerves and significantly decreased by the topical application of ASIC3 inhibitor APET×2, but they were not affected by the non-selective TRP channel inhibitor ruthenium red or the ASIC1 inhibitor mambalgin-1. Taken together, we speculate that capsaicin-sensitive nerves play an important role in the initiation of CW-evoked swallows.

DOI： 10.1152/ajpgi.00233.2020

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A major component of gastric acid is hydrochloric acid (HCl), which can activate transient receptor potential vanilloid 1 (TRPV1). In the present study, we investigated how sustained laryngeal TRPV1 activation affects the frequency of the swallowing reflex. Experiments were carried out on 85 male Sprague-Dawley rats. The effects of short and sustained application of chemicals (3 µl of 0.1 N HCl or capsaicin) on the frequency of swallowing and of time-dependent changes in the occurrence of swallowing evoked by supralaryngeal nerve stimulation were determined. To evaluate vascular permeability of the larynx, Evans blue dye was intravenously injected after 5 or 60 min of sustained TRPV1 activation. SB366791 (a TRPV1 inhibitor) and Cap/QX-314 (a TRPV1-expressed neuronal inhibitor) significantly inhibited HCl/capsaicin-induced swallowing, but air flow-induced swallowing was not affected. Although the number of air flow-induced swallows induced by capsaicin stimulation was not affected within 5 min, but significantly reduced by 60-min capsaicin or HCl application. The swallowing threshold associated with supralaryngeal nerve stimulation did not significantly change throughout the recording period. Evans blue dye concentrations in the larynx were significantly higher at 60 min in the 10-5 M capsaicin group than in the other groups. Our results suggest that sustained TPRV1 activation not only desensitizes TRPV1, but also inactivates mechanoreceptors, which may be attributed to increases in vascular permeability and edema, as part of an inflammatory process.

DOI： 10.1152/ajpgi.00082.2020

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

KEY POINTS: Afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows in anaesthetized rats. Amiloride and its analogues inhibit swallowing evoked by mechanical stimulation, but not swallowing evoked by chemical and electrical stimulation. The epithelial sodium channel is probably involved in the initiation of laryngeal mechanically evoked swallows. ABSTRACT: The swallowing reflex plays a critical role in airway protection. Because impaired laryngeal mechanosensation is associated with food bolus aspiration, it is important to know how the laryngeal sensory system regulates swallowing initiation. This study was performed to clarify the neuronal mechanism of mechanically evoked swallows. Urethane-anaesthetized Sprague-Dawley male rats were used. A swallow was identified by activation of the suprahyoid and thyrohyoid muscles on electromyography. The swallowing threshold was measured by von Frey filament and electrical stimulation of the larynx. The number of swallows induced by upper airway distension and capsaicin application (0.03 nmol, 3 μl) to the vocal folds was counted. The effects of topical application (0.3-30 nmol, 3 μl) of the epithelial sodium channel (ENaC) blocker amiloride and its analogues (benzamil and dimethylamiloride), acid-sensing ion channel (ASIC) inhibitors (mambalgine-1 and diminazene) and gadolinium to the laryngeal mucosa on swallowing initiation were evaluated. A nerve transection study indicated that afferents carried by the superior laryngeal nerve play a primary role in the initiation of laryngeal mechanically evoked swallows. The mechanical threshold of swallowing was increased in a dose-dependent manner by amiloride and its analogues and gadolinium, but not by ASIC inhibitors. The number of swallows by upper airway distension was significantly decreased by benzamil application. However, the initiation of swallows evoked by capsaicin and electrical stimulation was not affected by benzamil application. We speculate that the ENaC is involved in the initiation of laryngeal mechanically evoked swallows.

