Relationship between Dysphagia or Oral Intake and Oral Status Using the Revised Oral Assessment Guide / The Japanese Journal of Rehabilitation Medicine

Objective：The Revised Oral Assessment Guide (ROAG) is a screening tool for evaluating oral status. However, no study has directly investigated the relationship between ROAG and dysphagia or oral intake at discharge. Therefore, this study aimed to retrospectively analyze the presence, or absence, of such a relationship from the participants' medical records.Methods：In total, 88 patients who were admitted to our hospital from October 2019 to March 2020 and underwent swallowing tests after consultations with attending physicians were enrolled in the study. The degree of dysphagia was evaluated using the Dysphagia Severity Scale (DSS) after carrying out video fluoroscopy or fiberoptic endoscopic evaluation of swallowing. ROAG was performed weekly by a ward nurse, from the time of admission to discharge. Based on the results of the tests, the relationship between ROAG and dysphagia or oral intake was statistically analyzed.Results：A significant relationship was revealed between the ROAG score at admission and DSS. No significant relationship was found between ROAG score at admission and oral intake at discharge. On the other hand, in the group in which ROAG score at discharge increased (deteriorated) compared to that at admission, a significant negative correlation was observed between the degree of the ROAG increase and oral intake at discharge. This implied that deterioration of the oral status may possibly lead to difficulty in oral intake.Conclusion：These results suggest that the ROAG-based oral status assessment is useful for predicting dysphagia or oral intake in patients admitted to an acute care hospital.

Particle design for improving taste and homogeneity of traditional Chinese medicinal powder: taking Zhuhuang Chuihou Powder as an example / 中国中药杂志

Due to the complex source and different physical and chemical properties of traditional Chinese medicines(TCM) powder, there are many common pharmaceutical problems in its preparation, such as large particle size difference, poor mixing uniformity, and poor compliance with oral intake, which has directly affected the quality of solid preparations as well as their clinical efficacy and safety. This study observed the property of Zhuhuang Chuihou Powder and extract its pharmaceutical defects. It was found that realgar and calcined Borax in Zhuhuang Chuihou Powder were heavy in texture and toxic, and they were easy to be isolated, indicating the potential safety hazard. At the same time, Coptidis Rhizoma and Phellodendri Chinensis Cortex were the main sources of its bitterness. Therefore, based on the idea of "drug-excipients unity", the particle design technology was used to prepare core/shell-type composite particles with bitter medicines as the core and mineral medicines as shell. Both infrared spectroscopy and scanning electron microscopy results indicated the formation of composite particles, and the taste of these composite particles were improved. Compared with the physical mixtures, the composite particles exhibited significantly decreased RSD values in the content uniformity of berberine hydrochloride, arsenic disulfide, and sodium tetraborate and appearance uniformity. The introduction of particle design technology solved the problem of uneven dispersion of Zhuhuang Chuihou Powder, thus ensuring its uniform dispersion, stability, and control and improving the quality of the original preparation. This has provided a scientific basis for the quality control of TCM powder.

Safety of 8-weeks oral administration of Arctium lappa L / 한국실험동물학회지

Recently, worldwide dietary reference intakes have been considered an important guideline for public health. Some governments and the World Health Organization (WHO) provide guidelines concerning dietary intake. Although an ingredient may have a history of use as a culinary material, changes in the environment over time suggest that the acceptable maximum intake each of food/culinary material should be regularly evaluated. Arctium lappa L. has been used as a culinary material for many centuries in Korea and Japan and some recent studies have reported related therapeutic effects. However, there are no reports on the safety of repeated oral administration. In this study, we evaluated the safety of a 8-weeks repeated oral intake of A. lappa. We concluded that treatment with <250 mg/kg A. lappa, which was within the safety range, resulted in body weight decrease and blood glucose suppression.

Intensive Nutrition Management in a Patient with Short Bowel Syndrome Who Underwent Bariatric Surgery

