Pilocarpine Disposition and Salivary Flow Responses Following Intravenous Administration to Dogs

Oral doses of pilocarpine increase salivary flow rates in patients afflicted with xerostomia (dry mouth). This study examined the pharmacokinetics of and a pharmacodynamic response (salivation) to intravenous pilocarpine nitrate administration in dogs. Disposition was linear over a dose range of 225–600 µg/kg; plasma concentrations were 10–120 µg/L. Elimination was rapid and generally biphasic, with a terminal elimination half-life of approximately 1.3 hr. The systemic clearance of pilocarpine was high (2.22 ± 0.49 L/kg/hr) and its steady-state volume of distribution (2.30 ± 0.64 L/kg) was comparable to that of many other basic drugs. All doses of pilocarpine induced measurable submaxillary and parotid salivary flow rates which could be maintained constant over time. Cumulative submaxillary saliva flow was linearly related to total pilocarpine dose. Plasma pilocarpine concentration was linearly related to both steady-state and postinfusion submaxillary salivary flow rates.     

炙甘草汤防治鼻咽癌放疗后气阴两虚型口干症疗效观察及分析

目的:观察炙甘草汤防治鼻咽癌患者放疗后口干症的效果,并分析其可能机制。方法:将同期收治的100例鼻咽癌患者按照随机数字表法分为治疗组和对照组各50例。两组均予调强放疗30次,在此基础上治疗组予炙甘草汤含嗽5 min再咽下,对照组予安慰汤(颜色、气味与炙甘草汤相似)含嗽5 min再咽下。治疗时间均为放疗开始到放疗结束后6个月。放疗结束及结束后6个月分别对两组进行口干程度可视分析标尺法(VAS)评分,检测唾液腺分泌指数(EF)及血清白细胞介素(IL)-17、IL-10水平,同时记录不良反应发生情况。结果:放疗结束及结束后6个月,治疗组VAS评分均低于对照组,EF均高于对照组,血清IL-17水平均低于对照组,血清IL-10水平均高于对照组,组间比较差异有统计学意义(P0.05)。治疗期间两组均未出现严重不良反应。结论:炙甘草汤对防治鼻咽癌患者放疗后口干症效果确切,且无明显不良反应,其机制可能与修复患者受损的唾液腺、提高机体免疫功能有关。     

Determinants of level Ib involvement in oral squamous cell carcinoma and implications for submandibular gland-sparing neck dissection

Traditional neck dissection for oral squamous cell carcinoma (OSCC) involves removal of the submandibular salivary gland. Several studies have cited the low incidence of direct gland invasion by tumours and have recommended gland-sparing neck dissection. In this study, a detailed audit of level Ib involvement in OSCC was performed in order to assess the feasibility of submandibular gland-sparing in neck dissection; the rate of direct involvement by the primary tumours, the involvement of periglandular level Ib nodes, and their determinants were investigated. A total of 586 neck dissection specimens obtained between 2005 and 2014 from patients operated on at the study institution for floor of mouth, tongue, and buccal primaries, were evaluated for direct invasion of the gland and periglandular lymphadenopathy. Of 226 node-positive patients, 21 (9.3%) had direct gland invasion by tumour. Risk factors were tumour diameter >4 cm (P = 0.002) and depth of invasion >10 mm (P = 0.003). Determinants of periglandular lymphadenopathy were depth of invasion >10 mm (P < 0.001), perineural invasion (P = 0.02), lymphovascular invasion (P = 0.014), and moderate/poor differentiation (P < 0.0001). Gland-sparing neck dissection is safe in early tumours (pT1pN0–1), with a good chance of minimizing xerostomia without radiotherapy. Larger tumours without clear evidence of submandibular gland invasion or suspicious level Ib lymphadenopathy may be considered for gland preservation, however the oncological safety is unclear.     