DOI： 10.1113/JP277895

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We examined how attention alters chewing and swallowing behaviors. Twenty-one healthy volunteers were asked to freely eat 8 g of steamed rice in three separate trials, and we obtained the average number of chewing cycles (N) and chewing duration (T) prior to the first swallow in each trial. We also conducted an N-limited test, in which participants chewed the food while independently counting the number of chewing cycles and swallowed the food when they reached N, and a T-limited test, in which they chewed the food for T sec and then swallowed. We recorded electromyograms (EMGs) from masseter and suprahyoid muscles and collected videoendoscopic images. In the N-limited test, chewing speed decreased, masseter muscle activity (area under the curve of the rectified EMG burst) per cycle increased, and suprahyoid muscle activity per cycle decreased. In the T-limited test, the chewing speed increased, muscle activities per cycle decreased, and the number of cycles increased. The occurrence frequency of bolus propulsion into the pharynx before swallowing was smaller in the N- and T-limited tests than in the free chewing test. Further, the whiteout time was longer in the T-limited test than in the free chewing test. Attentional chewing changes not only chewing but also swallowing behavior.

DOI： 10.1038/s41598-019-42422-4

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This study aimed to investigate whether the jaw-opening (JOR) and jaw-closing reflexes (JCR) are modulated during not only peripherally, but also centrally, evoked swallowing. Experiments were carried out on 24 adult male Japanese white rabbits. JORs were evoked by trigeminal stimulation at 1 Hz for 30 s. In the middle 10 s, either the superior laryngeal nerve (SLN) or cortical swallowing area (Cx) was simultaneously stimulated to evoke swallowing. The peak-to-peak JOR amplitude was reduced during the middle and late 10-s periods (i.e., during and after SLN or Cx stimulation), and the reduction was dependent on the current intensity of SLN/Cx stimulation: greater SLN/Cx stimulus current resulted in greater JOR inhibition. The reduction rate was significantly greater during Cx stimulation than during SLN stimulation. The amplitude returned to baseline 2 min after 10-s SLN/Cx stimulation. The effect of co-stimulation of SLN and Cx was significantly greater than that of SLN stimulation alone. There were no significant differences in any parameters of the JCR between conditions. These results clearly showed that JOR responses were significantly suppressed, not only during peripherally evoked swallowing but also during centrally evoked swallowing, and that the inhibitory effect is likely to be larger during centrally compared with peripherally evoked swallowing. The functional implications of these results are discussed.

DOI： 10.1016/j.brainres.2018.05.002

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：PERGAMON-ELSEVIER SCIENCE LTD  

Phox2b encodes a paired-like homeodomain-containing transcription factor essential for development of the autonomic nervous system. Phox2b-expressing (Phox2b(+)) neurons are present in the reticular formation dorsal to the trigeminal motor nucleus (RdV) as well as the nucleus of the solitary tract and parafacial respiratory group. However, the nature of Phox2b(+) RdV neurons is still unclear. We investigated the physiological and morphological properties of Phox2b(+) RdV neurons using postnatal day 2-7 transgenic rats expressing yellow fluorescent protein under the control of Phox2b. Almost all of Phox2b(+) RdV neurons were glutamatergic, whereas Phox2b-negative (Phox2b(-)) RdV neurons consisted of a few glutamatergic, many GABAergic, and many glycinergic neurons. The majority (48/56) of Phox2b(+) neurons showed low frequency firing (LF), while most of Phox2b(-) neurons (35/42) exhibited high-frequency firing (HF) in response to intracellularly injected currents. All, but one, Phox2b(+) neurons (55/56) did not fire spontaneously, whereas three fourths of the Phox2b(-) neurons (31/42) were spontaneously active. K+ channel and persistent Na+ current blockers affected the firing of LF and HF neurons. The majority of Phox2b(+) (35/46) and half of the Phox2b(-) neurons (19/40) did not respond to stimulations of the mesencephalic trigeminal nucleus, the trigeminal tract, and the principal sensory trigeminal nucleus. Biocytin labeling revealed that about half of the Phox2b(+) (5/12) and Phox2b(-) RdV neurons (5/10) send their axons to the trigeminal motor nucleus. These results suggest that Phox2b(+) RdV neurons have distinct neurotransmitter phenotypes and firing properties from Phox2b(-) RdV neurons and might play important roles in feeding-related functions including suckling and possibly mastication. (C) 2017 IBRO. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.neuroscience.2017.06.035