Many individuals with short bowel syndrome (SBS) require long-term parenteral nutrition (PN) to maintain adequate nutritional status. Herein, we report a successful intestinal adaptation of a patient with SBS through 13 times intensive nutritional support team (NST) managements. A thirty-five-year-old woman who could not eat due to intestinal discontinuity visited Seoul National University Hospital for reconstruction of the bowel. She received laparoscopic Roux-en-Y gastric bypass (RYGB) due to morbid obesity in Jan 2013 at a certain hospital and successfully reduced her weight from 110 kg to 68 kg. However, after a delivery of the second baby by cesarean section in Jul 2016, most of small bowel was herniated through Peterson’s defect, and emergent massive small bowel resection was performed. Thereafter, she visited our hospital for the purpose of intestinal reconstruction. In Sep 2016, she received side–to-side gastrogastrostomy and revision of double barrel enterostomy. The remaining small bowel included whole duodenum, 30 cm of proximal jejunum, and 10 cm of terminal ileum. Pylorus and ileocecal valves were intact. The patient given only PN after surgery was provided rice-based soft fluid diet after 10 day of operation. Through intensive nutritional management care, she could start solid meals, and finally stop the PN and eat only orally at 45 days postoperatively. Three nutritional interventions were conducted over 2 months after the patient was discharged. She did not require PN during this period, and maintained her weight within the normal weight range. Similar interventions could be used for other patients with malabsorption problems similar to SBS.

An Investigation of the Oral Intake Recovery Rate as Defined by the 2014 Medical Treatment Reward Revision in Japan / The Japanese Journal of Rehabilitation Medicine

Objective : The 2014 Medical Treatment Reward Revision in Japan newly defines the oral intake recovery rate and requires a change of more than 35% to calculate various additions and subtractions. We calculated the recovery rate in various diseases and clarified some inherent problems. Methods : From April 2012 to March 2014, we retrospectively investigated the age, sex, removal rate from nasal nutrition or gastric fistula, oral intake recovery rate and days until removal of 286 inpatients with nasal nutrition or gastric fistula for dysphagia. Results : The removal rates for stroke, brain injury, oral and laryngopharyngeal cancer and other diseases were nearly always more than 50% because the disease did not cause dysphagia directly or the rehabilitation was effective for treating the remaining dysphagia. But the removal rates for neurodegenerative disease, complications due to stroke and brain injury in the chronic phase and respiratory disease did not reach 35% because the previous dysphagia progressed or actualized. Almost all oral intake recovery rates did not extend to 35% for exclusion of oral intake recovery within one month. Conclusion : The criteria of oral intake recovery rate needs to be reviewed in respect to setting goals to match the patient's underlying disease and to evaluate the possibility for early rehabilitation.

Ocorrência e distribuição de BanLec em cultivares de banana e avaliação da sua atividade imunomoduladora in vivo / Occurrence and distribution of BanLec in banana cultivars and evaluation of its immunomodulatory activity in vivo

Lectinas são proteínas cuja principal característica é a de se ligar específica e reversivelmente a carboidratos. BanLec é a lectina presente na polpa de bananas, que se liga especificamente a manose e glicose, e é capaz de induzir a proliferação de células T, podendo estimular a resposta imune. Existem indícios de que o teor de BanLec pode variar dependendo do estádio de amadurecimento e do tipo de cultivar, o que pode afetar a quantidade de BanLec existente na fruta quando consumida in natura e a possível resposta imune frente ao consumo de banana. Por este motivo, um dos objetivos desse trabalho foi determinar os teores e a atividade hemaglutinante de BanLec em extratos de farinha de banana verde, além de bananas das cultivares Pacovan, Figo, Terra, Mysore e Nanicão, nos estádios de maturação verde e maduro, e submetidas a tratamento com 1-MCP e baixa temperatura (para cv. Nanicão). Com vista a atender ao objetivo de avaliar seus efeitos imunomoduladores in vivo, a BanLec foi purificada da cultivar Nanicão e administrada por via oral a camundongos BALB/c. Os ensaios de atividade hemaglutinante dos extratos de banana apontaram para maior quantidade de BanLec no fruto maduro, quando comparado ao verde, e ausência dessa proteína na cultivar Figo. Os parâmetros imunológicos analisados após administração de BanLec aos camundongos demonstram que a resposta imune gerada após ingestão de BanLec é dose dependente, além disso, a administração de 50 µg de BanLec aos animais foi capaz de modular citocinas importantes na resposta imunológica, provavelmente causando um efeito que pode ser interpretado como mais protetor do que patogênico. Com base nos resultados obtidos, podemos concluir que existem diferenças nos teores de BanLec dependendo da cultivar e estádio de maturação analisado, sendo que essa proteína não está presente na polpa de todas as variedades de banana e finalmente, que ela tem grande potencial imunomodulador in vivo, uma vez que ativou citocinas de resposta anti-inflamatória