The stomatognathic system in the elderly. Useful information for the medical practitioner

Aging per se has a small effect on oral tissues and functions, and most changes are secondary to extrinsic factors. The most common oral diseases in the elderly are increased tooth loss due to periodontal disease and dental caries, and oral precancer/cancer. There are many general, medical and socioeconomic factors related to dental disease (ie, disease, medications, cost, educational background, social class). Retaining less than 20 teeth is related to chewing difficulties. Tooth loss and the associated reduced masticatory performance lead to a diet poor in fibers, rich in saturated fat and cholesterols, related to cardiovascular disease, stroke, and gastrointestinal cancer. The presence of occlusal tooth contacts is also important for swallowing. Xerostomia is common in the elderly, causing pain and discomfort, and is usually related to disease and medication. Oral health parameters (ie, periodontal disease, tooth loss, poor oral hygiene) have also been related to cardiovascular disease, diabetes, bacterial pneumonia, and increased mortality, but the results are not yet conclusive, because of the many confounding factors. Oral health affects quality of life of the elderly, because of its impact on eating, comfort, appearance and socializing. On the other hand, impaired general condition deteriorates oral condition. It is therefore important for the medical practitioner to exchange information and cooperate with a dentist in order to improve patient care.     

Effects of transcutaneous electrical nerve stimulation on the salivary flow of patients with hyposalivation induced by radiotherapy in the head and neck region—A randomised clinical trial

Hyposalivation is a frequent complication after treatment with radiotherapy. To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) on the hyposalivation assessed through stimulated salivary flow (SSF). In this clinical trial, 68 patients (with hyposalivation) were randomly assigned to control (n = 31) or TENS (n = 37) group. Participants in control group received habitual care, while those in TENS group received 8 sessions (20 minutes each) delivered twice a week for four weeks. The electrodes were attached over the skin covering the salivary glands. The electric pulse was adjusted at a frequency of 50 Hz, pulse width of 250 μs and as intense as tolerated. SSF was evaluated through sialometry. Self‐perception of salivary flow (SPSF) and quality of life (QL) was evaluated prior to, during and at 1, 3 and 6 months after treatment. Although no changes were observed in the control group for SSF at any timepoints, TENS group showed a progressive increase in SSF from the third session until the end of the treatment. Significant improvements were also found in SPSF, especially when the SSF reached values ≥0.7 mL/minute. The most expressive results were evident at 6 months after treatment so that SSF, SPSF and QL remained significantly higher (F = 9.5, P = 0.0001; H = 143.77, P < 0.0001; χ² = 9.162, P = 0.02, respectively). TENS was effective at improving hyposalivation. The benefits on SSF, SPSF and QL give base to a promising therapeutic strategy for patients with hyposalivation after radiotherapy treating head and neck cancer.     

集束化护理缓解重症监护室继发性口干症患者的临床研究

目的 探讨集束化护理缓解重症监护室(ICU)内长期禁食患者继发性口干症的效果。方法 选择2017年5-12月在上海某医院ICU内住院的患者42例,按信封法随机将其分为干预组和对照组各21例。对照组给予常规护理,干预组在常规护理的基础上给予集束化护理,即联合应用维生素C喷雾剂、薄荷水漱口及润唇膏。比较2组患者口干和口腔湿润情况。 结果 与对照组相比,干预组患者的口干及口腔湿润情况评分下降更多(t=5.66,P<0.01;t=4.66,P<0.01)。 结论 集束化护理大大减轻了ICU患者的继发性口干症,对继发性口干症患者是一种安全有效的干预。     

Primary Sjögren’s syndrome: oral aspects on pathogenesis,diagnostic criteria,clinical features and approaches for therapy

Primary Sjögren’s syndrome (pSS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine glands and predominantly the salivary and lacrimal glands. The impaired gland function is assumed to be a result of progressive lymphocyte-mediated destruction of the exocrine gland tissue leading to the cardinal manifestations, hyposalivation and keratoconjunctivitis sicca (KCS), as well as devastating symptoms of oral and ocular dryness. Although primarily characterised as an exocrine dysfunction, non-exocrine organs may also be affected. The onset and course of pSS is usually insidious but may develop into a disabling disease, which profoundly affects the patient’s general well being and quality of life. Moreover, pSS may even evolve into a lymphoid malignancy. The aetiology of pSS remains unknown but the pathogenesis of exocrine cell damage is apparently multi-factorial, including immunological, genetic, hormonal and viral components. Recent research also includes neurogenic aspects of exocrine gland dysfunction, including the interference of immune mediators with glandular response to neurotransmitters released from nerve fibres. pSS usually affects middle-aged women and the female:male ratio is 9:1. The prevalence varies from 0.29 - 4.8%, depending on the population sampled and the diagnostic criteria used. At present, there are no specific diagnostic tests for pSS and no universally accepted diagnostic criteria. The current therapy is primarily symptomatic. This review focuses on the current oral clinical, diagnostic, pathogenic and therapeutic aspects of pSS.