Web of Science

PubMed

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記述言語：英語   出版者・発行元：昭和大学学士会  

Mechanisms responsible for controlling masticatory muscle activity during suckling and mastication initiate in the brain. Premotor neurons situated in the brainstem transmit masticatory motor commands to the jaw-closing and jaw-opening motoneurons, which in turn activate the masticatory muscles. The premotor neurons receive inputs from multiple sources such as the orofacial sensory organs, the cerebral cortex, and the central pattern generator in the brainstem. These neural circuits might be important for controlling jaw movement, although their properties in this regard are likely to be altered in postnatal development as the oral motor behavior of mammals shifts significantly from suckling to chewing during the early postnatal period. This timing of jaw movement development mimics that of the orofacial musculoskeletal apparatus. The current article reviews findings on local neural circuits of trigeminal motoneurons and premotor neurons, during early development in rats. We describe findings from electrophysiological recordings, optical imaging with voltage-sensitive dyes, calcium imaging, and laser photolysis of caged glutamate. We also review research into the subtypes of premotor neurons in the supratrigeminal region （SupV） that differ in their electrophysiological properties and possess different morphological characteristics. We further describe how trigeminal motoneurons receive glutamatergic, glycinergic, and GABAergic inputs from the SupV and the reticular formation dorsal to the facial nucleus. Finally, we discuss how these synaptic and intrinsic membrane properties change in postnatal development. Taken together, the findings reviewed herein suggest that these neural circuits are important in diverse oral motor behaviors, and that their postnatal changes are involved in the transition from suckling to mastication functions.

DOI： 10.15369/sujms.29.221

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記述言語：日本語   出版者・発行元：(一社)歯科基礎医学会  

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記述言語：日本語   出版者・発行元：日本口腔リハビリテーション学会  

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記述言語：日本語   出版者・発行元：日本顎口腔機能学会  

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記述言語：日本語   出版者・発行元：(一社)歯科基礎医学会  

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記述言語：日本語   出版者・発行元：新潟歯学会  

聴神経腫瘍術後に嚥下障害を認めた一例を報告する。症例は56歳女性。2017年2月に小脳・脳幹を圧迫する聴神経鞘腫に対する摘出術施行、術後左小脳出血及び延髄から橋にかけて低吸収域を認めたため、脳内血腫除去および減圧開頭術が施行された。術後11日目に嚥下機能評価目的に当科初診となった。小脳前庭症状としての姿勢保持困難と失調性構音障害、球麻痺症状としての顔面神経麻痺、舌運動減弱、開鼻声を伴う右カーテン徴候を認めた。反復唾液嚥下テストは2回、改訂水飲みテストおよびとろみ付液体3ccでのテストでは3a点(嚥下後湿性音あり)であった。嚥下内視鏡検査時、安静時より咽頭内分泌物貯留、左側披裂・声帯は傍正中位固定で声門閉鎖不良、ホワイトアウトは減弱しており、とろみ付液体摂取時の食道流入不良、鼻咽腔逆流を認めた。さらに、残留物は不顕性誤嚥をしていた。重度摂食嚥下障害の診断にて、口腔ケア・間接訓練から介入を開始した。耐久性が改善した術後19日目以降は間接訓練の負荷を増やし、少量のとろみ付液体を用いた直接訓練も開始した。術後35日目に実施した嚥下造影検査では、依然として嚥下後の咽頭残留量が多く食事開始にはいたらなかった。転院を前に術後55日目に実施した最終評価では、幻暈などの前庭症状は改善していたものの球麻痺症状に大きな変化は認められなかった。最終的に食事開始までは至らなかったものの、訓練の効果による咽頭残留の軽減と姿勢調整を行うことで安全な経口摂取方法の提案ができた。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟歯学会  