Lectins are proteins which bind specifically and reversibly to carbohydrates. BanLec is the lectin present in banana pulp, and it binds to mannose and glucose, being capable of inducing T-cell proliferation, and to stimulate the immune response. There are some evidence that the amount of BanLec may vary depending on the maturation stage of the fruit and the cultivar (cv.), which may affect the amount of BanLec and the possible immune response after consumption of banana. Thus, this study aimed to evaluate the amount of BanLec and its hemagglutinating activity in crude extracts of bananas from cultivars Pacovan, Figo, Terra, Mysore and Nanicão, in both unripe and ripe maturation stage, and also fruits which were treated with 1-MCP and low temperature. In addition, in order to access their immunomodulatory effects in vivo, BanLec was purified by affinity chromatography and administered orally to BALB/c mice. The hemagglutinating activity assays indicate higher amount of BanLec in ripe fruit. Moreover, the possible was undetectable in the pulp of banana Figo. The immunological parameters of mice orally fed with BanLec showed that the immunological response is dependent on the amount of protein administrated, in agreement to previous in vitro studies. Besides, 50 µg of BanLec, were able to modulate some cytokines in immune response, causing an effect that seems to be more protective than pathogenic. We conclude that there are important differences in amount of BanLec depending on the cultivar and the maturation stage, and BanLec has a dose-dependent immunomodulatory effect in vivo

Evaluation of Nutrient Intake in Early Post Kidney Transplant Recipients

The purpose of our study was to evaluate the dietary intake of kidney transplant recipients (KTRs) and assess oral intake related nutrition problems. Fifty patients who had undergone kidney transplantation were included: 24 males, 26 females. The mean age was 46.8 +/- 11.2 years, height was 161.3 +/- 8.3 cm, and body weight was 60.5 +/- 8.7 kg. We conducted nutrition education based on the diet guideline for KTRs (energy 32 kcal/kg of ideal body weight [IBW], protein 1.3 g/kg of IBW) and neutropenic diet guideline before discharge. Dietary intake of the patients at 1 month after transplantation was investigated by 3-day food records. Body weight and laboratory values for nutritional status and graft function were also collected. Body weight was significantly decreased from admission to discharge. Body weight from discharge to 1 month and 3 months after transplantation was increased but was not significant. Biochemical measurements were generally improved but the number of patients with hypophosphatemia increased. The daily dietary intake of energy and protein was adequate (33.1 kcal/kg, 1.5 g/kg, respectively). However, the dietary intake of calcium, folate, and vitamin C did not meet the Korean Recommended Nutrient Intake of vitamins and minerals (86.8%, 62.4%, and 88.0%, respectively). Patients with low intake of calcium, folate, and vitamin C presented low intake in milk and dairy products, vegetables, and fruits, and these foods were related to restricted food items in neutropenic diet. More attention should be paid on improving quality of diet, and reconsideration of present neutropenic diet guideline is necessary. These results can be used to establish evidence-based medical nutrition therapy guideline for KTRs.

A Study of the Factors Affecting the Term of Engraftment During Hematopoietic Stem Cell Transplantation with a Focus on the Inhibitors of Oral Intake and the Period of Nutritional Support

Hematopoietic stem cell transplantation is being widely used in an attempt to treat many hematological diseases such as leukemia, anemia, and lymphoma. To evaluate the success of hematopoietic stem cell transplantation, it is very important to determine how rapidly engraftment occurs. Therefore, this retrospective study was conducted to determine which factors affected the term of engraftment during hematopoietic stem cell transplantation, while focusing on the oral intake status. To accomplish this, 416 patients who underwent transplant operations at St. Mary's hospital from May 2006 to April 2008 were evaluated. The long-term engraftment group was characterized as having longer fasting days and more frequent vomiting, diarrhea, and oral mucositis incidences than the short-term engraftment group. In addition, the inhibitors of oral intake such as vomiting, diarrhea, and oral mucositis developed frequently between the pre-transplantation and 2 weeks after transplantation. A significantly negative correlation was observed between the oral intake volume and the duration of the oral intake inhibitors. A multiple regression analysis revealed that the frequency of vomiting and oral mucositis during hematopoietic stem cell transplantation, the length of hospitalization, and the hematocrit level in the 2 weeks after hematopoietic stem cell transplantation were significant predictors of engraftment. The results of this study could be used to establish a guideline for nutritional assessment, nutritional goals, and nutritional support for patients during hematopoietic stem cell transplantation.

