Plasticity of the different neuropeptide-containing nerve fibres in the tongue of the diabetic rat

Common oral complications of diabetes mellitus are xerostomia, impairment of taste, atrophic lesions of the tongue, leukoplakia, lichen oris planus, and tumours, which might be the consequence of chronic inflammation and changes in innervation. In this work, we examined the density of different neuropeptide-containing nerve fibres immunohisto- and immunocytochemically in the root of the control and diabetic rat's tongue. Quantitative analysis showed that the number of immunoreactive (IR) nerve fibres was decreased after 1 week of the streptozotocin treatment, which was prevented by immediate insulin treatment. However, after 4 weeks duration of diabetes, the number of all investigated IR nerve fibres increased significantly (p<0.05), which was further enhanced by the delayed insulin treatment. The numbers of substance P (SP) and vasoactive intestinal polypeptide IR perikarya were also increased by insulin treatment. The electron-microscopic investigations showed that some of the nerve terminals from diabetic animals were found in degeneration. After 4 weeks duration of diabetes, the number of inflammatory cells as well as the mast cell/nerve fibre contacts was also increased. The immunocells also showed IR for SP and neuropeptide Y in the diabetic rats. The insulin treatment decreased both the number and the immunoreactivity of these cells. The increased synthesis and/or regeneration of neuropeptide-containing nerves might indicate the plasticity of nerve fibres in diabetes mellitus, which might happen as a consequence of the changes in the level of neurotrophic factors released by increased number of inflammatory cells or as an effect of insulin.     

Tissue engineered muscle implantation for tongue reconstruction: a preliminary report

OBJECTIVES/HYPOTHESIS: Because current tongue reconstructive methods introduce adynamic, variably sensate tissue into the mouth, the critical functions of the tongue in articulation and deglutition may be compromised. The objective of this work was to introduce a combination of myoblasts and scaffolding material into rat hemiglossectomy defects and to examine the extent of neomuscle formation in the reconstructed area, under the hypothesis that the presence of myoblasts leads to formation of new muscle. STUDY DESIGN: Randomized, prospective animal study. METHODS: Myoblasts were harvested from neonatal Lewis rats, and a growth factor enriched collagen gel was prepared. Syngeneic adult animals received either hemiglossectomy alone or reconstruction with one of four experimental reconstructive preparations: collagen gel alone, collagen gel with suspended myoblasts, the gel-cell combination in undifferentiated muscle construct form by way of tissue culture for 7 days in a preformed mold, or differentiated constructs, cultured in myoblast fusion medium. After 6 or 16 weeks, animal weight gain was recorded, animals were killed, and the tongues harvested. The tissue was examined histologically, and quality of the muscular regenerate was rated on a scale according to predefined criteria. RESULTS: Animals in all groups gained weight appropriately. In groups receiving hemiglossectomy alone or acellular (gel only) reconstruction, there was significant scarring and lack of neomuscle formation. In groups receiving myoblast transplantation, either by way of gel suspension or in the form of undifferentiated or differentiated constructs, muscle quality was superior to controls. CONCLUSIONS: Myoblast transplantation into hemiglossectomy defects appears to lead to new muscle formation and does not inhibit normal weight gain in animals after tongue implantation.     

Massive tongue swelling following the use of synthetic saliva

A 5-year-old boy with cerebral palsy and severe learning difficulties developed massive tongue swelling of sudden onset following the use of synthetic saliva. Acute airway obstruction and severe stridor ensued which required tracheal intubation and transfer to paediatric intensive care. The child was treated with intravenous steroids, antihistamines and epinephrine. With cessation of synthetic saliva, the swelling gradually resolved and the child was extubated on day 5.     

舌肌的肌内神经分支分布的观察

目的观察舌肌肌内神经入肌后的分支分布。方法采用改良的Sihler’s染色法染色肌内神经,通过浸解、脱钙、染色、脱色、中和、透明,进行舌内神经分布形态学观察。结果舌内神经染色观察到舌肌内舌神经细小分支分布舌前2/3区域和舌咽神经细小分支分布舌后1/3区域,都未越过舌中隔,而舌下神经细小分支几乎分布舌肌各个区域并越过舌中隔。结论舌前端来自舌神经和舌下神经的细小分支呈带(网)状分布,可能与舌前端较舌体其他部位接受刺激更为敏感和运动更灵活有关。     

Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation: an in vitro comparison of temperature-controlled irrigated tip ablation, power-controlled irrigated tip ablation, and standard temperature-controlled ablation

The limited success rate of radiofrequency catheter ablation in patients with ventricular tachycardias related to structural heart disease may be increased by enlarging the lesion size. Irrigated tip catheter ablation is a new method for enlarging the size of the lesion. It was introduced in the power-controlled mode with high power and high infusion rate, and is associated with an increased risk of crater formation, which is related to high tissue temperatures. The present study explored the tissue temperatures during temperature-controlled irrigated tip ablation, comparing it with standard temperature-controlled ablation and power-controlled irrigated tip ablation. In vitro strips of porcine left ventricular myocardium were ablated. Temperature-controlled irrigated tip ablation at target temperatures 60 degrees C, 70 degrees C, and 80 degrees C with infusion of 1 mL saline/min were compared with standard temperature-controlled ablation at 70 degrees C and power-controlled irrigated tip ablation at 40 W, and infusion of 20 mL/min. Lesion size and tissue temperatures were significantly higher during all modes of irrigated tip ablation compared with standard temperature-controlled ablation (P < 0.05). Lesion volume correlated positively with tissue temperature (r = 0.87). The maximum recorded tissue temperature was always 1 mm from the ablation electrode and was 67 +/- 4 degrees C for standard ablation and 93 +/- 6 degrees C, 99 +/- 6 degrees C, and 115 +/- 13 degrees C for temperature-controlled irrigated tip ablation at 60 degrees C, 70 degrees C, and 80 degrees C, respectively, and 112 +/- 12 degrees C for power-controlled irrigated tip ablation, which for irrigated tip ablation was significantly higher than tip temperature (P < 0.0001). Crater formation only occurred at tissue temperatures > 100 degrees C. We conclude that irrigated tip catheter ablation increases lesion size and tissue temperatures compared with standard ablation in the temperature-controlled mode at the same or higher target temperatures and in the power-controlled mode. Furthermore, tissue temperature and delivered power are the best indicators of lesion volume during temperature-controlled ablation.     