聴神経腫瘍術後に嚥下障害を認めた一例を報告する。症例は56歳女性。2017年2月に小脳・脳幹を圧迫する聴神経鞘腫に対する摘出術施行、術後左小脳出血及び延髄から橋にかけて低吸収域を認めたため、脳内血腫除去および減圧開頭術が施行された。術後11日目に嚥下機能評価目的に当科初診となった。小脳前庭症状としての姿勢保持困難と失調性構音障害、球麻痺症状としての顔面神経麻痺、舌運動減弱、開鼻声を伴う右カーテン徴候を認めた。反復唾液嚥下テストは2回、改訂水飲みテストおよびとろみ付液体3ccでのテストでは3a点(嚥下後湿性音あり)であった。嚥下内視鏡検査時、安静時より咽頭内分泌物貯留、左側披裂・声帯は傍正中位固定で声門閉鎖不良、ホワイトアウトは減弱しており、とろみ付液体摂取時の食道流入不良、鼻咽腔逆流を認めた。さらに、残留物は不顕性誤嚥をしていた。重度摂食嚥下障害の診断にて、口腔ケア・間接訓練から介入を開始した。耐久性が改善した術後19日目以降は間接訓練の負荷を増やし、少量のとろみ付液体を用いた直接訓練も開始した。術後35日目に実施した嚥下造影検査では、依然として嚥下後の咽頭残留量が多く食事開始にはいたらなかった。転院を前に術後55日目に実施した最終評価では、幻暈などの前庭症状は改善していたものの球麻痺症状に大きな変化は認められなかった。最終的に食事開始までは至らなかったものの、訓練の効果による咽頭残留の軽減と姿勢調整を行うことで安全な経口摂取方法の提案ができた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)歯科基礎医学会  

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記述言語：日本語   出版者・発行元：(一社)歯科基礎医学会  

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記述言語：日本語   出版者・発行元：日本顎口腔機能学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02994&link_issn=&doc_id=20180411290016&doc_link_id=%2Fex2gakuk%2F2017%2F002401%2F016%2F0050-0051%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2017%2F002401%2F016%2F0050-0051%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本顎口腔機能学会  

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記述言語：日本語   出版者・発行元：(一社)歯科基礎医学会  

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記述言語：日本語   出版者・発行元：昭和大学学士会  

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記述言語：日本語   出版者・発行元：(NPO)日本口腔科学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本障害者歯科学会  

われわれは従命不良な摂食嚥下障害患者に対し、入院下での集中的訓練および退院後の継続的な訓練により、3年間の経鼻胃管による栄養管理から全量経口摂取となった症例を経験したので報告する。患者は52歳男性、5歳時に難治性てんかんを発症し、以降精神遅滞を認めた。常食を自食していたが49歳時に誤嚥性肺炎を発症し、以降経鼻胃管栄養となっていた。医科よりの紹介にて当科来院した。初診時のADLはBarthel Indexにて5点であった。初診時の嚥下造影検査にてゼリー、ヨーグルトでは誤嚥を認めなかったため入居施設での直接訓練を開始した。訓練開始直後に誤嚥性肺炎を発症したため当科入院下での集中的な嚥下訓練を立案した。入院中訓練は家族の立会いのもとで実施し、退院後も統一された訓練を行うため患者家族に対し訓練方法や介助方法の指導を行った。また、スプーンの保持が可能であったため自食の訓練も行った。退院時には訓練の様子をDVDとして渡し、入居施設職員に対しても訓練方法の統一を図った。退院後体調の変化を認めず、担当医師、施設職員と相談のもと経口摂取量を増加させ、全量経口摂取開始1ヵ月後に経鼻胃管の抜去を行った。現在、食形態は米飯、キザミ食であり、家族の見守り下では常食を自食している。全量経口摂取開始以降も1年間明らかな体調の変化は呈していない。本症例より、従命不良な患者に対しても、集中的な嚥下訓練、介護者への指導によって良好な訓練効果が得られることが示唆された。(著者抄録)

DOI： 10.14958/jjsdh.36.630

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J02489&link_issn=&doc_id=20151113300006&doc_link_id=%2Fcp2disab%2F2015%2F003604%2F006%2F0630-0636%26dl%3D2&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcp2disab%2F2015%2F003604%2F006%2F0630-0636%26dl%3D2&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_5.gif

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：日本語   出版者・発行元：(一社)日本老年歯科医学会  

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記述言語：英語   出版者・発行元：昭和大学・昭和歯学会  

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J-GLOBAL

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