Effect of early oral intake on postoperative bowel function in patients undergoing lower extremities surgery under epidural anesthesia / 대한마취과학회지

BACKGROUND: Early oral intake (EOI) associated with early recovery of normal bowel function has been shown to be an important determinant for improving patients' satisfaction. We investigated the tolerability of EOI and its effects on the recovery of bowel function after epidural anesthesia. METHODS: A prospective randomized trial of patients undergoing lower extremities surgery under epidural anesthesia was performed. A liquid drink was given to 150 patients in the EOI group 1 hours after surgery, and to 150 patients in the delayed oral intake (DOI) group 8 hours after surgery. We recorded presence of bowel sounds immediately after operation, symptoms of ileus, time to the first flatus, time to the first defecation, degree of appetite before the first meal, and patients' satisfaction. RESULTS: There was no significant difference in the presence of immediate postoperative bowel sounds, the degree of appetite before the first meal, mild ileus, and severe ileus between groups. Time to the first flatus and time to the first defecation in the EOI group were shorter than those of the DOI group. The patients' satisfaction in the EOI group was higher than that of the DOI group. CONCLUSIONS: For uncomplicated patients undergoing lower extremities under epidural anesthesia, beginning oral hydration as early as 1 hour after the operation is safe and well tolerated and resulting in faster recovery of bowel function and higher patients' satisfaction.

A Study on the Effect of Oral Cryotherapy on Nausea Vomiting and Oral Intake by Anti Cancer Chemotherapy in Pediatric Cancer Patient / 아동간호학회지

This research objected to the diagnosed patients as acute lymphoblastic leukemia, acute myelogenous leukemia, neuroblastoma, non- Hodgkins lymphoma, Hodgkin's disease, kidney tumor, myelodysplastic syndrom and juvenile chronic leukemia after admission in the "P" hospital in Pusan from Aug. 1. 1999 to Jan. 31. 2000. The results of this study are summarized as follows. 1. On the specific character between the experimental(exp.) group and the control (con.) group : there were 7 of 4-7 years old patients(the most) in the experimental group(53.8%), 5 of 12 years old or older patients in the control group (38.5%). Patients who experienced operation were 7 in the exp. group(53.8%) and 6 in con. group(46.2%). The largest number of the patients' diagnosis was acute lymphoblastic leukemia by 5 in the exp. group(38.5%) and 4 in the con. group (30.8%). The hardest nausea came on the second day by 5 in the exp. group(38.5%), 9 in the con. group(69.2%). 2. P-score of the nausea vomiting on the number of daily anticancer drug administration : first day, the exp. group got 9.6 and the con. group 17.6(P = 0.03). 2nd day, 10.9 and 19.4(P = 0.00), 3rd day, 10.6 and 18.3(P = 0.00), 4th day 10.0 and 18.0, 5th day 10.9 and 16.8(P = 0.05). The score showed statistically significant difference(P < .05). 3.Oral intake didn't show statistically significant difference between two groups. However the average of Oral intake of the exp. group was continually higher than the con. group except to the first day after administration. In conclusion, nursing intervention and nutrition care are much more needed on the 2-3th day after administration to reduce nausea vomiting, and for remission of nausea and enlarging oral intake it is utilizable to apply the easy, economic Oral Cryotherapy to the young patients who undergo chemotherapy.

Is Early Postoperative Oral Intake Safe after Elective Colorectal Surgery?

PURPOSE: The routine use of postoperative nasogastric decompression after abdominal surgery has been challenged. Furthermore, investigators have recently shown that early postoperative oral feeding is safe and generally well tolerated. This study was aimed to determine whether or not early postoperative feeding is safe after elective colorectal surgery. METHODS: All patients who underwent elective colorectal surgeries between June 1998 and March 1999 were permitted to take oral intake one day after the operations. The patients were compared with other patients, who had underwent elective colorectal surgeries between September 1997 and June 1998 and permitted to have a meal after resolving postoperative ileus. The nasogastric tube was removed from all patients immediately after surgery. The patients were monitored for the time of ileus resolution, nausea/vomiting, abdominal distension, nasogastric tube reinsertion and complications. RESULTS: Fifty-one patients were studied, 24 patients in early feeding group and 27 patients in traditional feeding group. Eighteen patients (75.0%) in the early feeding group tolerated the early oral intake. There were no significant differences between two groups in the time for resolution of ileus (3.46 1.38 days vs 3.56 1.80 days), nausea/vomiting (33.3% vs 29.6%), abdominal distension (16.6% vs 14.8%) and nasogastric tube reinsertion (12.5% vs 7.4%). No significant difference was noted in complications such as wound infection, pulmonary problems, intestinal obstruction and anastomotic leak. CONCLUSIONS: Early oral intake after elective colorectal surgery was safe and most of the patients tolerated it. And it may become a kind of managements after elective colorectal surgery.