急性脑血管病舌诊临床研究

目的探讨急性脑血管病舌诊的临床意义。方法选择发病1～7d内经颅脑CT检查确诊为急性脑血管病者为观察对象，重点观察舌象变化与CT检查结果、辨证分型、肌力与意识状态的关系，动态观察急剧进展与恢复阶段的舌象变化，并进行对比分析。结果缺血性与出血性脑血管病的舌象有别，舌随证候的演变而有相应变化，舌象变化与偏瘫程度、意识状态有一定关系；舌形卷缩，舌色红（紫）绛、紫暗者预后不良，舌形瘫痿、舌色紫枯者则为死兆。结论舌诊可作为急性脑血管病辨证的客观指标之一，对观察疾病的顺逆、判断病情的轻重、推断疾病的预后具有重要临床意义。     

复方黄黛片治疗慢性粒细胞白血病前后舌微循环观察

应用WX-6型多部位微循环显微仪进行舌微循环观察。对舌乳头状态、微血管形态、血流状态、微血管周围状态,综合定量评价分为五度:即正常(加权积分值≤2.0)、大致正常(加权积分值>2.0)、轻度改变(加权积分值>4.0)、中度改变(加权积分值>6.0)、重度改变(加权积分值≥8.0)。临床分析45例慢性粒细胞白血病。服用复方黄黛片前、一个月后、两个月后舌微循环状态。结果示用药前舌乳头增大,上皮层变薄,微血管管袢多,管径扩张。加权积分总值8.06±3.89,微循环障碍重。用药后一个月加权积分总值7.61±3.80,用药后两个月舌菌状乳头大小正常或偏小,丝状乳头增多,上皮层增厚,可见外层水肿现象。微血管较初治患者明显减少,仍有管径增宽,边缘模糊不清。加权积分值6.37±2.73,微循环障碍减轻。证明复方黄黛片对舌微循环有一定影响。     

舌鳞癌患者术前颈部淋巴结分期价值的探讨

目的:通过分析颈淋巴结转移与其临床特点的关系,对可能有助于判断颈淋巴结转移的临床指标进行评价。方法:比较170例舌鳞癌患者临床分期与病理分期的符合率,分析淋巴结的数目、最大淋巴结长径、最大淋巴结所在区域及淋巴结实质的影像学表现与颈淋巴结转移的关系。结果:颈淋巴结临床N分期与病理N分期的总符合率为60%,其中N1～N3期病例的符合率仅为17.6%(12/68)。多个淋巴结肿大患者的颈淋巴结转移率高于单个淋巴结肿大者;最大淋巴结长径≥2cm患者的颈淋巴结转移率高于<2cm患者;临床最大淋巴结在同侧Ⅰ区组与同侧Ⅱ、Ⅲ区组患者的颈淋巴结转移率差异有统计学意义,P<0.05;在影像学(CT为主)上表现淋巴结实质异常,发生颈淋巴结转移的概率较高。结论:临床N分期与病理N分期的总符合率比较低。若舌癌患者在术前颈部检查中发现肿大淋巴结数目≥2、最大淋巴结长径≥2cm或淋巴结实质异常时,发生颈淋巴结转移的概率均>50%。因此,具有以上指标之一的舌鳞癌患者行颈淋巴结清除是安全的。     

Occult cervical lymph node metastases in 100 consecutive patients with cN0 tongue cancer

Background Squamous cell carcinoma （SCC） of the tongue maxillofacial region. To provide clinical evidence for selective analyzing the characteristics and correlation of factors of occult with SCC of the tongue. is one of the most common cancers in the oral and neck dissection in management of cN0 patients by cervical lymph node metastases （OCLNM） in patients Methods From 2002 to 2006, 100 consecutive patients with SCC of the tongue were reviewed by analyzing the characteristics of OCLNM, diameter of the tumor, T classifications, depth of invasion, forms of growth, pathological grade and degree of differentiation. Results The rate of OCLNM in 100 patients with SCC of the tongue was 22%. The most common region with OCLNM was level Ⅱ in the ipsilateral neck, followed by levels Ⅰ and Ⅲ. There were 51.61% （16/31） of OCLNM in level Ⅱ and 87.10% （27/31） of OCLNM in levels Ⅰ-Ⅲ. There was no significant correlation between the diameter of tumor and OCLNM （P 〉0.05）. OCLNM was statistically significantly correlated with the depth of invasion, forms of growth, pathological grade and degree of differentiation （P 〈0.05）. The rate of occult metastases increased with the increased pathological grade, the decreased degree of differentiation and the increased depth of invasion. Conclusions The most common regions with OCLNM in cN0 patients with SCC of the tongue were levels Ⅰ-Ⅲ in the ipsilateral neck. Supraomohyoid neck dissection should be the elective treatment to the neck in patients with cN0 SCC of the tongue by consideration of the clinical and pathological factors for the depth of invasion, forms of growth, pathological grade, and degree of differentiation.